Preoperative lung nodule localization: comparison of hook-wire and indocyanine green

Abstract

Introduction: Computed tomography (CT)-guided localization approaches are commonly used to guide video-assisted thoracoscopic surgery (VATS)-based lung nodule (LN) resection.

Aim: To compare the relative safety and efficacy of CT-guided hook-wire (HW) and indocyanine green (IG) approaches to preoperative LN localization.

Material and methods: In total, this study analyzed data from 41 patients who underwent CT-guided HW localization prior to VATS-based LN resection between December 2017 and December 2020, as well as 53 patients who underwent CT-guided IG localization prior to VATS-based LN resection between January 2021 and September 2021. Both clinical efficacy and complication rates were compared in these two groups.

Results: Overall, 41 patients underwent HW localization for 42 LNs, while 53 patients underwent IG localization for 55 LNs in the respective groups. The respective rates of successful localization in the HW and IG groups were 97.6% and 100% (p = 1.000). The average duration of CT-guided localization was significantly shorter for patients in the IG group relative to the HW group (p = 0.003). The total complication rate was significantly higher in the HW group than that in the IG group (p = 0.004). Prolonged localization duration was an independent risk factor of pneumothorax (p = 0.004). Rates of technical success for the wedge resection procedure (p = 1.000), VATS duration (p = 0.623), and blood loss (p = 0.800) were comparable in both patient groups.

Conclusions: HW and IG localization procedures achieved similar efficacy outcomes when used to preoperatively localize LNs. However, IG localization may exhibit better safety than HW localization.

Keywords: computed tomography; hook-wire; indocyanine green; lung nodules.

Photo 1

The LN was located by HW. A – LN (arrow) located at the left upper lobe. B – The introducer needle was punctured into the lung and the needle tip was advanced near the LN. C – The HW (long arrow) was released via the needle (short arrow)

Photo 2

The LN was located by IG. A – LN (arrow) located at the left upper lobe. B – The introducer needle was punctured into the lung and the needle tip was advanced near the LN, and the IG was injected via the needle. C – IG fluorescence (arrow) was detected during the VATS procedure