Progress in preoperative localization for small pulmonary nodules

Video-assisted thoracic surgery (VATS) is associated with reduced postoperative pain, shorter hospital stay, and fewer perioperative complications than thoracotomy, and its application in surgery for both primary lung cancer and metastatic lung tumors is increasing. Lung cancer screening with annual low-dose computed tomography (CT) has reduced morality from lung cancer, as compared with chest radiography (1), while 24.2% of screened cases were positive in the low-dose CT group. The current guidelines recommend surgical biopsy if a lung nodule is ≥8 mm in size and the probability of malignancy is high (2). Furthermore, VATS wedge resection is recommended to obtain diagnosis for an indeterminate nodule. The increased use of CT screening for lung cancer will increase the number of cases where VATS is necessary for small pulmonary nodules.