在胸腔镜手术中检测位于肺部外缘之外的小肺结节是困难的。对于玻璃状浸润病变，常常无法触及该病变。使用放射性示踪剂标记肺结节是一种常用技术。我们分析了该技术的准确性和安全性，以及在混合手术室进行手术的潜在好处。共纳入了57名患者，其中33名（58%）为女性，中位年龄为67岁（范围21-82）。在27名患者中，我们在混合手术室标记和切除了病变。在30名患者中，病变在放射科标记，于术前一天进行切除。我们在混合手术室使用1 MBq的[99mTc]Tc-Macrosalb（Pulmocis®）活性，而在术前一天使用3 MBq的活性，以获得技术可行的结果。使用Neoprobe®检测系统检测出放射性。在95%的病变和93%的患者中，可以精确检测和切除结节。90%的患者可以进行完整的胸腔镜切除。总转换率为10%，但只有5%的患者由于结节标记失败而转换。组织学检查显示，28例（37%）为原发性肺癌，24例（32%）为转移病变，21例（28%）为良性病变。13例（23%）患者出现了轻微并发症，其中没有一个患者需要额外干预治疗。在CT引导下注射[99mTc]Tc-Macrosalb后，放射引导的肺小结节检测非常准确和安全。在混合手术室中进行手术具有多个后勤优势，并允许使用较低的锝-99m活性。这种技术可以进行最小创伤的肺部保留切除，避免了对良性和转移性病变的过度治疗。© 2023. The Author(s).

The detection of small lung nodules in thoracoscopic procedure is difficult when the lesions are not located within the outer border of the lung. In the case of ground-glass opacities, it is often impossible to palpate the lesion. Marking lung nodules using a radiotracer is a known technique. We analysed the accuracy and safety of the technique and the potential benefits of operating in a hybrid operating room.57 patients, including 33 (58%) females with a median age of 67 years (range 21-82) were included. In 27 patients, we marked and resected the lesion in a hybrid room. In 30 patients, the lesion was marked at the department of radiology the day before resection. [99mTc]Tc-Macrosalb (Pulmocis®) was used at an activity of 1 MBq in the hybrid room and at an activity of 3 MBq the day before to get technical feasible results. Radioactivity was detected using the Neoprobe® detection system.Precise detection and resection of the nodules was possible in 95% of the lesions and in 93% of the patients. Complete thoracoscopic resection was possible in 90% of the patients. Total conversion rate was 10%, but conversion due to failure of the marking of the nodule was observed in only 5% of the patients. Histology revealed 28 (37%) primary lung cancers, 24 (32%) metastases and 21 (28%) benign lesions. In 13 (23%) patients, minor complications were observed. None of them required additional interventions.The radio-guided detection of small pulmonary nodules is very accurate and safe after CT-guided injection of [99mTc]Tc-Macrosalb. Performing the operation in a hybrid room has several logistic advantages and allows using lower technetium-99m activities. The technique allows minimally invasive lung sparing resection and prevents overtreatment of benign and metastatic lesions.© 2023. The Author(s).