Localized lung adenocarcinoma: disease-free after CT-guided marking and VATS wedge resection

What happened, in summary

This 51-year-old woman had a history of malignant melanoma treated in 2013, including left axillary lymph node dissection and BRAF inhibitor therapy after melanoma metastasis was found in 1 of 19 axillary lymph nodes. During routine lung CT follow-up in November 2017, doctors found a new asymptomatic 7 mm pure ground-glass nodule in segment S10 of the right lower lobe. The lesion was watched for 4 years. By June 2020, it had changed into a subsolid lesion with a solid component, although PET/CT in July 2020 did not show increased metabolic activity. In April 2021, the lesion persisted and the solid component showed slight growth. Because the nodule had not regressed and measured 12 mm overall with a 7 mm solid portion, the multidisciplinary pulmonary committee recommended surgery in May 2021. The nodule was 13 mm from the pleural surface and could not be seen by videothoracoscopy, so it was marked before surgery under CT guidance using 0.2 mL of a mixture of Omnipaque iodine contrast and Patent Blue V dye. This allowed successful localization during videothoracoscopic wedge resection, which was supplemented with mediastinal lymph node sampling. Pathology showed primary lung adenocarcinoma, predominantly acinar growth at 85% with a lepidic component of 15%. Resection margins were adequate, and examined mediastinal lymph nodes showed no metastasis. She recovered without complications and went home on postoperative day 4, continuing regular clinical surveillance after surgical resection. As of March 2025, she continued regular follow-up with no signs of lung cancer recurrence.