Reevaluation of the efficacy of preoperative computed tomography-guided hook wire localization: A retrospective analysis

Background: Small pulmonary nodules (SPNs) often cannot be accurately located during video-assisted thoracoscopic (VATS) resection, and preoperative computed tomography (CT)-guided localization performed using hook wire placement can be helpful. However, recent studies revealed a trend towards more frequent and severe complications occurring in association with hook wire insertion. The aim of this study is to reevaluate the safety, and reliability of the preoperative CT-guided hook wire localization technique and also identify the risk factors for localization-related pneumothorax. Methods: This retrospective study enrolled 95 patients (with 105 pulmonary nodules) who underwent preoperative CT-guided hook wire localization and followed VATS resection from January 2013 to September 2016. Univariate and multivariate logistic regression analyses were used to identify factors associated with localization-related pneumothorax. Results: All the 105 nodules were successfully localized. Two (1.9%) hook wires dislodged before VATS resection. Mean largest diameter of the nodules was 10.1 mm (range, 3-19 mm). Mean depth from the nearest pleural surface was 11.2 mm (range, 2-38 mm). Mean needle insertion depth was 24.3 mm (range, 4-49 mm), and mean procedure time was 17.3 min (range, 7-48 min). Asymptomatic pneumothorax was observed in 18 patients (18.9%) and hemorrhage in 7 patients (7.4%). Multivariate logistic regression analysis revealed the number of needle insertions (OR 8.893, p = 0.019) as the only significant independent risk factor of pneumothorax. Conclusions: CT-guided hook wire localization is a safe, reliable and convenient technique and can be applied widely to facilitate the resection of SPNs. Simultaneous localization for multiple nodules in ipsilateral lung may be associated with a higher risk of localization-related pneumothorax.