Background and objective Localization of pulmonary ground glass small nodule is the technical dif-ficulty of minimally invasive operation resection. The aim of this study is to evaluate the value of intraoperative computed tomography (CT)-guided localization using a hook-wire system for small ground glass opacity (GGO) in minimally invasive resection, as well as to discuss the necessity and feasibility of surgical resection of small GGOs (<10 mm) through a minimally invasive approach.MethodshTe records of 32 patients with 41 small GGOs who underwent intraoperative CT-guided double-thorn hook wire localization prior to video-assisted thoracoscopic wedge resection from October 2009 to October 2013 were retrospectively reviewed. All patients received video-assisted thoracoscopic surgery (VATS) within 10 min atfer wire localiza-tion. hTe effcacy of intraoperative localization was evaluated in terms of procedure time, VATS success rate, and associated complications of localization.Results A total of 32 patients (15 males and 17 females) underwent 41 VATS resections, with 2 simultaneous nodule resections performed in 3 patients, 3 lesion resections in 1 patient, and 5 lesions in a patient. Nodule di-ameters ranged from 2 mm-10 mm (mean: 5 mm). hTe distance of lung lesions from the nearest pleural surfaces ranged within 5 mm-24 mm (mean: 12.5 mm). All resections of lesions guided by the inserted hook wires were successfully performed by VATS (100% success rate). hTe mean procedure time for the CT-guided hook wire localization was 8.4 min (range: 4 min-18 min). hTe mean procedure time for VATS was 32 min (range: 14 min-98 min). hTe median hospital time was 8 d (range: 5 d-14 d). Results of pathological examination revealed 28 primary lung cancers, 9 atypical adenomatous hyperplasia, and 4 nonspe-ciifc chronic inlfammations. No major complication related to the intraoperative hook wire localization and VATS was noted. Conclusion Intraoperative CT-guided hook wire localization is useful, particularly in small GGO localization in VATS wedge resection and has a signiifcantly low rate of minor complications. Lung GGOs carry a 90% risk of malignancy. Aggressive surgi-cal resection of these GGOs is necessary and feasible through the guidance of intraoperative CT localization technique.

Background and objective Lung cancer presenting as cystic lesions was ifrst described by Anderson and Pierce in 1954. Lung cancer presenting as cysts is a rare entity in clinical practice. Differential diagnosis is diffcult in the benign-like cyst. hTis study investigated the clinical characteristics, diagnosis and treatment of lung cancer presenting as cysts. Methods We conducted a retrospective analysis of the clinical records of 24 patients who underwent surgery for a primary lung cancer presenting as cysts in our department between 2007 and 2013. We deifned a‘hTin-walled cyst’ as a cavitary lesion with a wall thickness of 4 mm or less along at least 75%of the circumference of the lesion. hTe whole group underwent post-operative follow-up. Results hTe incidence of cystic lung cancer was 0.49%(24/4,897) of surgical cases. hTe subjects’ age ranged from 19 to 77 yr with a median age of 56.5 yr. Ten cases presented with respiratory symptoms while 14 showed abnormal shadows on a chest CT without symptoms. Histological analysis showed that 18 cases were of adenocarcinoma, three of squamous cell carcinoma, one of small cell carcinoma, one of adenosquamous carcinoma and one of large cell carcinoma. hTree patients were dead, and the remaining 21 patients are alive and disease free at the end of follow-up. Conclusion Cystic lung cancer should be kept in mind during the differential diagnosis of focal benign cyst. Cystic lung cancer could achieve a good outcome if early diagnose can be obtained.