Factors determining successful computed tomography-guided localization of lung nodules

Objectives: To investigate the factors related to the successful computed tomography-guided nodule localization for subsequent nodule excision. Methods: We retrospectively reviewed the medical records for 181 patients who had undergone computed tomography-guided nodule localization using hook wire and subsequent video-assisted thoracic surgery resection for lung nodules. The demographic factors, nodule factors, and technical factors were reviewed to determine what affects effective nodule localization for video-assisted thoracic surgery resection using both univariate and multivariate models. Results: A total of 174 patients were included in our study. Successful localization was accomplished in 166 patients (95%). Univariate analysis implicated patient age, nodule solidity, zonal location, and a sufficient distance between the hook wire tip and pleural surface as significant factors for successful localization. Multivariate analysis focused on the distance between the wire tip and pleural surface as the sole independent factor for successful localization (P = .012). Conclusions: The distance between the hook wire tip and pleural surface was the major significant factor for successful computed tomography-guided nodule localization for subsequent video-assisted thoracic surgery resection. Thus, the localization of a hook wire adjacent to a target nodule with sufficient depth from the pleural surface is crucial to the success of the procedure. (J Thorac Cardiovasc Surg 2012;143:809-14)