Comparison of two methods for CT-guided pulmonary nodule location before thoracoscopic surgery

Abstract

Introduction: Preoperative computed tomography (CT)-guided localization can shorten the time of video-assisted thoracoscopic surgery (VATS) and accurately aid in pulmonary nodule removal.

Aim: To discuss the application value and safety of 2 kinds of breast localization needles and anchor localization needles in clinical practice for pulmonary nodules under CT guidance before VATS.

Material and methods: We retrospectively studied 215 patients with 247 pulmonary nodules, who underwent CT-guided pulmonary nodule location before VATS. The 2 kinds of localization needles were randomly used, and we collected and analysed the clinical data.

Results: We used breast and anchor localization needles in 27.9% and 72.1% of cases, respectively. Differences were observed in puncture localization time, detachment rate, and visual analogue scale (VAS). The detachment rate (0%) and positioning time (median: 12 min) were less in the anchor than in the breast localization needle group (8.7% and median: 13 min, respectively). The median VAS was approximately 2 and 5 in the anchor and breast localization needle groups, respectively. Surgical pathology revealed that 155 (62.8%) pulmonary nodules were malignant while 92 (37.2%) were benign. The primary distinction in surgical procedures is the higher proportion of segmental resections in the middle and inner band group (19.3%) compared to the periphery band group (4.2%).

Conclusions: Unlike breast localization needles, anchor localization needles can reduce pain and discomfort after positioning, and they are not easy to decouple. These 2 needles are safe for CT-guided localization, which can shorten the time of VATS and accurately aid in pulmonary nodule removal.

Keywords: localization needles; lung adenocarcinoma; pulmonary nodules; video-assisted thoracoscopic surgery.

Photo 1

Comparison of the structure of the anchor localization needles (left) and 20 G breast localization needles (right); (A) overall structure of the anchor localization needles (left) and 20 G breast localization needles (right); (B) the structure after the positioning needle has been pushed out of the sheath. The anchor positioning needle consists of the 4-claw and tri-coloured positioning lines (left); 20 G breast localization needle consists of single hooks and a wire positioning needle (right)

Photo 2

Failed cases of resection of pulmonary nodules under video-assisted thoracoscopic surgery (VATS) without preoperative localization in a middle-aged woman; (A) the CT image showed a ground glass nodule in the right upper lobe; (B) the CT image still showed the presence of pulmonary nodules in the right upper lobe; (C) preoperative localization was performed before VATS again; (D) a second post-VATS CT review showed that the ground glass nodule had been resected on the image; (E) half a year after operation, CT showed that there was no abnormal density shadow in the operation area; (F) the pathological results of the second postoperative surgical specimen showed pulmonary interstitial hyperplasia with focal collagenization