CT-guided Preoperative Localization of Pulmonary Nodules Using a Glucose Test and Tissue Adhesive

Intraoperative localization of ground-glass nodules (GGNs) is challenging. This study evaluates a CT-guided protocol that innovatively combines a glucose solution test with tissue adhesive marking to enhance safety and efficacy. The standardized procedure involves preoperative thin-slice CT (≤1 mm) with a 5 × 5 cm grid for planning, followed by percutaneous puncture to a shallow (5 mm) subpleural depth. A key safety innovation is the injection of 0.3 mL of 5% glucose solution to confirm extra-bronchial needle position via cough reflex testing before depositing 0.3 mL of 2-octyl cyanoacrylate to create a palpable marker. This protocol not only achieves precise localization of pulmonary nodules but also significantly reduces the incidence of pneumothorax by minimizing the number of required puncture attempts. The method is readily reproducible and integrates seamlessly into standard preoperative workflows. This approach establishes a safer, non-radioactive alternative for GGN localization, with its core innovations -- the glucose confirmation step and shallow subpleural injection -- serving as key mechanisms for complication prevention.