Accuracy and application of noninvasive computed tomography-guided skin marking in surgery for peripheral small pulmonary nodules.

OBJECTIVE: Intraoperative localization of small peripheral pulmonary nodules can be challenging due to the size, characteristics, or depth of nodules. This study introduced a computed tomography (CT)-guided skin marking method and evaluated its feasibility and accuracy. METHODS: From January 2017 to January 2026, 89 patients underwent CT-guided skin marking followed by wedge lung resection. Eligible nodules were located in the outer third of the lung and measured ≤ 1 cm in diameter or ≤ 2 cm in maximum diameter, with a consolidation-to-tumor ratio of ≤ 0.25 were considered eligible. CT-guided skin marking was performed a day before surgery. During the operation, a port was created at the marked skin site, and a dyed cotton swab was used to mark the visceral pleura. Wedge resection was conducted using the pigmented mark as a guide. Distance from the marker to the visceral pleural surface directly above the lesion (hereinafter referred to as distance) was measured, and factors associated with a value of ≥ 10 mm were identified using logistic regression analysis. RESULTS: All nodules were completely resected without complications. The median distance was 6 (range: 0-25) mm. A greater chest wall thickness and a larger port insertion angle were significantly associated with distance of ≥10 mm. CONCLUSIONS: CT-guided skin marking is a simple and safe technique and does not require special equipment. Notably, distance increases in cases involving thick chest walls or large port insertion angles. Hence, this method can be a reliable and widely applicable approach for the accurate resection of small peripheral pulmonary nodules.