CT-guided localization techniques of small pulmonary nodules: a prospective non-randomized controlled study on pulmonary nodule localization needle and methylene blue staining with surgical glue

Abstract

Background: Thoracoscopic resection of small pulmonary nodules (SPNs) is challenging. Accurate preoperative computed tomography-guided localization of SPNs is key to successful rection. The aim of the present study was to evaluate the clinical value of a novel localization needle and methylene blue staining combined with surgical glue (MBSG) and to explore the risk factors for post-localization complications. Methods: This prospective, non-randomized controlled study was conducted on 110 patients who received either MBSG or novel needle localization prior to video-assisted thoracoscopic surgery (VATS) from January 2019 to December 2019 at Shenzhen People's Hospital. The primary endpoints were the safety and the success rates of the 2 localization techniques. The secondary endpoints were operative time and feasibility. Results: The 110 patients were categorized into 2 groups: the MBSG group (n=84) and the pulmonary nodule localization needle group (n=26). The success rate of pre-VATS localization was 100% in both groups. No deaths or serious complications occurred during localization. The rates of pneumothorax, pulmonary hemorrhage, and localization-induced cough were 38.1%, 25%, and 7.14%, respectively, in the MBSG group, and 26.92%, 19.23%, and 0%, respectively, in the pulmonary nodule localization needle group. Differences between the 2 groups were not statistically significant (P>0.05). Total complication rate and the incidence of pain were significantly lower in the pulmonary nodule localization needle group (χ 2 =4.441 and 4.295, respectively; P<0.05). The difference in operative time between the 2 groups was not statistically significant (P>0.05). Dye diffusion occurred in 2 patients in the MBSG group; however, it had no impact on VATS or on the pathological analysis. Neither displacement nor dislocation was observed in the pulmonary nodule localization needle group. Logistic regression analysis showed that the localization technique was an independent risk factor for total complications (odds ratio: 2.634, 95% confidence interval: 1.022-6.789, P<0.05).Conclusions: Both techniques can localize SPNs effectively prior to VATS. The pulmonary nodule localization needle technique has a lower incidence of complications.

The 4-hook anchor coaxial needle with scaled suture is superior to the double spring coil for preoperative localization

“…In cases where mild pneumothorax and pneumorrhagia appeared along the path of puncture needle, the second marked spring coil would immediately block the puncture passage. Relevant studies have shown that positioning-related complications may be a consequence of unskilled operation, excessively superficial lesions, exceedingly shallow depth of the spring coil release, and nodules that are hidden in the interlobar fissure (7,11). Experienced and proficient operators have a better potential to complete the operation (9,12).…”

“…(6). However, various problems have arisen in the application of the above technologies (7). In this study, our team aimed to preoperatively position small-sized nodules with a new device, the 4-hook anchor coaxial needle with scaled suture, and compared its effectiveness and complications with the double spring coil.…”

Cyanoacrylate glue foreign body after CT-guided localization of a pulmonary nodule during video-assisted thoracoscopic surgery: a case report

“…Coughing is a common adverse reaction of preoperative localization using medical glue. It has been reported that the incidence of cough after medical glue localization was 5–7.14% [ 9 , 10 ]. It is often thought to be an airway reaction to the pungent smell of the cyanoacrylate glue, which is a type of medical sclerosing agent.…”

Virtual navigation bronchoscopy‐guided intraoperative indocyanine green localization in simultaneous surgery for multiple pulmonary nodules

“…However, the accurate localization of pulmonary nodules is the main difficulty experienced in wedge resection. At present, the commonly used pulmonary nodule localization methods include preoperative CT‐guided percutaneous lung puncture, 1 , 2 spring coil localization, 3 methylene blue localization, 4 X‐ray localization under thoracoscopy, 5 , 6 intraoperative ultrasonic localization, 7 , 8 intraoperative localization using infrared imaging, 9 , 10 biological glue injection, 11 , 12 , 13 , 14 , 15 and intraoperative fluorescence localization under electromagnetic navigation bronchoscopy electromagnetic navigational bronchoscopy (ENB)/virtual navigation bronchoscope (VNB), 16 , 17 , 18 , 19 and others. 20 Each localization method has its own advantages and disadvantages, but clinical work has demonstrated that intraoperative indocyanine green localization under ENB/VNB has more advantages for patients with multiple pulmonary nodules undergoing simultaneous surgery, especially for those undergoing bilateral lung surgery.…”