Non-inferiority comparison of medical glue and hook-wire for preoperative localization of multiple pulmonary nodules

TL;DR

This study compares medical glue and hook-wire for locating lung nodules before surgery, finding glue to be just as effective with fewer complications and less pain.

Contribution

Demonstrates medical glue is non-inferior to hook-wire for preoperative localization of multiple pulmonary nodules with better safety outcomes.

Findings

Medical glue had a non-inferior success rate compared to hook-wire (97.5% vs. 95%).

Medical glue significantly reduced pneumothorax and pulmonary hemorrhage compared to hook-wire.

Patients using medical glue reported lower pain scores 2 hours post-localization.

Abstract

Video-assisted thoracoscopic surgery is a widely employed minimally invasive approach for resecting pulmonary nodules. However, precisely localizing deep-seated or poorly visualized nodules remains a prominent challenge. This study aims to compare the effectiveness and safety of medical glue vs. hook-wire in the CT-guided localization of multiple pulmonary nodules.

A prospective cohort of patients scheduled for CT-guided localization of multiple pulmonary nodules between February 2024 and August 2024 was enrolled. Patients were randomized into a medical glue group and a hook-wire group in a 1:1 ratio. The primary endpoint was the localization success rate, with the objective of conducting a non-inferiority comparison of medical glue and hook-wire for the preoperative localization of multiple pulmonary nodules at a non-inferiority margin of 10%. Secondary endpoints consisted of complication incidence following localization and pain scores assessed via the Numerical Rating Scale.

Medical glue demonstrated non-inferior success rates vs. hook-wire [97.5% vs. 95%, absolute difference = 2.5%, 95% CI (−5.82%, 10.82%); P = 1.00]. Although overall complications were comparable (42.5% vs. 55.0%, P = 0.263), medical glue significantly reduced pneumothorax (22.5% vs. 47.5%, P = 0.019) and pulmonary hemorrhage (7.5% vs. 27.5%, P = 0.019). Patients receiving medical glue reported lower 2 h pain scores (2.70 ± 0.76 vs. 3.71 ± 1.42, P = 0.007).

The application of medical glue for the CT-guided localization of multiple pulmonary nodules demonstrated a non-inferior success rate comparable to that of hook-wire. Furthermore, compared to hook-wire, medical glue was associated with a lower incidence of pneumothorax and pulmonary hemorrhage, as well as reduced pain scores at 2 h post-localization.

https://www.chictr.org.cn, identifier (ChiCTR2400080040).

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