Percutaneous placement of marking coils before stereotactic radiation therapy of malignant lung lesions

PURPOSE: To evaluate a technique for implantation of radiopaque markers in lung nodules as an aid in extracranial stereotactic radiation therapy. MATERIALS AND METHODS: An implantation technique was developed for marking intrapulmonary lung lesions by introducing a vascular coil through a coaxial needle in or near the target tumor. The markers were placed percutaneously through 15- or 20-gauge coaxial needles in 41 lesions (25 patients) under computed tomographic fluoroscopic guidance. Two different types of vascular helical coils where used. RESULTS: All lesions were accessible for puncture and coils could be placed in all lesions. Four types of complications were observed, some as a result of the learning curve in the technique: W coil misplacement subcutaneously (5%); (ii) small needle trajectory bleeding in the lung (10%); (iii) pneumothorax, for which one patient (10%) in whom the coil was placed through a 15-gauge coaxial needle needed chest tube drainage and required hospitalization; and (iv) one subcutaneous metastasis probably unrelated to the puncture (2.5%). CONCLUSION: With this technique, lung nodules can be marked with radiopaque implants in a safe and accurate way.