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Journal of Cardiothoracic Surgery

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Open Access 01-12-2023 | Computed Tomography | Research

Application of computed tomography-guided hook-wire localization technique in thoracoscopic surgery for small pulmonary nodules (≤ 10 mm)

Authors: Yuan Yang, Chenhui Qin, Yue Ma, Zhongting Lu, Yun Zhang, Tao Li

Published in: Journal of Cardiothoracic Surgery | Issue 1/2023

Abstract

Objective

This study aimed to investigate the safety and efficacy of the computed tomography (CT)-guided hook-wire localization technique in thoracoscopic surgery for small pulmonary nodules (≤ 10 mm) and to identify the risk factors for localization-related complications.

Methods

The medical records of 150 patients with small pulmonary nodules treated from January 2018 to June 2021 were retrospectively analyzed. According to preoperative hook-wire positioning status, they were divided into the localization group (50 cases) or the control group (100 cases). The operation time, intraoperative blood loss, hospital stay, and conversion rate to thoracotomy were recorded and compared between groups. Uni- and multivariate binary logistic regression analysis was used to identify the risk factors for localization-related complications.

Results

A total of 58 nodules were localized in 50 patients in the localization group, and the localization success rate was 98.3% (57/58). In one case, the positioning pin fell off before wedge resection was performed. The mean nodule diameter was 7.05 mm (range, 2.8–10.0 mm), while the mean depth from the pleura was 22.40 mm (range, 5.47–79.47 mm). There were 8 cases (16%) of asymptomatic pneumothorax, 2 (4%) of intrapulmonary hemorrhage, and 1 (2%) of pleural reaction.The mean operation time of the localization group (103.88 ± 41.74 min) was significantly shorter than that of the control group (133.30 ± 45.42 min) (P < 0.05). The mean intraoperative blood loss of the localization group (44.20 ± 34.17 mL) was significantly lower than that of the control group (112.30 ± 219.90 mL) (P < 0.05). The mean hospital stay of the localization group (7.96 ± 2.34 days) was significantly shorter than that of the control group (9.21 ± 3.25 days).Multivariate binary logistic analysis showed that localization times of small pulmonary nodules in the localization group was an independent risk factor for localization-related pneumothorax.

Conclusions

Our results suggest that the CT-guided hook-wire localization technique is beneficial for localizing small pulmonary nodules. Specifically, it is helpful for the diagnosis and treatment of early lung cancer because it can accurately remove lesions, decrease intraoperative blood loss, shorten operation time and hospitalization stay, and reduce thoracotomy conversion rate. Simultaneous positioning of multiple nodules can easily lead to positioning-related pneumothorax.

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Aberle DR, Abtin F, Brown K. Computed tomography screening for lung cancer: has it finally arrived? Implications of the national lung screening trial. J Clin Oncol Off J Am Soc Clin Oncol. 2013;31(8):1002–8. https://doi.org/10.1200/JCO.2012.43.3110.CrossRef

Baldwin DR, Callister ME, Guideline Development Group. The British thoracic society guidelines on the investigation and management of pulmonary nodules. Thorax. 2015;70(8):794–8. https://doi.org/10.1136/thoraxjnl-2015-207221.CrossRefPubMed

Lung Cancer Group of the Chinese Medical Association Respiratory, Expert Group of Chinese Alliance Against Lung Cancer. Chinese Expert Consensus on the Diagnosis and Treatment of Pulmonary Nodules (2018 Edition). Chinese Journal of Tuberculosis and Respiratory Diseases. 2018, 41(10):763–771.

Wahidi Momen M, Govert Joseph A, Goudar Ranjit K, et al. Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines. Chest. 2007;132:94S-107S.CrossRefPubMed

Park CH, Han K, Hur J, Lee SM, Lee JW, Hwang SH, Seo JS, Lee KH, Kwon W, Kim TH, Choi BW. Comparative effectiveness and safety of preoperative lung localization for pulmonary nodules: a systematic review and meta-analysis. Chest. 2017;151(2):316–28. https://doi.org/10.1016/j.chest.2016.09.017.CrossRefPubMed

Keun LN, Min PC, Hyun KC, et al. CT-guided percutaneous transthoracic localization of pulmonary nodules prior to video-assisted thoracoscopic surgery using barium suspension. Korean J Radiol. 2012;13:694–701.CrossRef

Agha RA, Borrelli MR, Vella-Baldacchino M, Thavayogan R, Orgill DP, STROCSS Group. The STROCSS statement: strengthening the reporting of cohort studies in surgery. Int J Surg. 2017;46:198–202. https://doi.org/10.1016/j.ijsu.2017.08.586.CrossRefPubMedPubMedCentral

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49. https://doi.org/10.3322/caac.21660.CrossRefPubMed

Congregado Loscertales M, Girón Arjona JC, Jiménez Merchán R, Arroyo Tristán A, Arenas Linares C, Ayarra Jarne J, Loscertales J. Utilidad de la cirugía videotoracoscópica en el diagnóstico de los nódulos pulmonares solitarios [Usefulness of video-assisted thoracoscopy for the diagnosis of solitary pulmonary nodules]. Arch Bronconeumol. 2002;38(9):415–20. https://doi.org/10.1016/s0300-2896(02)75254-x.CrossRefPubMed

10.

Baldwin DR, Eaton T, Kolbe J, Christmas T, Milne D, Mercer J, Steele E, Garrett J, Wilsher ML, Wells AU. Management of solitary pulmonary nodules: how do thoracic computed tomography and guided fine needle biopsy influence clinical decisions? Thorax. 2002;57(9):817–22. https://doi.org/10.1136/thorax.57.9.817.PMID:12200528;PMCID:PMC1746431.CrossRefPubMedPubMedCentral

11.

Didier L, Walter W, Hany TF, Kamel EM, Stephan K, Burkhardt S, von Schulthess Gustav K, Steinert Hans C. Staging of non-small-cell lung cancer with integrated positron-emission tomography and computed tomography. N Engl J Med. 2003;348(25):2500–7. https://doi.org/10.1056/NEJMoa022136.CrossRef

12.

Awais O, Reidy MR, Mehta K, Bianco V, Gooding WE, Schuchert MJ, Luketich JD, Pennathur A. Electromagnetic navigation bronchoscopy-guided dye marking for thoracoscopic resection of pulmonary nodules. Ann Thorac Surg. 2016;102(1):223–9. https://doi.org/10.1016/j.athoracsur.2016.02.040.CrossRefPubMed

13.

Luo K, Lin Y, Lin X, Yu X, Wen J, Xi K, Lin P, Zhang L. Localization of peripheral pulmonary lesions to aid surgical resection: a novel approach for electromagnetic navigation bronchoscopic dye marking. Eur J Cardio Thorac Surg Off J Eur Assoc Cardio Thorac Surg. 2017;52(3):516–21. https://doi.org/10.1093/ejcts/ezx114.CrossRef

14.

Chao YK, Wen CT, Fang HY, Hsieh MJ. A single-center experience of 100 image-guided video-assisted thoracoscopic surgery procedures. J Thorac Dis. 2018;10(null):S1624–30. https://doi.org/10.21037/jtd.2018.04.44.CrossRefPubMedPubMedCentral

15.

Wang G, Lin Y, Luo K, Lin X, Zhang L. Zhongguo Fei Ai Za Zhi = Chinese Journal of Lung Cancer. 2020;23(6), 503–508. https://doi.org/10.3779/j.issn.1009-3419.2020.103.01.

16.

Fan L, Yang H, Yu L, Wang Z, Ye J, Zhao Y, Cai D, Zhao H, Yao F. Multicenter, prospective, observational study of a novel technique for preoperative pulmonary nodule localization. J Thorac Cardiovasc Surg. 2020;160(2):532-539.e2. https://doi.org/10.1016/j.jtcvs.2019.10.148.CrossRefPubMed

17.

Hanauer M, Perentes JY, Krueger T, Ris HB, Bize P, Schmidt S, Gonzalez M. Pre-operative localization of solitary pulmonary nodules with computed tomography-guided hook wire: report of 181 patients. J Cardiothorac Surg. 2016;11:5. https://doi.org/10.1186/s13019-016-0404-4.CrossRefPubMedPubMedCentral

18.

Iguchi T, Hiraki T, Gobara H, Fujiwara H, Matsui Y, Miyoshi S, Kanazawa S. CT fluoroscopy-guided preoperative short hook wire placement for small pulmonary lesions: evaluation of safety and identification of risk factors for pneumothorax. Eur Radiol. 2016;26(1):114–21. https://doi.org/10.1007/s00330-015-3815-z.CrossRefPubMed

19.

Li C, Liu B, Jia H, Dong Z, Meng H. Computed tomography-guided hook wire localization facilitates video-assisted thoracoscopic surgery of pulmonary ground-glass nodules. Thorac Cancer. 2018;9(9):1145–50. https://doi.org/10.1111/1759-7714.12801.CrossRefPubMedPubMedCentral

20.

Hwang S, Kim TG, Song YG. Comparison of hook wire versus coil localization for video-assisted thoracoscopic surgery. Thorac cancer. 2018;9(3):384–9. https://doi.org/10.1111/1759-7714.12589.CrossRefPubMedPubMedCentral

21.

Gao F, Li M, Sun Y, Xiao L, Hua Y. Diagnostic value of contrast-enhanced CT scans in identifying lung adenocarcinomas manifesting as GGNs (ground glass nodules). Medicine. 2017;96(43):e7742. https://doi.org/10.1097/MD.0000000000007742.CrossRefPubMedPubMedCentral

22.

Yao F, Wang J, Yao J, Xu L, Wang J, Gao L. Reevaluation of the efficacy of preoperative computed tomography-guided hook wire localization: a retrospective analysis. Int J Surg. 2018;51:24–30. https://doi.org/10.1016/j.ijsu.2018.01.014.CrossRefPubMed

23.

Zhong Y, Xu XQ, Pan XL, Zhang W, Xu H, Yuan M, Kong LY, Pu XH, Chen L, Yu TF. Retrospective evaluation of safety, efficacy and risk factors for pneumothorax in simultaneous localizations of multiple pulmonary nodules using hook wire system. Cardiovasc Intervent Radiol. 2017;40(9):1408–14. https://doi.org/10.1007/s00270-017-1631-3.CrossRefPubMed

Title: Application of computed tomography-guided hook-wire localization technique in thoracoscopic surgery for small pulmonary nodules (≤ 10 mm)
Authors: Yuan Yang
Chenhui Qin
Yue Ma
Zhongting Lu
Yun Zhang
Tao Li
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Computed Tomography
Pneumothorax
Computed Tomography
Pulmonary Nodule
Pneumothorax
Pneumothorax
Thoracotomy
Published in: Journal of Cardiothoracic Surgery / Issue 1/2023
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/s13019-023-02188-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Application of computed tomography-guided hook-wire localization technique in thoracoscopic surgery for small pulmonary nodules (≤ 10 mm)

Abstract

Objective

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

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