Clinical analysis of CT-guided preoperative Hookwire localization of pulmonary nodules in 102 patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHEN Xueyu ¹ , ZHAO Guangyin ¹ , XU Jingci ² , CHEN Xiaoyong ² , ZHU Lianggang ¹ ,  LI Hecheng ¹

1. Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201801, P.R.China;
2. Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201801, P.R.China;

Corresponding author：

LI Hecheng, Email: lihecheng2000@hotmail.com

Keywords：

Hookwire; pulmonary nodules; preoperative localization; computed tomography

DOI：

10.7507/1007-4848.202010003

Video：

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Objective To study the feasibility and safety of CT-guided preoperative Hookwire localization of pulmonary nodules in clinical application.Methods Clinical data of 102 patients who were scheduled to undergo surgical treatment for pulmonary nodules from June 2015 to April 2020 in the North Ward of Thoracic Surgery Department of Ruijin Hospital were retrospectively analyzed. There were 38 males and 64 females, aged 23-82 (53.2±12.8) years.Results All 102 patients with pulmonary nodules underwent CT-guided preoperative Hookwire localization successfully, with a localization success rate of 100.0%. The localization time was 27.0 (11-67) min; the number of times to adjust the angle during the positioning process was 6.9 (3-14); the needle depth of the positioning needle was 41.5 (16.3-69.1) mm. A total of 48 (47.1%) patients had a small amount of bleeding in the lung tissue in the positioning area after positioning; 53 (51.9%) patients had a small amount of pneumothorax after positioning; 16 (15.7%) patients were found that the positioning needle completely shedded from the lung tissue in the subsequent surgery. One patient was transferred to open thoracotomy because of extensive dense adhesion in the thorax, and the remaining 101 patients were operated on under thoracoscopy. Postoperative pathology showed that 5 (4.9%) patients were adenocarcinoma in situ, 28 (27.5%) were microinvasive adenocarcinoma, 36 (35.3%) patients were invasive carcinoma and 32 (31.3%) patients were benign lesions. No patients had complications or adverse events related to preoperative positioning.Conclusion Preoperative CT-guided localization of Hookwire intrapulmonary nodules is safe and effective, and can meet the intraoperative localization needs of thoracic surgeons in most clinical situations, and is not inferior to other preoperative localization methods currently used in clinics.

Citation： CHEN Xueyu, ZHAO Guangyin, XU Jingci, CHEN Xiaoyong, ZHU Lianggang, LI Hecheng. Clinical analysis of CT-guided preoperative Hookwire localization of pulmonary nodules in 102 patients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(1): 56-61. doi: 10.7507/1007-4848.202010003 Copy

1.	Kaneko M, Eguchi K, Ohmatsu H, et al. Peripheral lung cancer: Screening and detection with low-dose spiral CT versus radiography. Radiology, 1996, 201(3): 798-802.
2.	Swensen SJ, Jett JR, Hartman TE, et al. CT screening for lung cancer: Five-year prospective experience. Radiology, 2005, 235(1): 259-265.
3.	胡骏, 冯继宁. 健康体检人群中18106例肺部CT检查结果分析. 中国实用医药, 2014, 9(28): 33-35.
4.	赵江, 唐栋. 低剂量螺旋CT在肺部结节筛查中的应用价值. 中华肿瘤防治杂志, 2016, 23(S1): 98-99.
5.	Wahidi MM, Govert JA, Goudar RK, et al. Evidence for the treatment of patients with pulmonary nodules: When is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition). Chest, 2007, 132(3 Suppl): 94S-107S.
6.	Goo JM, Park CM, Lee HJ. Ground-glass nodules on chest CT as imaging biomarkers in the management of lung adenocarcinoma. AJR Am J Roentgenol, 2011, 196(3): 533-543.
7.	Gould MK, Donington J, Lynch WR, et al. Evaluation of individuals with pulmonary nodules: When is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2013, 143(5 Suppl): e93S-e120S.
8.	Lee SM, Park CM, Goo JM, et al. Transient part-solid nodules detected at screening thin-section CT for lung cancer: Comparison with persistent part-solid nodules. Radiology, 2010, 255(1): 242-251.
9.	Felix L, Serra-Tosio G, Lantuejoul S, et al. CT characteristics of resolving ground-glass opacities in a lung cancer screening programme. Eur J Radiol, 2011, 77(3): 410-416.
10.	Oh JY, Kwon SY, Yoon HI, et al. Clinical significance of a solitary ground-glass opacity (GGO) lesion of the lung detected by chest CT. Lung Cancer, 2007, 55(1): 67-73.
11.	Yap CS, Schiepers C, Fishbein MC, et al. FDG-PET imaging in lung cancer: How sensitive is it for bronchioloalveolar carcinoma? Eur J Nucl Med Mol Imaging, 2002, 29(9): 1166-1173.
12.	Shimizu K, Ikeda N, Tsuboi M, et al. Percutaneous CT-guided fine needle aspiration for lung cancer smaller than 2 cm and revealed by ground-glass opacity at CT. Lung Cancer, 2006, 51(2): 173-179.
13.	Suzuki K, Nagai K, Yoshida J, et al. Video-assisted thoracoscopic surgery for small indeterminate pulmonary nodules: Indications for preoperative marking. Chest, 1999, 115(2): 563-568.
14.	Schwarz CD, Lenglinger F, Eckmayr J, et al. VATS (video-assisted thoracic surgery) of undefined pulmonary nodules. Preoperative evaluation of videoendoscopic resectability. Chest, 1994, 106(5): 1570-1574.
15.	Matsutani N, Sawabata N, Yamaguchi M, et al. Does lung cancer surgery cause circulating tumor cells?—A multicenter, prospective study. J Thorac Dis, 2017, 9(8): 2419-2426.
16.	Hashimoto M, Tanaka F, Yoneda K, et al. Significant increase in circulating tumour cells in pulmonary venous blood during surgical manipulation in patients with primary lung cancer. Interact Cardiovasc Thorac Surg, 2014, 18(6): 775-783.
17.	Hanauer M, Perentes JY, Krueger T, et al. Pre-operative localization of solitary pulmonary nodules with computed tomography-guided hook wire: Report of 181 patients. J Cardiothoracic Surgery, 2016, 11: 5.
18.	Abbas A, Kadakia S, Ambur V, et al. Intraoperative electromagnetic navigational bronchoscopic localization of small, deep, or subsolid pulmonary nodules. J Thorac Cardiovasc Surg, 2017, 153(6): 1581-1590.
19.	Piolanti M, Coppola F, Papa S, et al. Ultrasonographic localization of occult pulmonary nodules during video-assisted thoracic surgery. Eur Radiol, 2003, 13(10): 2358-2364.
20.	Hou YL, Wang YD, Guo HQ, et al. Ultrasound location of pulmonary nodules in video-assisted thoracoscopic surgery for precise sublobectomy. Thorac Cancer, 2020, 11(5): 1354-1360.
21.	Bellomi M, Veronesi G, Trifirò G, et al. Computed tomography-guided preoperative radiotracer localization of nonpalpable lung nodules. Ann Thorac Surg, 2010, 90(6): 1759-1764.
22.	Magistrelli P, D'Ambra L, Berti S, et al. Use of India ink during preoperative computed tomography localization of small peripheral undiagnosed pulmonary nodules for thoracoscopic resection. World J Surg, 2009, 33(7): 1421-1424.
23.	Li C, Liu B, Jia H, et al. Computed tomography-guided hook wire localization facilitates video-assisted thoracoscopic surgery of pulmonary ground-glass nodules. Thorac Cancer, 2018, 9(9): 1145-1150.
24.	Wada H, Anayama T, Hirohashi K, et al. Thoracoscopic ultrasonography for localization of subcentimetre lung nodules. Eur J Cardiothorac Surg, 2016, 49(2): 690-697.
25.	肺小结节术前辅助定位技术专家共识(2019版)专家组. 肺小结节术前辅助定位技术专家共识(2019版). 中国胸心血管外科临床杂志, 2019, 26(2): 109-113.
26.	Thaete FL, Peterson MS, Plunkett MB, et al. Computed tomography-guided wire localization of pulmonary lesions before thoracoscopic resection: Results in 101 cases. J Thorac Imaging, 1999, 14(2): 90-98.

1. Kaneko M, Eguchi K, Ohmatsu H, et al. Peripheral lung cancer: Screening and detection with low-dose spiral CT versus radiography. Radiology, 1996, 201(3): 798-802.
2. Swensen SJ, Jett JR, Hartman TE, et al. CT screening for lung cancer: Five-year prospective experience. Radiology, 2005, 235(1): 259-265.
3. 胡骏, 冯继宁. 健康体检人群中18106例肺部CT检查结果分析. 中国实用医药, 2014, 9(28): 33-35.
4. 赵江, 唐栋. 低剂量螺旋CT在肺部结节筛查中的应用价值. 中华肿瘤防治杂志, 2016, 23(S1): 98-99.
5. Wahidi MM, Govert JA, Goudar RK, et al. Evidence for the treatment of patients with pulmonary nodules: When is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition). Chest, 2007, 132(3 Suppl): 94S-107S.
6. Goo JM, Park CM, Lee HJ. Ground-glass nodules on chest CT as imaging biomarkers in the management of lung adenocarcinoma. AJR Am J Roentgenol, 2011, 196(3): 533-543.
7. Gould MK, Donington J, Lynch WR, et al. Evaluation of individuals with pulmonary nodules: When is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2013, 143(5 Suppl): e93S-e120S.
8. Lee SM, Park CM, Goo JM, et al. Transient part-solid nodules detected at screening thin-section CT for lung cancer: Comparison with persistent part-solid nodules. Radiology, 2010, 255(1): 242-251.
9. Felix L, Serra-Tosio G, Lantuejoul S, et al. CT characteristics of resolving ground-glass opacities in a lung cancer screening programme. Eur J Radiol, 2011, 77(3): 410-416.
10. Oh JY, Kwon SY, Yoon HI, et al. Clinical significance of a solitary ground-glass opacity (GGO) lesion of the lung detected by chest CT. Lung Cancer, 2007, 55(1): 67-73.
11. Yap CS, Schiepers C, Fishbein MC, et al. FDG-PET imaging in lung cancer: How sensitive is it for bronchioloalveolar carcinoma? Eur J Nucl Med Mol Imaging, 2002, 29(9): 1166-1173.
12. Shimizu K, Ikeda N, Tsuboi M, et al. Percutaneous CT-guided fine needle aspiration for lung cancer smaller than 2 cm and revealed by ground-glass opacity at CT. Lung Cancer, 2006, 51(2): 173-179.
13. Suzuki K, Nagai K, Yoshida J, et al. Video-assisted thoracoscopic surgery for small indeterminate pulmonary nodules: Indications for preoperative marking. Chest, 1999, 115(2): 563-568.
14. Schwarz CD, Lenglinger F, Eckmayr J, et al. VATS (video-assisted thoracic surgery) of undefined pulmonary nodules. Preoperative evaluation of videoendoscopic resectability. Chest, 1994, 106(5): 1570-1574.
15. Matsutani N, Sawabata N, Yamaguchi M, et al. Does lung cancer surgery cause circulating tumor cells?—A multicenter, prospective study. J Thorac Dis, 2017, 9(8): 2419-2426.
16. Hashimoto M, Tanaka F, Yoneda K, et al. Significant increase in circulating tumour cells in pulmonary venous blood during surgical manipulation in patients with primary lung cancer. Interact Cardiovasc Thorac Surg, 2014, 18(6): 775-783.
17. Hanauer M, Perentes JY, Krueger T, et al. Pre-operative localization of solitary pulmonary nodules with computed tomography-guided hook wire: Report of 181 patients. J Cardiothoracic Surgery, 2016, 11: 5.
18. Abbas A, Kadakia S, Ambur V, et al. Intraoperative electromagnetic navigational bronchoscopic localization of small, deep, or subsolid pulmonary nodules. J Thorac Cardiovasc Surg, 2017, 153(6): 1581-1590.
19. Piolanti M, Coppola F, Papa S, et al. Ultrasonographic localization of occult pulmonary nodules during video-assisted thoracic surgery. Eur Radiol, 2003, 13(10): 2358-2364.
20. Hou YL, Wang YD, Guo HQ, et al. Ultrasound location of pulmonary nodules in video-assisted thoracoscopic surgery for precise sublobectomy. Thorac Cancer, 2020, 11(5): 1354-1360.
21. Bellomi M, Veronesi G, Trifirò G, et al. Computed tomography-guided preoperative radiotracer localization of nonpalpable lung nodules. Ann Thorac Surg, 2010, 90(6): 1759-1764.
22. Magistrelli P, D'Ambra L, Berti S, et al. Use of India ink during preoperative computed tomography localization of small peripheral undiagnosed pulmonary nodules for thoracoscopic resection. World J Surg, 2009, 33(7): 1421-1424.
23. Li C, Liu B, Jia H, et al. Computed tomography-guided hook wire localization facilitates video-assisted thoracoscopic surgery of pulmonary ground-glass nodules. Thorac Cancer, 2018, 9(9): 1145-1150.
24. Wada H, Anayama T, Hirohashi K, et al. Thoracoscopic ultrasonography for localization of subcentimetre lung nodules. Eur J Cardiothorac Surg, 2016, 49(2): 690-697.
25. 肺小结节术前辅助定位技术专家共识(2019版)专家组. 肺小结节术前辅助定位技术专家共识(2019版). 中国胸心血管外科临床杂志, 2019, 26(2): 109-113.
26. Thaete FL, Peterson MS, Plunkett MB, et al. Computed tomography-guided wire localization of pulmonary lesions before thoracoscopic resection: Results in 101 cases. J Thorac Imaging, 1999, 14(2): 90-98.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical analysis of CT-guided preoperative Hookwire localization of pulmonary nodules in 102 patients

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