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

Abstract

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 ± 3.5 mm vs. 10.7 ± 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 points: Comparison of the efficacy and safety of two methods in preoperative pulmonary nodule localization in order to determine the optimal method.

Keywords: Localization; lung cancer; nodule; thoracoscopic.

Figure 1

(a) Cook's embolization microcoil. (b) Angiotech's hookwire.

Figure 2

Imaging findings before and after coil positioning operation. (a) CT scan before localization found pulmonary nodules. (b) CT scan during localization confirmed that the puncture need lewas located in the lung tissue around the lesion. (c, d) chest X‐ray after localization showed the proximal part coiling beyond the parietal pleura and the distal part anchoring in the lung parenchyma.

Figure 3

The positioning process of hookwire with CT guided. CT scan chose puncture plane before operation (a), CT scan determines the angle and depth of insertion during operation (b), and CT scan confirmed that the hookwire was located in the lung tissue around the lesion after operation (c).

Figure 4

Tendency score distribution histogram. (a and c) PS histograms of the microcoil group and (b and d) the hookwire group. After matching (c and d), the histograms of the PS distributions in the two groups were similar, suggesting a good match.