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.

Keywords

Multiple lung nodules simultaneous positioning pneumothorax coil

Get full access to this article

View all access options for this article.

References

Larscheid

Thorpe

Scott

. Percutaneous transthoracic needle aspiration biopsy: a comprehensive review of its current role in the diagnosis and treatment of lung tumors. Chest 1998;114:704–709.

Naidich

Bankier

MacMahon

, et al. Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society. Radiology 2013;266:304–317.

Congregado

Merchan

Gallardo

, et al. Video-assisted thoracic surgery (VATS) lobectomy: 13 years’ experience. Surg Endosc 2008;22:1852–1857.

Hsu

Chuang

. Electromagnetic navigation-guided preoperative localization of small malignant pulmonary tumors. Ann Thorac Surg 2020;109:1566–1573.

Zhong

, et al. Clinical study of video-assisted thoracoscopic surgery wedge resection in early-stage lung cancer by tumor mapping with indocyanine green. Videosurgery Miniinv 2019;14:545–550.

Tao

Jingying

Tan

, et al. A novel CT-guided technique using medical adhesive for localization of small pulmonary ground-glass nodules and mixed ground-glass nodules (≤20 mm) before video-assisted thoracoscopic surgery. Diagn Interv Radiol 2018;24:209–212.

Liu

Wang

, et al. Comparison of CT-guided localization using hook wire or coil before thoracoscopic surgery for ground glass nodules. Br J Radiol 2020;93:20190956.

Aoun

Littrup

Heath

, et al. Methylene blue/collagen mixture for CT-guided presurgical lung nodule marking: high efficacy and safety. J Vasc Interv Radiol 2020;31:1682.e1–1682.e7.

Yao

Yang

Zhao

. Single-stage bilateral pulmonary resections by video-assisted thoracic surgery for multiple small nodules. J Thorac Dis 2016;8:469–475.

10.

Mun

Kohno

. Single-stage surgical treatment of synchronous bilateral multiple lung cancers. Ann Thorac Surg 2007;83:1146–1151.

11.

Hansell

Bankier

MacMahon

, et al. Fleischner Society: glossary of terms for thoracic imaging. Radiology 2008;246:697–722.

12.

Zhong

Pan

, et al. Retrospective evaluation of safety, efficacy and risk factors for pneumothorax in simultaneous localizations of multiple pulmonary nodules using hook wire system. Cardiovasc Intervent Radiol 2017;40:1408–1414.

13.

Iguchi

Hiraki

Gobara

, et al. CT fluoroscopy-guided preoperative short hook wire placement for small pulmonary lesions: evaluation of safety and identification of risk factors for pneumothorax. Eur Radiol 2016;26:114–121.

14.

Turgut

Duran

Bakdık

, et al. Effectiveness of autologous blood injection in reducing the rate of pneumothorax after percutaneous lung core needle biopsy. Diagn Interv Radiol 2020;26:470–475.

15.

Filippo

Saba

Silva

, et al. CT-guided biopsy of pulmonary nodules: is pulmonary hemorrhage a complication or an advantage? Diagn Interv Radiol 2014;20:421–425.

16.

Kadeer

Wang

Zhang

, et al. Modified hook-wire placement technique for localizing multiple pulmonary nodules. J Surg Oncol 2018;118:1188–1193.

17.

Teng

Yang

, et al. Preoperative computed tomography-guided coil localization for multiple lung nodules. Ther Adv Respir Dis 2020;14:1–7.

18.

Tseng

Lee

Hsieh

, et al. Preoperative computed tomography-guided dye injection to localize multiple lung nodules for video-assisted thoracoscopic surgery. J Thorac Dis 2016;8:S666–S671.

19.

Iguchi

Hiraki

Gobara

, et al. Simultaneous multiple preoperative localizations of small pulmonary lesions using a short hook wire and suture system. Cardiovascular & Interventional Radiology 2015;38:971–976.

20.

Gao

Zhang

, et al. Computed tomography-guided simultaneous coil localization as a bridge to one-stage surgery for multiple lung nodules: a retrospective study. J Cardiothorac Surg 2019;14:43.