Fei Yao1, Jian Wang3, Ju Yao1, Lei Xu1, Jian Wang3, Libing Gao3. 1. Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China. 2. Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China. Electronic address: wangjian_428@126.com. 3. Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
Abstract
BACKGROUND: Small pulmonary nodules (SPNs) often cannot be accurately located during video-assisted thoracoscopic (VATS) resection, and preoperative computed tomography (CT)-guided localization performed using hook wire placement can be helpful. However, recent studies revealed a trend towards more frequent and severe complications occurring in association with hook wire insertion. The aim of this study is to reevaluate the safety, and reliability of the preoperative CT-guided hook wire localization technique and also identify the risk factors for localization-related pneumothorax. METHODS: This retrospective study enrolled 95 patients (with 105 pulmonary nodules) who underwent preoperative CT-guided hook wire localization and followed VATS resection from January 2013 to September 2016. Univariate and multivariate logistic regression analyses were used to identify factors associated with localization-related pneumothorax. RESULTS: All the 105 nodules were successfully localized. Two (1.9%) hook wires dislodged before VATS resection. Mean largest diameter of the nodules was 10.1 mm (range, 3-19 mm). Mean depth from the nearest pleural surface was 11.2 mm (range, 2-38 mm). Mean needle insertion depth was 24.3 mm (range, 4-49 mm), and mean procedure time was 17.3 min (range, 7-48 min). Asymptomatic pneumothorax was observed in 18 patients (18.9%) and hemorrhage in 7 patients (7.4%). Multivariate logistic regression analysis revealed the number of needle insertions (OR 8.893, p = 0.019) as the only significant independent risk factor of pneumothorax. CONCLUSIONS: CT-guided hook wire localization is a safe, reliable and convenient technique and can be applied widely to facilitate the resection of SPNs. Simultaneous localization for multiple nodules in ipsilateral lung may be associated with a higher risk of localization-related pneumothorax.
BACKGROUND: Small pulmonary nodules (SPNs) often cannot be accurately located during video-assisted thoracoscopic (VATS) resection, and preoperative computed tomography (CT)-guided localization performed using hook wire placement can be helpful. However, recent studies revealed a trend towards more frequent and severe complications occurring in association with hook wire insertion. The aim of this study is to reevaluate the safety, and reliability of the preoperative CT-guided hook wire localization technique and also identify the risk factors for localization-related pneumothorax. METHODS: This retrospective study enrolled 95 patients (with 105 pulmonary nodules) who underwent preoperative CT-guided hook wire localization and followed VATS resection from January 2013 to September 2016. Univariate and multivariate logistic regression analyses were used to identify factors associated with localization-related pneumothorax. RESULTS: All the 105 nodules were successfully localized. Two (1.9%) hook wires dislodged before VATS resection. Mean largest diameter of the nodules was 10.1 mm (range, 3-19 mm). Mean depth from the nearest pleural surface was 11.2 mm (range, 2-38 mm). Mean needle insertion depth was 24.3 mm (range, 4-49 mm), and mean procedure time was 17.3 min (range, 7-48 min). Asymptomatic pneumothorax was observed in 18 patients (18.9%) and hemorrhage in 7 patients (7.4%). Multivariate logistic regression analysis revealed the number of needle insertions (OR 8.893, p = 0.019) as the only significant independent risk factor of pneumothorax. CONCLUSIONS: CT-guided hook wire localization is a safe, reliable and convenient technique and can be applied widely to facilitate the resection of SPNs. Simultaneous localization for multiple nodules in ipsilateral lung may be associated with a higher risk of localization-related pneumothorax.