Clinical application of two types of Hook-Wire needle localization procedures for pulmonary small nodule biopsy

Abstract

Background: With the widespread use of low-dose spiral computed tomography (LDCT) and increasing awareness of personal health, the detection rate of pulmonary nodules is steadily rising.

Objective: To evaluate the success rate and safety of two different models of Hook-Wire needle localization procedures for pulmonary small nodule biopsy.

Methods: Ninety-four cases with a total of 97 pulmonary small nodules undergoing needle localization biopsy were retrospectively analyzed. The cases were divided into two groups: Group A, using breast localization needle steel wire (Bard Healthcare Science Co., Ltd.); Group B, using disposable pulmonary nodule puncture needle (SensCure Biotechnology Co., Ltd.). All patients underwent video-assisted thoracoscopic surgery (VATS) for nodule removal on the same day after localization and biopsy. The puncture localization operation time, success rate, complications such as pulmonary hemorrhage, pneumothorax, hemoptysis, and postoperative comfort were observed and compared.

Results: In Group A, the average localization operation time for 97 nodules was 15.47 ± 5.31 minutes, with a success rate of 94.34%. The complication rate was 71.69% (12 cases of pneumothorax, 35 cases of pulmonary hemorrhage, 2 cases of hemoptysis), and 40 cases of post-localization discomfort were reported. In Group B, the average localization operation time was 25.32 ± 7.83 minutes, with a 100% success rate. The complication rate was 29.55% (3 cases of pneumothorax, 15 cases of pulmonary hemorrhage, 0 cases of hemoptysis), and 3 cases reported postoperative discomfort. According to the data analysis in this study, Group B had a lower incidence of puncture-related complications than Group A, along with a higher success rate and significantly greater postoperative comfort.

Conclusions: The disposable pulmonary nodule puncture needle is safer and more effective in pulmonary small nodule localization biopsy, exhibiting increased comfort compared to the breast localization needle. Additionally, the incidence of complications is significantly lower.

Keywords: CT-guided; Hook-Wire needle; needle localization; pulmonary small nodule.

Figure 1.

Depicts the case of a single patient with a nodule in the left lower lobe (highlighted by yellow arrows) in the right lateral decubitus position. Puncture was performed using a breast localization needle: A. Pre-puncture localization of the nodule.B. After adjusting the angle of the puncture needle, it was inserted into the lung, revealing alveolar hemorrhage (indicated by red arrows) and a small pneumothorax (indicated by blue arrows). C. Release of the hook-wire, with the distal end anchored (indicated by green arrows) within 1 cm of the lesion. D. Post-release scan confirming the position of the localization needle and assessing lung complications. The steel wire tail (indicated by black arrows) was then externally ligated.The difficulty in securing the metal tail wire after hook-wire anchoring may lead to increased friction with the chest wall, resulting in a higher likelihood of secondary pneumothorax and alveolar hemorrhage, contributing to a less favorable patient experience.E and F: Surgical field views observing the condition of the hook-wire and postoperative excised pathological specimens, with the specimens removed for further examination after detaching the localization needle.

Figure 2.

Illustrates the case of the same patient with a nodule in the right upper lobe (highlighted by yellow arrows) in the supine position. Puncture was performed using a disposable pulmonary nodule puncture needle: A. Pre-puncture localization of the nodule. B. After adjusting the angle of the puncture needle(indicated by green arrows), it was inserted into the lung. C. Post-release scan confirming the position of the localization needle (indicated by green arrows) and assessing lung complications. The steel wire tail was then externally ligated. No alveolar hemorrhage or pneumothorax was observed within the lung, and the tail wire was easily secured after hook-wire anchoring, providing a comfortable experience for the patient. D and F. Surgical field views observing the condition of the hook-wire (indicated by black arrows) and postoperative excised pathological specimens. The specimens were sent for examination, carrying the hook-wire along for further analysis.