Medical adhesive vs hookwire for computed tomography-guided preoperative localization and risk factors of major complications

Abstract

Objective: To compare the efficacy of medical adhesive and hookwire as CT-guided non-palpable pulmonary nodule (NPN) localization methods before video-assisted thoracoscopic surgery (VATS) resection, and determine the risk factors for common complications during localization. Methods: This was a single-center non-randomized retrospective study. 102 consecutive patients with 109 NPNs were divided into Group A (medical adhesive, 66 patients, 72 nodules) and Group B (hookwire, 36 patients, 37 nodules) before VATS. Patient- and nodule-based characteristics were compared. Logistic regression was performed to identify the risk factors for complications. Results: Localization was successfully performed in all the NPNs. For Group A, the rate of pneumothorax immediately after localization was lower (p = 0.049) and the localization-to-surgery interval was longer (p = 0.011) than Group B. There was no significant difference in rates of hemorrhage after needle withdrawal between the two groups (p = 0.198). Hookwire ( vs medical adhesive) (β = 1.12, p = 0.018), total insertion depth (β = −0.41, p = 0.013), pleura-needle angle (β = −0.04, p = 0.025) and grade of hemorrhage after needle withdrawal (β = −0.96, p = 0.030) were independently associated with pneumothorax, while age (β = −0.94, p = 0.018), tumor size (β = 0.29, p = 0.007) and its distance from the pleural surface (β = 0.14, p = 0.004) were associated with higher grade hemorrhage after needle withdrawal. Conclusion: Compared with hookwire, localization with medical adhesive excelled in lower risk of pneumothorax, a more flexible localization-to-surgery interval, and had similar rates of hemorrhage after needle withdrawal. Hookwire is an independent risk factor of pneumothorax immediately after localization. Advances in knowledge: This study added new clinical evidence to the efficacy of medical adhesive in pre-operative CT-guided NPN localization.

Comparison of hook-wire and medical glue for CT-guided preoperative localization of pulmonary nodules

“…It has been reported in the literature that the incidence of pneumothorax during localization of pulmonary nodules using medical glue was 31.9% compared to 51.4% during hook-wire localization. In addition, pulmonary parenchymal hemorrhage occurred in 13.9% of lung nodules using medical glue, compared with 13.5% with hook-wire placement ( 32 ). It can be seen that medical glue has the advantage of reducing pneumothorax and pulmonary hemorrhage during the process of locating pulmonary nodules.…”

Risk factors of pneumothorax in computed tomography guided lung nodule marking using autologous blood: a retrospective study

“…2 Receiver operating characteristic curve analysis was performed using puncture needle penetration depth and nodule size as independent variables and pneumothorax as dependent variables. The area under the curve was 0.713 (95% confidence interval = 0.618-0.750) medical glue, compared with 13.5% of those treated with hook wire placement [28]. In this study, the incidence of pneumothorax was 17.3% and that of pulmonary hemorrhage was 2.2%.…”

The efficacy and safety of CT-guided localization of pulmonary nodules by medical adhesives containing methylene blue before surgery

“…Pulmonary hemorrhage is another common complication of localization, with the occurrence rate from 13.9 % to 36 % [ 28 ]. The incidences of parenchymal hemorrhage were 13.9 % and 13.5 % for medical adhesive and hook wire localization procedures, respectively [ 29 ]. In previous study, the occurrence rate of pulmonary hemorrhage in localization with hook wire was 22.5 % [ 30 ].…”