Preoperative computed tomography-guided localization for pulmonary nodules: comparison between hook-wire and anchored needle localization

Abstract

Introduction: Both hook-wire (HW) and anchored needle (AN) techniques can be used for preoperative computed tomography (CT)-guided localization for pulmonary nodules (PNs). But the outcomes associated with these two materials remain unclear.

Aim: To assess the relative safety and efficacy of preoperative CT-guided HW and AN localization for PNs.

Material and methods: This was a retrospective analysis of data collected from two institutions. Consecutive patients with PNs between January 2020 and December 2021 who underwent preoperative CT-guided HW or AN localization followed by video-assisted thoracoscopic surgery (VATS) procedures were included in these analyses, which compared the safety and clinical efficiency of these two localization strategies.

Results: In total, 98 patients (105 PNs) and 93 patients (107 PNs) underwent CT-guided HW and AN localization procedures, respectively. The HW and AN groups exhibited similar rates of successful PN localization (95.2% vs. 99.1%, p = 0.117), but the dislodgement rate in the HW group was significantly higher than that for the AN group (4.8% vs. 0.0%, p = 0.029). The mean pain score of patients in the HW group was significantly higher than that for the AN group (p = 0.001). HW and AN localization strategies were associated with comparable pneumothorax (21.4% vs. 16.1%, p = 0.349) and pulmonary hemorrhage (29.6% vs. 23.7%, p = 0.354) rates. All patients other than 1 individual in the HW group successfully underwent VATS-guided limited resection.

Conclusions: These data suggest that AN represents a safe, well-tolerated, feasible preoperative localization strategy for PNs that may offer value as a replacement for HW localization.

Keywords: anchored needle; hook-wire; localization; pulmonary nodule.

Photo 1

Procedures of CT-guided HW localization. A – CT image shows the GGN (arrow) at the right lower lobe. B – The HW (arrow) was placed near the GGN for localization. C – The HW (arrow) could be seen during the VATS procedures

Photo 2

Procedures of CT-guided AN localization. A – CT image shows the needle tip (long arrow) placed near the GGN (short arrow). B – The anchor claw (arrow) was placed just beside the PN for localization. C – The tri-colored suture (arrow) could be seen during the VATS procedures