Preoperative percutaneous localization of multiple ipsilateral pulmonary nodules: A systematic review

With the increased radiological investigations applied to lung cancer screening, a growing number of small pulmonary nodules that should undergo biopsy or surgical removal are being identified. Accurate lesion localization is a key prerequisite for successful excision. Unfortunately, repeated pleural punctures in patients with multiple pulmonary nodules (MPNs) may significantly increase the risk of pneumothorax. To illustrate the role and limitations of current techniques for simultaneous localization of MPNs, we searched PubMed, Embase, and the Chinese Electronic Periodical Services for published articles from January 2000 to February 2022. A total of eight references were selected for this systematic review. Compared with techniques for localizing single pulmonary nodules (SPNs), localization of MPNs required a longer procedural time (14-56 min) and demonstrated lower success rates (83.5%-100%). The rates of pneumothorax were markedly higher in patients with MPNs (up to 57.9%) than in those with SPNs (12.7%-32.5%). Various localization methods have been proposed to deal with MPNs, including hook wire, microcoils, and dye localization. Failures most commonly occurred after localization of the first nodule, and the main causes (i.e., hook wire dislodgement, dye diffusion, patient repositioning, or pneumothorax) differed according to the localization technique. Novel approaches - including simultaneous multiple needle insertion and the use of hybrid operating room - hold promise for reducing complications rates and procedural times. Collectively, preoperative percutaneous localization of ipsilateral MPNs is safe and feasible, but future technological innovations are needed in order to enhance localization safety and accuracy.