Safety and effectiveness of simultaneous localization of multiple lung nodules using coils and risk factors for pneumothorax: a retrospective study

Background Localization of lung nodule before video-assisted thoracoscopic surgery (VATS) can help the surgeon to quickly and accurately find the lesion during surgery. Purpose To evaluate the safety and effectiveness of using coils to simultaneously locate multiple lung nodules under computed tomography guidance and to clarify the risk factors for pneumothorax. Material and Methods From January 2020 to December 2020, 61 patients underwent simultaneous localization of multiple lung nodules (Group A) and 120 patients underwent localization of a single lung nodule (Group B). The demographics, information related to localization procedure, and incidence of pulmonary hemorrhage and pneumothorax were compared between the patients in Groups A and B. Group A was further divided into a pneumothorax group and non-pneumothorax group. Univariate and multivariate regression analyses were used to determine the risk factors for pneumothorax in patients who underwent simultaneous localization of multiple lung nodules using coils. Results The success rates in Groups A and B were 96.9% and 96.7%, respectively (P = 1.000). The number of pleural punctures (P<0.001), the positioning operation time (P<0.001), the rates of pneumothorax (P<0.001), and hemorrhage (P = 0.034) were higher in Group A than in Group B. The pneumothorax and bleeding in Group A did not require special treatment. Transfissural puncture (odds ratio [OR]=16.798; P = 0.033) and the numbers of pleural punctures (OR=2.437; P = 0.013) were independent risk factors for pneumothorax caused by simultaneous localization of multiple lung nodules, and hemorrhage was a protective factor against pneumothorax (OR=0.069; P = 0.002). Conclusion Simultaneous localization of multiple lung nodules using coils under computed tomography guidance is safe and effective. Transfissural puncture and higher numbers of pleural punctures will increase the risk of pneumothorax, whereas hemorrhage will reduce the risk of pneumothorax.