Safety and effectiveness of simultaneous localization of multiple lung nodules using coils and risk factors for pneumothorax: a retrospective study

Abstract

Background Localization of lung nodule before video-assisted thoracoscopic surgery (VATS) can help the surgeon to quickly and accurately find the lesion during surgery. Purpose To evaluate the safety and effectiveness of using coils to simultaneously locate multiple lung nodules under computed tomography guidance and to clarify the risk factors for pneumothorax. Material and Methods From January 2020 to December 2020, 61 patients underwent simultaneous localization of multiple lung nodules (Group A) and 120 patients underwent localization of a single lung nodule (Group B). The demographics, information related to localization procedure, and incidence of pulmonary hemorrhage and pneumothorax were compared between the patients in Groups A and B. Group A was further divided into a pneumothorax group and non-pneumothorax group. Univariate and multivariate regression analyses were used to determine the risk factors for pneumothorax in patients who underwent simultaneous localization of multiple lung nodules using coils. Results The success rates in Groups A and B were 96.9% and 96.7%, respectively (P = 1.000). The number of pleural punctures ( P<0.001), the positioning operation time ( P<0.001), the rates of pneumothorax ( P<0.001), and hemorrhage ( P = 0.034) were higher in Group A than in Group B. The pneumothorax and bleeding in Group A did not require special treatment. Transfissural puncture (odds ratio [OR]=16.798; P = 0.033) and the numbers of pleural punctures (OR=2.437; P = 0.013) were independent risk factors for pneumothorax caused by simultaneous localization of multiple lung nodules, and hemorrhage was a protective factor against pneumothorax (OR=0.069; P = 0.002). Conclusion Simultaneous localization of multiple lung nodules using coils under computed tomography guidance is safe and effective. Transfissural puncture and higher numbers of pleural punctures will increase the risk of pneumothorax, whereas hemorrhage will reduce the risk of pneumothorax.

Factors influencing the accuracy and safety of preoperative computed tomography (CT)-guided soft hook-wire localization for pulmonary nodules: a comprehensive analysis

“…In the present study, demographics, pulmonary nodules, and technical factors were found to have no significant impact on pneumothorax. In support of this, some studies have indicated that frequency is the only significant independent risk factor for pneumothorax ( 19 - 21 ). However, this study only considered patients with a single nodule, and excluded the possible impact of multiple injections.…”

Complications during CT-Guided Lung Nodule Localization: Impact of Needle Insertion Depth and Patient Characteristics

“…Our results are consistent with these previous findings; however, we excluded patients with multiple nodules to reduce the potential interference from the simultaneous analysis of single and multiple nodule cases. This approach might address the differing complication rates for single and multiple nodules in previous studies that may have influenced multivariate regression analysis outcomes [9,12]. Furthermore, our study consistently used PBV dye for localization, whereas a previous study used various methods, such as hook wires, for deeper nodules [18].…”

“…Because complication rates differ between multiple and single nodules and because most patients in our cohort had a single nodule, we used single nodules as the standard for analysis [9,12]. The inclusion criteria were based on those used in previous studies based on the research of Kong et al assessing individuals with a single lung nodule [11]: (a) being 18-80 years old; (b) having a single small lung nodule measuring 5-15 mm in diameter that was diagnosed by at least two radiologists as being potentially malignant; (c) having no imaging evidence of emphysema, pulmonary hypertension, or pulmonary fibrosis; (d) having intraoperative and postoperative pathological results; (e) having no obvious vasculitis, bullae, or other important tissues or structures in the needle puncture path; and (f) having normal coagulation function.…”

“…Although most cases of pneumothorax and pulmonary hemorrhage are asymptomatic and selfresolving, a small proportion of cases require chest tube drainage [3,4,7]. Many studies on CT-guided localization have demonstrated that a considerable proportion of patients develop iatrogenic pneumothorax and pulmonary hemorrhage [2,8,9]. For instance, Lin et al's research reported that iatrogenic pneumothorax occurred in 54.2% of cases, while pulmonary hemorrhage was observed in 29.4% of cases [2].…”

“…Most studies on CT-guided localization have primarily focused on the assessment of procedural safety and efficacy [2,[8][9][10][11][12][13][14][15][16][17]. By contrast, the discussion of the factors influencing complications resulting from CT-guided localization is frequently secondary [9,11,12,15]. Few studies have specifically examined the factors influencing the complications associated with CT-guided localization [18].…”