Preoperative computed tomography–guided localization of pulmonary ground‑glass nodules: a comparison of conventional and soft hook‑wires

TL;DR

This study compares two methods for localizing lung nodules before surgery, finding that the soft hook-wire method is safer but equally effective.

Contribution

The study provides a direct comparison of safety and efficacy between conventional and soft hook-wire localization for pulmonary ground-glass nodules.

Findings

Soft hook-wire localization had a higher technical success rate (100%) compared to conventional (96.8%), though not statistically significant.

Soft hook-wire localization resulted in fewer complications (32.9%) compared to conventional (48.9%).

Both methods had similar durations and success rates for limited resection procedures.

Abstract

Hook-wire (HW) localization is the most frequently employed approach for preoperative localization of pulmonary ground-glass nodules (GGNs); however, the relative outcomes of conventional and soft HW localization of GGNs remain poorly understood.

This study sought to compare the safety and efficacy of preoperative computed tomography–guided conventional and soft HW localization of pulmonary GGNs.

Between January 2023 and June 2024, consecutive patients with pulmonary GGNs underwent conventional or soft HW localization prior to video-assisted thoracoscopic surgery. Safety and clinical efficacy of these 2 localization strategies were compared.

In total, 88 patients underwent conventional HW localization of 95 GGNs, and 82 patients underwent soft HW localization of 88 GGNs. Technical success rates for the conventional and soft HW groups were 96.8% and 100%, respectively (P = 0.25), and the duration of localization was similar in both groups (mean [SD], 10.1 [4.5] vs 10 [5.9] min; P = 0.97). Complications were significantly more common in the conventional HW group than in the soft HW group (48.9% vs 32.9%, respectively; P = 0.04). Visual analog scale scores in the conventional HW group were significantly higher than those observed in the soft HW group (mean [SD], 4.6 [0.6] vs 3.4 [0.6]; P = 0.001). The rates of technical success for limited resection procedures were similar in both groups (96.8% vs 100% in the conventional and soft HW groups, respectively; P >0.99).

Conventional and soft HW strategies can both effectively facilitate preoperative pulmonary GGN localization, but the soft HW approach has a more favorable safety profile.

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