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To evaluate the efficacy and safety of CT-guided marking at our institution, we retrospectively analyzed backgrounds and complications of 244 patients with 267 lesions who underwent preoperative marking for tumor localization.Hookwires with nylon thread (VATS marker) were placed in 223 lesions (83.5%), and 44 lesions (16.5%) were marked with a dye method (indigocarmine).The marking completion rate was 98.5% and success rate was 99.3%. Complications were pneumothorax in 110 cases (41.2%), intrapulmonary hemorrhage in 76 lesions (28.5%), marker dropout in 14 lesions (6.3% of VATS marker placements), and air embolization in one case (0.37%).In a study of two groups divided by the marking method, pneumothorax was significantly more common in the group with VATS marker placement.Three predictors of pneumothorax and intrapulmonary hemorrhage were: 1) age, 2) distance from the visceral pleura to tumor along the puncture route, and 3) marking technique.CT-guided marking with puncture of the lung parenchyma requires careful attention to complications, as well as appropriate case and marking method selection.

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