Email updates

Keep up to date with the latest news and content from BMC Cancer and BioMed Central.

Open Access Research article

A new technique combining virtual simulation and methylene blue staining for the localization of small peripheral pulmonary lesions

Yang Shentu1, Liang Zhang12, Hengle Gu1, Feng Mao1, Minghui Cai1, Zhengping Ding1 and Zhiqiang Wang3*

Author Affiliations

1 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China

2 Department of Thoracic Oncology Medicine, Jilin Tumor Hospital, Changchun 130012, Jilin Province, China

3 School of Medicine, University of Queensland, QLD 4029 Queensland, Australia

For all author emails, please log on.

BMC Cancer 2014, 14:79  doi:10.1186/1471-2407-14-79

Published: 11 February 2014



Quickly and accurately localizing small peripheral pulmonary lesions can avoid prolonged operative time and unplanned open thoracotomy. In this study, we aimed to introduce and evaluate a new technique combining virtual simulation and methylene blue staining for the localization of small peripheral pulmonary lesions.


Seventy four (74) patients with 80 peripheral pulmonary lesions <20 mm in size on computer tomography (CT) were virtually punctured using a radiotherapy planning simulator on the day before operation. Under general anaesthesia, methylene blue dye was injected to the virtually identified point according to the surface point, angle and depth previously determined by the simulator. The wedge resection of the marked lesion was performed under video-assisted thoracoscopic surgery (VATS) and the specimens were sent for immediate pathologic examination. According to pathology results, appropriate surgical procedures were decided and undertaken.


The average lesion size was 10.4±3.5 mm (range: 4-17 mm) and the average distance to the pleural surface was 9.4±4.9 mm. Our preoperative localization procedure was successful in 75 of 80 (94%) lesions. Histological examination showed 28 benign lesions and 52 lung cancers. The shortest distance between the edges of the stain and lesion was 5.1±3.1 mm. Localization time was 17.4±2.3 min. All patients with malignant lesions subsequently underwent lobectomy and systematic lymph node dissection. No complications were observed in all participants.


The novel technique combining the preoperative virtual simulation and methylene blue staining techniques has a high success rate for localizing small peripheral pulmonary lesions, particularly for those tiny lesions which are difficult to visualise and palpate during VATS.

Lung cancer; Pulmonary lesions; Thoracoscopy; Localization; Simulation; Methylene blue