Computed Tomography-Guided Hookwire Localization for Ground-glass Opacity Dominant Pulmonary Nodules Before Video-Assisted Thoracoscopic Surgery: Analysis of 472 Lesions

Recent advances in imaging technique and the deterioration of environment have promoted increased detection of ground-glass opacities (GGOs). The aims of the present study were to evaluate the clinical efficiency and safety of CT-guided hookwire localization of GGO-dominant pulmonary nodules before video-assisted thoracoscopic surgery (VATS) and to summarize the key points for differential diagnosis of GGOs. From April 2008 to December 2015, 472 solitary GGO-dominant (GGO component > 50%) pulmonary nodules localized by hookwire were retrospectively analyzed. They ranged from 2.9 to 29.8 mm and were successfully localized with mean duration of 8.1 ± 3.6 min. Postoperative complications were mild and included asymptomatic needle track hemorrhage (28.8%), minimal pneumothorax (8.9%), and haemoptysis (0.4%). All patients accepted VATS resection but one patient (0.2%) was converted to thoracotomy because of strong pleural adhesion. Histological results revealed 102 benign nodules and 370 primary pulmonary adenocarcinomas. The malignant rate of lesions with 50–90% GGO component common in T_1bN₀M₀ and T_1cN₀M₀ was higher than that of over 90% occurred more in T_1aN₀M₀ (83.5% and 87.0% vs. 52.3%, P < 0.001). Besides, there were significant statistical differences between malignant and benign GGOs in terms of age, nodular size, percentage of GGO component, margin, spiculation, lobulation, and vascular convergence (P < 0.05). CT-guided hookwire location for GGO-dominant pulmonary nodules before VATS showed to have a great clinical value for diagnosis and treatment without serious complications. If a GGO-dominant nodule with larger size, 50–90% GGO component, irregular margin, spiculation, lobulation, and vascular convergence was detected in an elder patient, it might have a higher malignant tendency.