Accuracy of a 3-Dimensionally Printed Navigational Template for Localizing Small Pulmonary Nodules: A Noninferiority Randomized Clinical Trial

Lei Zhang, Long Wang, Xiermaimaiti Kadeer, Li Zeyao, Xiwen Sun, Weiyan Sun, Yunlang She, Dong Xie, Mu Li, Liling Zou, Gaetano Rocco, Ping Yang, Chang Chen, Chia Chuan Liu, René H. Petersen, Calvin Sze Hang Ng, Scott Parrish, Yu Shrike Zhang, Raffaele Giordano, Luigi Di Tommaso

Research output: Contribution to journalArticle

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Abstract

Importance: Localization of small lung nodules are challenging because of the difficulty of nodule recognition during video-assisted thoracoscopic surgery. Using 3-dimensional (3-D) printing technology, a navigational template was recently created to assist percutaneous lung nodule localization; however, the efficacy and safety of this template have not yet been evaluated. Objective: To assess the noninferiority of the efficacy and safety of a 3-D-printed navigational template guide for localizing small peripheral lung nodules. Design, Setting, and Participants: This noninferiority randomized clinical trial conducted between October 2016 and October 2017 at Shanghai Pulmonary Hospital, Shanghai, China, compared the safety and precision of lung nodule localization using a template-guided approach vs the conventional computed tomography (CT)-guided approach. In total, 213 surgical candidates with small peripheral lung nodules (<2 cm) were recruited to undergo either CT- or template-guided lung nodule localization. An intention-to-treat analysis was conducted. Interventions: Percutaneous lung nodule localization. Main Outcomes and Measures: The primary outcome was the accuracy of lung nodule localization (localizer deviation), and secondary outcomes were procedural duration, radiation dosage, and complication rate. Results: Of the 200 patients randomized at a ratio of 1:1 to the template- and CT-guided groups, most were women (147 vs 53), body mass index ranged from 15.4 to 37.3, the mean (SD) nodule size was 9.7 (2.9) mm, and the mean distance between the outer edge of target nodule and the pleura was 7.8 (range, 0.0-43.9) mm. In total, 190 patients underwent either CT- or template-guided lung nodule localization and subsequent surgery. Among these patients, localizer deviation did not significantly differ between the template- and CT-guided groups (mean [SD], 8.7 [6.9] vs 9.6 [5.8] mm; P =.36). The mean (SD) procedural durations were 7.4 (3.2) minutes for the template-guided group and 9.5 (3.6) minutes for the CT-guided group (P <.001). The mean (SD) radiation dose was 229 (65) mGy × cm in the template-guided group and 313 (84) mGy × cm in CT-guided group (P <.001). Conclusions and Relevance: The use of the 3-D-printed navigational template for localization of small peripheral lung nodules showed efficacy and safety that were not substantially worse than those for the CT-guided approach while significantly simplifying the localization procedure and decreasing patient radiation exposure. Trial Registration: ClinicalTrials.gov identifier: NCT02952261.

Original languageEnglish
Pages (from-to)295-303
Number of pages9
JournalJAMA Surgery
Volume154
Issue number4
DOIs
Publication statusPublished - Apr 1 2019

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Randomized Controlled Trials
Lung
Tomography
Safety
Video-Assisted Thoracic Surgery
Radiation Dosage
Intention to Treat Analysis
Pleura
China
Body Mass Index
Outcome Assessment (Health Care)
Radiation
Technology

ASJC Scopus subject areas

  • Surgery

Cite this

Accuracy of a 3-Dimensionally Printed Navigational Template for Localizing Small Pulmonary Nodules : A Noninferiority Randomized Clinical Trial. / Zhang, Lei; Wang, Long; Kadeer, Xiermaimaiti; Zeyao, Li; Sun, Xiwen; Sun, Weiyan; She, Yunlang; Xie, Dong; Li, Mu; Zou, Liling; Rocco, Gaetano; Yang, Ping; Chen, Chang; Liu, Chia Chuan; Petersen, René H.; Ng, Calvin Sze Hang; Parrish, Scott; Zhang, Yu Shrike; Giordano, Raffaele; Di Tommaso, Luigi.

In: JAMA Surgery, Vol. 154, No. 4, 01.04.2019, p. 295-303.

Research output: Contribution to journalArticle

Zhang, L, Wang, L, Kadeer, X, Zeyao, L, Sun, X, Sun, W, She, Y, Xie, D, Li, M, Zou, L, Rocco, G, Yang, P, Chen, C, Liu, CC, Petersen, RH, Ng, CSH, Parrish, S, Zhang, YS, Giordano, R & Di Tommaso, L 2019, 'Accuracy of a 3-Dimensionally Printed Navigational Template for Localizing Small Pulmonary Nodules: A Noninferiority Randomized Clinical Trial', JAMA Surgery, vol. 154, no. 4, pp. 295-303. https://doi.org/10.1001/jamasurg.2018.4872
Zhang, Lei ; Wang, Long ; Kadeer, Xiermaimaiti ; Zeyao, Li ; Sun, Xiwen ; Sun, Weiyan ; She, Yunlang ; Xie, Dong ; Li, Mu ; Zou, Liling ; Rocco, Gaetano ; Yang, Ping ; Chen, Chang ; Liu, Chia Chuan ; Petersen, René H. ; Ng, Calvin Sze Hang ; Parrish, Scott ; Zhang, Yu Shrike ; Giordano, Raffaele ; Di Tommaso, Luigi. / Accuracy of a 3-Dimensionally Printed Navigational Template for Localizing Small Pulmonary Nodules : A Noninferiority Randomized Clinical Trial. In: JAMA Surgery. 2019 ; Vol. 154, No. 4. pp. 295-303.
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abstract = "Importance: Localization of small lung nodules are challenging because of the difficulty of nodule recognition during video-assisted thoracoscopic surgery. Using 3-dimensional (3-D) printing technology, a navigational template was recently created to assist percutaneous lung nodule localization; however, the efficacy and safety of this template have not yet been evaluated. Objective: To assess the noninferiority of the efficacy and safety of a 3-D-printed navigational template guide for localizing small peripheral lung nodules. Design, Setting, and Participants: This noninferiority randomized clinical trial conducted between October 2016 and October 2017 at Shanghai Pulmonary Hospital, Shanghai, China, compared the safety and precision of lung nodule localization using a template-guided approach vs the conventional computed tomography (CT)-guided approach. In total, 213 surgical candidates with small peripheral lung nodules (<2 cm) were recruited to undergo either CT- or template-guided lung nodule localization. An intention-to-treat analysis was conducted. Interventions: Percutaneous lung nodule localization. Main Outcomes and Measures: The primary outcome was the accuracy of lung nodule localization (localizer deviation), and secondary outcomes were procedural duration, radiation dosage, and complication rate. Results: Of the 200 patients randomized at a ratio of 1:1 to the template- and CT-guided groups, most were women (147 vs 53), body mass index ranged from 15.4 to 37.3, the mean (SD) nodule size was 9.7 (2.9) mm, and the mean distance between the outer edge of target nodule and the pleura was 7.8 (range, 0.0-43.9) mm. In total, 190 patients underwent either CT- or template-guided lung nodule localization and subsequent surgery. Among these patients, localizer deviation did not significantly differ between the template- and CT-guided groups (mean [SD], 8.7 [6.9] vs 9.6 [5.8] mm; P =.36). The mean (SD) procedural durations were 7.4 (3.2) minutes for the template-guided group and 9.5 (3.6) minutes for the CT-guided group (P <.001). The mean (SD) radiation dose was 229 (65) mGy × cm in the template-guided group and 313 (84) mGy × cm in CT-guided group (P <.001). Conclusions and Relevance: The use of the 3-D-printed navigational template for localization of small peripheral lung nodules showed efficacy and safety that were not substantially worse than those for the CT-guided approach while significantly simplifying the localization procedure and decreasing patient radiation exposure. Trial Registration: ClinicalTrials.gov identifier: NCT02952261.",
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T1 - Accuracy of a 3-Dimensionally Printed Navigational Template for Localizing Small Pulmonary Nodules

T2 - A Noninferiority Randomized Clinical Trial

AU - Zhang, Lei

AU - Wang, Long

AU - Kadeer, Xiermaimaiti

AU - Zeyao, Li

AU - Sun, Xiwen

AU - Sun, Weiyan

AU - She, Yunlang

AU - Xie, Dong

AU - Li, Mu

AU - Zou, Liling

AU - Rocco, Gaetano

AU - Yang, Ping

AU - Chen, Chang

AU - Liu, Chia Chuan

AU - Petersen, René H.

AU - Ng, Calvin Sze Hang

AU - Parrish, Scott

AU - Zhang, Yu Shrike

AU - Giordano, Raffaele

AU - Di Tommaso, Luigi

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Importance: Localization of small lung nodules are challenging because of the difficulty of nodule recognition during video-assisted thoracoscopic surgery. Using 3-dimensional (3-D) printing technology, a navigational template was recently created to assist percutaneous lung nodule localization; however, the efficacy and safety of this template have not yet been evaluated. Objective: To assess the noninferiority of the efficacy and safety of a 3-D-printed navigational template guide for localizing small peripheral lung nodules. Design, Setting, and Participants: This noninferiority randomized clinical trial conducted between October 2016 and October 2017 at Shanghai Pulmonary Hospital, Shanghai, China, compared the safety and precision of lung nodule localization using a template-guided approach vs the conventional computed tomography (CT)-guided approach. In total, 213 surgical candidates with small peripheral lung nodules (<2 cm) were recruited to undergo either CT- or template-guided lung nodule localization. An intention-to-treat analysis was conducted. Interventions: Percutaneous lung nodule localization. Main Outcomes and Measures: The primary outcome was the accuracy of lung nodule localization (localizer deviation), and secondary outcomes were procedural duration, radiation dosage, and complication rate. Results: Of the 200 patients randomized at a ratio of 1:1 to the template- and CT-guided groups, most were women (147 vs 53), body mass index ranged from 15.4 to 37.3, the mean (SD) nodule size was 9.7 (2.9) mm, and the mean distance between the outer edge of target nodule and the pleura was 7.8 (range, 0.0-43.9) mm. In total, 190 patients underwent either CT- or template-guided lung nodule localization and subsequent surgery. Among these patients, localizer deviation did not significantly differ between the template- and CT-guided groups (mean [SD], 8.7 [6.9] vs 9.6 [5.8] mm; P =.36). The mean (SD) procedural durations were 7.4 (3.2) minutes for the template-guided group and 9.5 (3.6) minutes for the CT-guided group (P <.001). The mean (SD) radiation dose was 229 (65) mGy × cm in the template-guided group and 313 (84) mGy × cm in CT-guided group (P <.001). Conclusions and Relevance: The use of the 3-D-printed navigational template for localization of small peripheral lung nodules showed efficacy and safety that were not substantially worse than those for the CT-guided approach while significantly simplifying the localization procedure and decreasing patient radiation exposure. Trial Registration: ClinicalTrials.gov identifier: NCT02952261.

AB - Importance: Localization of small lung nodules are challenging because of the difficulty of nodule recognition during video-assisted thoracoscopic surgery. Using 3-dimensional (3-D) printing technology, a navigational template was recently created to assist percutaneous lung nodule localization; however, the efficacy and safety of this template have not yet been evaluated. Objective: To assess the noninferiority of the efficacy and safety of a 3-D-printed navigational template guide for localizing small peripheral lung nodules. Design, Setting, and Participants: This noninferiority randomized clinical trial conducted between October 2016 and October 2017 at Shanghai Pulmonary Hospital, Shanghai, China, compared the safety and precision of lung nodule localization using a template-guided approach vs the conventional computed tomography (CT)-guided approach. In total, 213 surgical candidates with small peripheral lung nodules (<2 cm) were recruited to undergo either CT- or template-guided lung nodule localization. An intention-to-treat analysis was conducted. Interventions: Percutaneous lung nodule localization. Main Outcomes and Measures: The primary outcome was the accuracy of lung nodule localization (localizer deviation), and secondary outcomes were procedural duration, radiation dosage, and complication rate. Results: Of the 200 patients randomized at a ratio of 1:1 to the template- and CT-guided groups, most were women (147 vs 53), body mass index ranged from 15.4 to 37.3, the mean (SD) nodule size was 9.7 (2.9) mm, and the mean distance between the outer edge of target nodule and the pleura was 7.8 (range, 0.0-43.9) mm. In total, 190 patients underwent either CT- or template-guided lung nodule localization and subsequent surgery. Among these patients, localizer deviation did not significantly differ between the template- and CT-guided groups (mean [SD], 8.7 [6.9] vs 9.6 [5.8] mm; P =.36). The mean (SD) procedural durations were 7.4 (3.2) minutes for the template-guided group and 9.5 (3.6) minutes for the CT-guided group (P <.001). The mean (SD) radiation dose was 229 (65) mGy × cm in the template-guided group and 313 (84) mGy × cm in CT-guided group (P <.001). Conclusions and Relevance: The use of the 3-D-printed navigational template for localization of small peripheral lung nodules showed efficacy and safety that were not substantially worse than those for the CT-guided approach while significantly simplifying the localization procedure and decreasing patient radiation exposure. Trial Registration: ClinicalTrials.gov identifier: NCT02952261.

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