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Yin C, Chen Y, Zhang R, Chen A, Fang H, Liu W, Cui K, Wang Z, Pan H. Analysis of complication risk factors in preoperative computed tomography-guided hookwire location of pulmonary nodules. Eur J Med Res 2024; 29:369. [PMID: 39014473 PMCID: PMC11253328 DOI: 10.1186/s40001-024-01970-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 07/10/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND This study aimed to explore the efficacy of hookwire for computed tomography (CT)-guided pulmonary nodule (PN) localization before video-assisted thoracoscopic surgery (VATS) resection and determine the risk factors for localization-related complications. METHODS We enrolled 193 patients who underwent preoperative CT-guided PN hookwire localization. The patients were categorized into groups A (103 patients had no complications) and B (90 patients had complications) according to CT and VATS. Uni- and multivariate logistic regression analyses were used to identify risk factors for localization-related complications. A numerical rating scale was used to evaluate hookwire localization-induced pain. RESULTS We successfully performed localization in 173 (89.6%) patients. Pneumothorax was the main complication in 82 patients (42.5%). Patient gender, age, body mass index, tumor diameter, consolidation tumor ratio, pathologic diagnosis, position adjustment during location, lesion location, waiting time for surgery, and pleural adhesions were not significantly different between the two groups. The number of nodules, number of punctures, scapular rest position, and depth of insertion within the lung parenchyma were significant factors for successful localization. Multivariate regression analysis further validated the number of nodules, scapular rest position, and depth of insertion within the lung parenchyma as risk factors for hookwire-localization-related complications. Hookwire localization-induced pain is mainly mild or moderate pre- and postoperatively, and some patients still experience pain 7 days postoperatively. CONCLUSIONS Hookwire preoperative PN localization has a high success rate, but some complications remain. Thus, clinicians should be vigilant and look forward to further improvement.
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Affiliation(s)
- Chuntong Yin
- Department of Thoracic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Yu Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Renquan Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Anguo Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Hanlin Fang
- Department of Thoracic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Wenjian Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Kai Cui
- Department of Thoracic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Zhengqiao Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Huaguang Pan
- Department of Thoracic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China.
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Zeng Y, Gou X, Yin P, Sui X, Chen X, Hu L. The influence of respiratory movement on preoperative CT-guided localization of lung nodules. Clin Radiol 2024; 79:e963-e970. [PMID: 38589276 DOI: 10.1016/j.crad.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/31/2024] [Accepted: 03/17/2024] [Indexed: 04/10/2024]
Abstract
AIM To evaluate the motion amplitude of lung nodules in different locations during preoperative computed tomography (CT)-guided localization, and the influence of respiratory movement on CT-guided percutaneous lung puncture. MATERIALS AND METHODS A consecutive cohort of 398 patients (123 men and 275 women with a mean age of 53.9 ± 10.7 years) who underwent preoperative CT-guided lung nodule localization from May 2021 to Apr 2022 were included in this retrospective study. The respiratory movement-related nodule amplitude in the cranial-caudal direction during the CT scan, characteristics of patients, lesions, and procedures were statistically analyzed. Univariate and multivariate logistic regression analyses were used to evaluate the influence of these factors on CT-guided localization. RESULTS The nodule motion distribution showed a statistically significant correlation within the upper/middle (lingular) and lower lobes (p<0.001). Motion amplitude was an independent risk factor for CT scan times (p=0.011) and procedure duration (p=0.016), but not for the technical failure rates or the incidence of complications. Puncture depth was an independent risk factor for the CT scan times, procedure duration, technical failure rates, and complications (p<0.01). Female, prone, and supine (as opposed to lateral) positions were significant protective factors for pneumothorax, while the supine position was an independent risk factor for parenchymal hemorrhage (p=0.025). CONCLUSION Respiratory-induced motion amplitude of nodules was greater in the lower lobes, resulting in more CT scan times/radiation dose and longer localization duration, but showed no statistically significant influence on the technical success rates or the incidence of complications during preoperative CT-guided localization.
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Affiliation(s)
- Y Zeng
- Department of Radiology, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing, PR China
| | - X Gou
- Department of Radiology, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing, PR China
| | - P Yin
- Department of Radiology, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing, PR China
| | - X Sui
- Department of Thoracic Surgery, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing, PR China
| | - X Chen
- Department of Thoracic Surgery, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing, PR China
| | - L Hu
- Department of Thoracic Surgery, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing, PR China.
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Zhu X, Chen Z, Zhu KL, Zhou S, Xing FB, Chen WB, Zhang L. Clinical application of CT-assisted body surface localization combined with intraoperative stereotactic anatomical localization in thoracoscopic lung nodule resection: a single-centre retrospective study. J Cardiothorac Surg 2024; 19:404. [PMID: 38943205 PMCID: PMC11212230 DOI: 10.1186/s13019-024-02923-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/15/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND Today, the detection rate of lung nodules is increasing. Some of these nodules may become malignant. Thus, timely resection of potentially malignant nodules is essential. However, Identifying the location of nonsurface or soft-textured nodules during surgery is challenging. Various localization techniques have been developed to accurately identify lung nodules. Common methods include preoperative CT-guided percutaneous placement of hook wires and microcoils. Nonetheless, these procedures may cause complications such as pneumothorax and haemothorax. Other methods regarding localization of pulmonary nodules have their own drawbacks. We conducted a clinical study which was retrospective to identify a safe, accurate and suitable method for determining lung nodule localization. To evaluate the clinical value of CT-assisted body surface localization combined with intraoperative stereotactic anatomical localization in thoracoscopic lung nodule resection. METHODS We retrospectively collected the clinical data of 120 patients who underwent lung nodule localization and resection surgery at the Department of Thoracic Surgery, First Affiliated Hospital of Bengbu Medical College, from January 2020 to January 2022. Among them, 30 patients underwent CT-assisted body surface localization combined with intraoperative stereotactic anatomical localization, 30 patients underwent only CT-assisted body surface localization, 30 patients underwent only intraoperative stereotactic anatomical localization, and 30 patients underwent CT-guided percutaneous microcoil localization. The success rates, complication rates, and localization times of the four lung nodule localization methods were statistically analysed. RESULTS The success rates of CT-assisted body surface localization combined with intraoperative stereotactic anatomical localization and CT-guided percutaneous microcoil localization were both 96.7%, which were significantly higher than the 70.0% success rate in the CT-assisted body surface localization group (P < 0.05). The complication rate in the combined group was 0%, which was significantly lower than the 60% in the microcoil localization group (P < 0.05). The localization time for the combined group was 17.73 ± 2.52 min, which was significantly less than that (27.27 ± 7.61 min) for the microcoil localization group (P < 0.05). CONCLUSIONS CT-assisted body surface localization combined with intraoperative stereotactic anatomical localization is a safe, painless, accurate, and reliable method for lung nodule localization.
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Affiliation(s)
- Xiao Zhu
- Department of Thoracic Surgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, 233000, Anhui Province, China
| | - Zhi Chen
- Bengbu Medical University, Bengbu, 233000, Anhui Province, China
| | - Kun-Lun Zhu
- Department of Thoracic Surgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, 233000, Anhui Province, China
| | - Shao Zhou
- Department of Thoracic Surgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, 233000, Anhui Province, China
| | - Fu-Bao Xing
- Department of Thoracic Surgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, 233000, Anhui Province, China
| | - Wen-Bang Chen
- Department of Thoracic Surgery, Nanfang Hospital Southern Medical University, Guangzhou, 510000, Guangdong Province, China
| | - Lei Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Bengbu Medical University, Bengbu, 233000, Anhui Province, China.
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Zhang H, Zhang X, Li Y, Huang Z, Liu H, Chen X. The efficacy and safety of CT-guided localization of pulmonary nodules by medical adhesives containing methylene blue before surgery. Heliyon 2024; 10:e31404. [PMID: 38832261 PMCID: PMC11145235 DOI: 10.1016/j.heliyon.2024.e31404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 05/15/2024] [Accepted: 05/15/2024] [Indexed: 06/05/2024] Open
Abstract
Background The accurate preoperative localization of pulmonary nodules is essential for a successful video-assisted thoracic surgery (VATS). The aim of this research was to clarify the efficacy and safety of CT-guided localization of pulmonary nodules by mixture of methylene blue and medical adhesive. Methods Between January 2020 and January 2021, 103 subjects who have received the CT-guidance pulmonary nodules localization operation were included and retrospectively analyzed. The data on efficiency and complications of preoperative localization using medical adhesives mixed with methylene blue mixture were collected and analyzed. Results 103 patients with 111 localized pulmonary nodules were included, 95 of whom had one nodule and 8 of whom had two nodules. The nodule localization success rate reaches as high as 100 %. The mean diameter of pulmonary nodules was 9.50 ± 3.67 mm. The mean distance of pulmonary nodule and pleural surface was 19.95 ± 14.92 mm. The mean depth of localized adhesive in the lung parenchyma was 18.99 ± 11.62 mm, and the mean time required for localization was 16.98 ± 5.72 min. The average time from the nodule localization to VATS surgery was 16.97 ± 7.34 h. The common complications of localization were minor pulmonary hemorrhage (9.74 %) and mild pneumothorax (15.53 %). Besides, pulmonary hemorrhage was related with depths of medical adhesives and nodules in lung parenchyma (p = 0.018 and 0.002, respectively). Conclusion Medical adhesive mixed with methylene blue is safe and effective in pulmonary nodules localization for VATS, and surgeons have flexibility in scheduling the procedure.
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Affiliation(s)
- Huijun Zhang
- Department of Cardiothoracic Surgery, Huashan Hospital of Fudan University, Shanghai, 200040, China
| | - Xiujuan Zhang
- Department of Pulmonary and Critical Care Medicine, Huashan Hospital of Fudan University, Shanghai, 200040, China
| | - Ying Li
- Department of Cardiothoracic Surgery, Shanghai Pulmonary Hospital, Shanghai, 200433, China
| | - Zhifei Huang
- Department of Radiation Oncology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, 233000, Anhui, China
| | - Huahua Liu
- Nursing Department of the Eighth People's Hospital of Shanghai, Shanghai, 200235, China
| | - Xiaofeng Chen
- Department of Cardiothoracic Surgery, Huashan Hospital of Fudan University, Shanghai, 200040, China
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Wu S, Wu J, Xiong J, Huang C, Lin Y, Guan J, Xu J. Risk factors of pneumothorax in computed tomography guided lung nodule marking using autologous blood: a retrospective study. J Cardiothorac Surg 2024; 19:317. [PMID: 38824602 PMCID: PMC11143724 DOI: 10.1186/s13019-024-02810-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 05/25/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND To investigate the risk factors of pneumothorax of using computed tomography (CT) guidance to inject autologous blood to locate isolated lung nodules. METHODS In the First Hospital of Putian City, 92 cases of single small pulmonary nodules were retrospectively analyzed between November 2019 and March 2023. Before each surgery, autologous blood was injected, and the complications of each case, such as pneumothorax and pulmonary hemorrhage, were recorded. Patient sex, age, position at positioning, and nodule type, size, location, and distance from the visceral pleura were considered. Similarly, the thickness of the chest wall, the depth and duration of the needle-lung contact, the length of the positioning procedure, and complications connected to the patient's positioning were noted. Logistics single-factor and multi-factor variable analyses were used to identify the risk factors for pneumothorax. The multi-factor logistics analysis was incorporated into the final nomogram prediction model for modeling, and a nomogram was established. RESULTS Logistics analysis suggested that the nodule size and the contact depth between the needle and lung tissue were independent risk factors for pneumothorax. CONCLUSION The factors associated with pneumothorax after localization are smaller nodules and deeper contact between the needle and lung tissue.
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Affiliation(s)
- Shaohang Wu
- Department of Thoracic Surgery, The First Hospital of Putian, The School of Clinical Medicine, Fujian Medical University, No. 449 Nanmenxi Road, Putian, Fujian, 351100, China
| | - Jianyang Wu
- Department of Thoracic Surgery, The First Hospital of Putian, The School of Clinical Medicine, Fujian Medical University, No. 449 Nanmenxi Road, Putian, Fujian, 351100, China
| | - Junkai Xiong
- Department of Thoracic Surgery, The First Hospital of Putian, The School of Clinical Medicine, Fujian Medical University, No. 449 Nanmenxi Road, Putian, Fujian, 351100, China
| | - Chengbin Huang
- Department of Thoracic Surgery, The First Hospital of Putian, The School of Clinical Medicine, Fujian Medical University, No. 449 Nanmenxi Road, Putian, Fujian, 351100, China
| | - Yiwei Lin
- Department of Thoracic Surgery, The First Hospital of Putian, The School of Clinical Medicine, Fujian Medical University, No. 449 Nanmenxi Road, Putian, Fujian, 351100, China
| | - Jun Guan
- Department of Thoracic Surgery, The First Hospital of Putian, The School of Clinical Medicine, Fujian Medical University, No. 449 Nanmenxi Road, Putian, Fujian, 351100, China.
| | - Jianxin Xu
- Department of Thoracic Surgery, The First Hospital of Putian, The School of Clinical Medicine, Fujian Medical University, No. 449 Nanmenxi Road, Putian, Fujian, 351100, China.
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Chu S, Wei N, Lu D, Chai J, Liu S, Lv W. Comparative study of the effect of preoperative hookwire and methylene blue localization techniques on post-operative hospital stay and complications in thoracoscopic pulmonary nodule surgery. BMC Pulm Med 2022; 22:336. [PMID: 36064381 PMCID: PMC9446788 DOI: 10.1186/s12890-022-02129-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Direct localization of small and deep pulmonary nodules before thoracoscopic surgery using the hookwire or methylene blue techniques has been recently attempted for better surgical outcomes. In this study, we compare the outcomes of the above two techniques. METHODS Two hundred and nineteen patients undergoing 135 hookwire and 151 methylene blue techniques in our University Hospital between July 2020 and January 2022 were compared for localization and hospitalization durations, and the complication risk. Other confounders included patients' age, gender, localization position, nodules location, count, diameter, and depth. RESULTS After adjustment of all predictors, the methylene blue technique was associated with a significant 0.6-min (parameter estimate (PE) = -0.568, p value = 0.0173) and an 0.7-day shorter localization and hospitalization time (PE = -0.713, p value = < 0.0001) as compared to using the hookwire technique. The hookwire technique was significantly associated with 5 times the risk of developing a post-localization complication (Adjusted Odds Ratio (Adj OR) = 4.52, 95% CI 1.53-13.33) and 3.6 times the risk of developing a pneumothorax (Adj OR = 3.57, 95% CI 1.1-11.62) as compared to adopting the methylene blue technique. CONCLUSIONS Compared to the hook wire technique, the methylene blue technique offers a shorter procedure and hospitalization stay, as well as a safer post-operative experience.
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Affiliation(s)
- Senlin Chu
- Department of Interventional Radiology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, 17 Lujiang Road, Hefei City, 230001, Anhui Province, China
| | - Ning Wei
- Department of Interventional Radiology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, 17 Lujiang Road, Hefei City, 230001, Anhui Province, China
| | - Dong Lu
- Department of Interventional Radiology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, 17 Lujiang Road, Hefei City, 230001, Anhui Province, China
| | - Jie Chai
- Department of Interventional Radiology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, 17 Lujiang Road, Hefei City, 230001, Anhui Province, China
| | - Shun Liu
- Department of Interventional Radiology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, 17 Lujiang Road, Hefei City, 230001, Anhui Province, China
| | - Weifu Lv
- Department of Interventional Radiology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, 17 Lujiang Road, Hefei City, 230001, Anhui Province, China.
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Zhang H, Li Y, Chen X, He Z. Comparison of hook-wire and medical glue for CT-guided preoperative localization of pulmonary nodules. Front Oncol 2022; 12:922573. [PMID: 36003778 PMCID: PMC9393881 DOI: 10.3389/fonc.2022.922573] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/13/2022] [Indexed: 12/09/2022] Open
Abstract
BackgroundPreoperative localization is challenging due to the small diameter of pulmonary nodules or their deep location in the lung parenchyma during VATS surgery. The purpose of this study was to compare the efficacy and safety of both hook-wire and medical glue for pre-operative localization of pulmonary nodules.MethodsIn the current study, 158 patients were retrospectively analyzed (January 2019 and January 2020). The patients underwent hook-wire or medical glue for pre-operative localization of pulmonary nodules. Among them, 74 patients in the hook-wire group and 84 patients in the medical glue group underwent VATS anatomic segmentectomy or wedge resection after localization of pulmonary nodules. Pre-operative localization data from all patients were compiled. Moreover, the efficacy and safety of the two methods were evaluated according to localization success rates and localization-related complications.ResultsThe success rate of localization in the medical glue group was 100% while 97.3% in the hook-wire group. After localization of the pulmonary nodules, the incidence of minor pneumothorax in the medical glue group (11.9%) was lower than that in the hook-wire group (37.8%) (p=0.01). The incidence of mild pulmonary parenchymal hemorrhage in the medical glue group (13.1%) was also lower than that in the hook-wire group (24.3%) (p=0.000). The mean time from the completion of localization to the start of surgery was also longer in the medical glue group than in the hook-wire group (p=0.000). The mean visual analog scale (VAS) scores after localization were higher in the hook-wire group than in the medical glue group (p=0.02). In both groups, parenchymal hemorrhage was significantly associated with the needle length in hook-wire localization and the depth of the medical glue in the lung parenchyma (p = 0.009 and 0.001, respectively).ConclusionThese two localization methods are safe and effective in pre-operative pulmonary nodule localization. The medical glue localization method had a lower risk of complications, a higher localization success rate, less pain after localization and more flexibility in the arrangement of operation time.
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Affiliation(s)
- Huijun Zhang
- Department of Cardiothoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Huijun Zhang, ; Xiaofeng Chen, ; Zelai He,
| | - Ying Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Yangpu, Shanghai, China
| | - Xiaofeng Chen
- Department of Cardiothoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Huijun Zhang, ; Xiaofeng Chen, ; Zelai He,
| | - Zelai He
- Department of Radiation Oncology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, China
- *Correspondence: Huijun Zhang, ; Xiaofeng Chen, ; Zelai He,
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