Computed tomography-guided localization for multiple pulmonary nodules: a meta-analysis.

Abstract

Introduction: Preoperative computed tomography (CT)-guided localization is commonly employed to facilitate video-assisted thoracoscopic surgery (VATS)-guided diagnostic wedge resection of pulmonary nodules (PNs). Aim: The present meta-analysis was conducted with the goal of better evaluating the feasibility, safety, and clinical efficacy of preoperative CT-guided localization for multiple PNs (MPNs). Material and methods: PubMed, Embase, and the Cochrane Library databases were reviewed in order to identify all relevant studies published as of June 2020. Random effects modeling was then used to evaluate the pooled data. The meta-analysis was conducted using Stata v12.0 software. Results: Eight relevant studies were identified for inclusion in the present meta-analysis. In total, 345 patients with 799 PNs were treated with preoperative CT-guided localization and subsequent wedge resection. The overall pooled technical success rate based on the nodules and patients was calculated to be 97% (95% confidence interval (CI): 0.94-0.99) and 92% (95% CI: 0.86-0.97), respectively. The overall pooled incidence rate of complications was calculated to be 40% (95% CI: 0.16-0.63). Significant heterogeneity was observed among the studies for all the parameters described above (I 2 = 74.5%, 77.7%, and 96.3%, respectively). No significant differences were detected in the technical success of localization and incidence of complications between coil and hook-wire groups. The risk of publication bias in the reporting of technical success rate of localization based on both nodules and patients was found to be high (p < 0.001 and < 0.001, respectively). Conclusions: Preoperative CT-guided localization may be effective in guiding VATS-guided wedge resection in patients with MPNs.

Preoperative computed tomography-guided localization for multiple pulmonary nodules: comparison of methylene blue and coil

“…While different needle sizes were used in the MBL and CL groups (22G vs. 18G), prior evidence suggests that pneumothorax rates do not rise signi cantly provided the size of the utilized needle remains under 16G [24]. Importantly, the pneumothorax rates in both the MBL and CL groups were relatively low (20.0% and 18.8%, respectively), with these rates being substantially lower than those reported for hook-wire localization (mean: 56%) [11].…”

“…An estimated 17.7-22.2% of patients with PNs harbor multiple PNs (MPNs) that warrant resection [9,10], and the simultaneous localization of these MPNs has been explained to be correlated with substantial VATS sublobar resection rates for all target nodules [9][10][11]. Approaches most frequently employed for localization include the use of coils, hook-wire, and methylene blue (MB) [11], with all three of these materials being associated with high (> 90%) and comparable rates of technical success when used for localization [11]. However, complication rates are generally higher for individuals undergoing hook-wire localization, with adverse events occurring in up to 90% of MPN patients undergoing hook-wire localization [12].…”

“…However, complication rates are generally higher for individuals undergoing hook-wire localization, with adverse events occurring in up to 90% of MPN patients undergoing hook-wire localization [12]. In contrast, MB localization (MBL) and coil localization (CL) are correlated with substantially lower rates of complication (13-55%) for patients with MPNs [11]. The relative clinical e cacy of MBL and CL techniques in patients with MPNs, however, has yet to be rigorously evaluated.…”

3D localization based on anatomical LANDmarks in the treatment of pulmonary nodules

“…Various positioning methods can be used, such as preoperative CT-guided hookwire positioning and coil positioning as well as lipiodol positioning, electromagnetic navigation bronchoscopeguided positioning, and intraoperative ultrasound-assisted positioning. The success rate of these positioning methods is 89.6% to 100% (21)(22)(23)(24)(25)(26). However, these methods have their own advantages and disadvantages.…”

Computed tomography-guided Sens-cure needle localization for scapular-blocked lung nodules.

“…The use of preoperative localization using computed tomography (CT) for guiding wedge resection (WR) of lung nodules (LNs) under video-assisted thoracoscopic surgery (VATS) has been described [1][2][3]. Other methods of localization include the use of coils, hookwire, radio-labeling, and a variety of liquid materials [4][5][6]. Each material has its specific benefits and disadvantages.…”