Indocyanine green (ICG) fiducial coil guided wedge resection of recurrent adenocarcinoma in a patient with prior segmentectomy: a case report

Background: Localizing a pulmonary nodule with an indocyanine green (ICG) dye-soaked fiducial coil has recently emerged as a promising technique for bronchoscopic lung nodule marking before surgical resection. Previous reports have highlighted the ability to identify the ICG dye-soaked fiducial coil up to several days after deployment. The case report described here highlights additional advantages of this localization method in a patient with a recurrence of multifocal adenocarcinoma in the setting of dense adhesions associated with a previous nearby segmentectomy. Case Description: A 76-year-old woman with prior right upper lobe apicoposterior segmentectomy for T1bN0 adenocarcinoma presented with a new enlarging part-solid lung nodule in the superior segment of the right lower lobe. An ICG dye-soaked fiducial coil was deployed at the beginning of the operation using robotic bronchoscopy. The ICG dye-soaked fiducial coil provided precise localization in the setting of dense adhesions and distorted anatomy. A wedge resection was performed, followed by completion right lower lobe superior segmentectomy and lymph node dissection. She had no complications. The final pathology was consistent with T1miN0 adenocarcinoma. She has an EGFR mutation and is doing well on adjuvant osimertinib. Conclusions: ICG dye-soaked fiducial coil is a promising technique for precisely localizing challenging lung nodules, including those surrounded by dense adhesions from prior operations. Thoracic surgeons may also widely adapt this technique in other challenging situations, including fibrothorax from any etiology or enlarging non-solid nodules deeper than 1 cm suspicious for lung adenocarcinoma.