Clinical Analysis of Percutaneous Computed Tomography–Guided Hook Wire Localization of 168 Small Pulmonary Nodules

Xu, Xuanli; Yao, Yake; Shen, Yihong; Zhang, Pei; Zhou, Jianying

doi:10.1016/j.athoracsur.2015.05.029

Cited by 25 publications

(28 citation statements)

References 28 publications

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“…The the applicable implementation of localizing small pulmonary nodules and detecting segmental plain with ICG fluorescence by fluoroscopy and comparable localization accuracy to previously reported localization with microcoil placement and other techniques was shown. [16][17][18] Another interesting finding from the present study was that among these consecutive enrolled patients, female patients seemed more likely to develop subsolid pulmonary nodules confirmed to be malignant diseases than male patients (69.6% vs. 30.4%), which, in a way, is consistent with the current published finding. 23 Whether gender should be taken into consideration for constituting screening and surveillance strategy warrants further verification.…”

Section: Discussionsupporting

confidence: 92%

Application of indocyanine green fluorescence for precision sublobar resection

Zhang

Lin

et al. 2019

Thoracic Cancer

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Background Increasing identification of small pulmonary nodules promotes sublobar resection, but localization and surgical margins of non‐palpable pulmonary nodules through sublobar resection are challenging. Our aim was explicate the feasibility of applying indocyanine green (ICG) fluorescence to localized nodules, and to carry out surgical resection. Methods A total of 46 patients with subpleural pulmonary nodules <3 cm were enrolled, including 35 for wedge resection and 11 for segmentectomy. For wedge resection, patients underwent computed tomography‐guided percutaneous injection of ICG preoperatively. Wedge resection was carried out after confirmation of the fluorescence using fluoroscopy. For segmentectomy, ICG was injected through the peripheral vein during surgery and resection of the segmental plain was carried out. Detailed measurements were taken and information was collected for the whole procedure. Results A total of 33 out of 35 patients underwent successful wedge resection using ICG fluorescence. Segmentectomy was successfully carried out for all 11 patients who underwent the procedure. For two patiens, the nodules failed to be localized with unclear fluorescence, and one patient with an undetected nodule was altered to perform lobectomy. For wedge resection, the mean tumor size and depth from the pleural surface were 7.8 ± 0.5 mm and 10.5 ± 1.6 mm, respectively. The median time taken for preoperative computed tomography‐guided percutaneous injection was 28 min (range 18–40 min), and 25 min (range 16–30 min) for wedge resection. For segmentectomy, the ICG fluorescence occurred 14 s after injecting ICG through the peripheral vein, and the median duration was 15 min. All surgical margins were negative based on pathological evaluation. Conclusions The implementation of ICG fluorescence could provide surgeons carrying out precision sublobar resection with a time‐saving surgical technique with less unnecessary intraoperative damage.

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Section: Discussionsupporting

confidence: 92%

Application of indocyanine green fluorescence for precision sublobar resection

Zhang

Lin

et al. 2019

Thoracic Cancer

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“…The use of methylene blue may also be limited in patients with anthracotic swine mentation for it is difficult to see during VATS. While, hook wires, do not require intraoperative fluoroscopy to detect targets, perform better in resecting small pulmonary nodules via VATS for the short procedure time, precise wedge resection and a better intraoperative manipulation (lift up the lung for wedge resection) (9,10,12,13,22,23). Kastl (8) hold the point that hook wires are easily dislodged, resulting in high failure rates.…”

Section: Discussionmentioning

confidence: 99%

“…In decades, various techniques, including preoperative localization procedures, intraoperative localization using imaging modalities such as intraoperative ultrasonography, hook-wire, contrast media (5,6), dyes, microcoil, finger palpation, radio-guided, were used to overcome the aforementioned unfavorable factors, and the positive and negative aspects have been described (7). Along with the application of various localization methods and the accumulation of operating experience, numerous of doctors have been gradually recognized that physical methods such as hook wire localization showed excellent superiority (8)(9)(10)(11)(12)(13). In addition, this method is also relatively safe, since the operating procedure takes shorter time.…”

Section: Introductionmentioning

confidence: 99%

Semi-rigid single hook localization the best method for localizing ground glass opacities during video-assisted thoracoscopic surgery: re-aerated swine lung experimental and primary clinical results

et al. 2017

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Background: The aim of this study was to compare the effects of currently available preoperative localization methods, including semi-rigid single hook-wire, double-thorn hook-wire, and microcoil, in localizing the pulmonary nodules, thus to select the best technology to assist video-assisted thoracoscopic surgery (VATS) for small ground glass opacities (GGO).Methods: Preoperative CT-guided localizing techniques including semi-rigid single hook-wire, doublethorn hook-wire and microcoil were used in re-aerated fresh swine lung for location experiments. The advantages and drawbacks of the three positioning technologies were compared, and then the most optimal technique was used in patients with GGO. Technical success and post-operative complications were used as primary endpoints.Results: All three localizing techniques were successfully performed in the re-aerated fresh swine lung.The median tractive force of semi-rigid single hook wire, double-thorn hook wire and microcoil were 6.5, 4.85 and 0.2 N, which measured by a spring dynamometer. The wound sizes in the superficial pleura, caused by unplugging the needles, were 2 mm in double-thorn hook wire, 1 mm in semi-rigid single hook and 1 mm in microcoil, respectively. In patients with GGOs, the semi-rigid hook wires localizations were successfully performed, without any complication that need to be intervened. Dislodgement was reported in one patient before VATS. No major complications related to the preoperative hook wire localization and VATS were observed. Conclusions:We found from our localization experiments in the swine lung that, among the commonly used three localization methods, semi-rigid hook wire showed the best operability and practicability than doublethorn hook wire and microcoil. Preoperative localization of small pulmonary nodules with single semi-rigid hook wire system shows a high success rate, acceptable utility and especially low dislodgement in VATS. IntroductionThe widespread application of low-dose computed tomography (LDCT) has led to a great increase in the identification rate of small pulmonary nodules, especially small ground glass opacities (GGO). GGO is defined as a hazy opacity that does not obscure underlying bronchial structures or pulmonary vessels on CT scans (1). It has been reported that 33-60% GGO was malignant carcinoma when the nodules size ranges from 11-20 mm, while the malignant rate increase to 64-82% when the size grows up greater than 20 mm (2). Although the identification of pulmonary nodules could be effectively accomplished by many imaging modalities, including high-resolution CT, positron emission tomography (PET/CT), and bronchoscopy, whereas the identification of lesions with GGO remains difficult. Thus, more reliable diagnosis and therapeutic options for uncertain pulmonary nodules are still in need (3).Video-assisted thoracoscopic surgery (VATS) is less invasive in diagnosing and treating thoracic lesions, thus how to locate and mark the nodules more precisely before the VATS becomes one of the most important ...

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“…In the microcoil group,two patients had complications that required treatment, one for medium‐sized pneumothorax on the day after positioning, the other for thoracic puncture wound. Most of the complications reported in the literature are asymptomatic, and postoperative surgical treatment addresses complications at the same time, requiring fewer cases of clinical intervention, which have previously been reported to occur in approximately 0%–4.6% of cases …”

Section: Discussionmentioning

confidence: 99%

Comparative study on preoperative localization techniques using microcoil and hookwire by propensity score matching

et al. 2020

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Background: The purpose of this study was to compare the efficacy and safety of two preoperative pulmonary nodule localization techniques using microcoil and hookwire. Methods: A total of 307 patients with 324 pulmonary nodules were included in the study from March 2012 to October 2016 in two medical centers. Baseline data, positioning operation data, success rate, complications, surgery and pathological results were statistically analyzed. Complications were used as the dependent variables, whereas others were used as covariates for the propensity score matching of the two groups. Statistical analyses were performed to compare the success rate and complication rate of the matched groups. Results: There were 218 lesions in the microcoil group and 106 nodules in the hookwire group. There were no significant differences in gender, age and the location of nodules between the two groups. The diameters of the nodules were smaller (8.2 AE 3.5 mm vs. 10.7 AE 4.3 mm) and solid nodules were fewer (11.5% vs. 26.4%) in the microcoil group. The complication rate of the two groups was not statistically significant. After propensity score matching, 71 patients in each group were successfully matched. We found that the success rate was higher (97.2% vs. 94.4%) and the incidence of complications was lower (31% vs. 15.5%) in the microcoil group. Conclusions: Both techniques have been shown to be effective in preoperative localization of tiny pulmonary nodules. The method of microcoil localization has more advantages in clinical application. Key pointsComparison of the efficacy and safety of two methods in preoperative pulmonary nodule localization in order to determine the optimal method.

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Clinical Analysis of Percutaneous Computed Tomography–Guided Hook Wire Localization of 168 Small Pulmonary Nodules

Cited by 25 publications

References 28 publications

Application of indocyanine green fluorescence for precision sublobar resection

Application of indocyanine green fluorescence for precision sublobar resection

Semi-rigid single hook localization the best method for localizing ground glass opacities during video-assisted thoracoscopic surgery: re-aerated swine lung experimental and primary clinical results

Comparative study on preoperative localization techniques using microcoil and hookwire by propensity score matching

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