Abstract
ObjectivesThe study aimed to retrospectively evaluate the success rate, utility, practicality and results of pre-operative CT (computed tomography)–guided semi-rigid single hook-wire placement and the pathology results of small pulmonary nodules (SPN).Materials and methodsSeventy-four patients with 81 small pulmonary nodules underwent CT-guided semi-rigid single hook wire localization consecutively between 2016 and 2017 were reviewed. VATS (video-assisted thoracoscopic surgery) resection of lung tissue containing each pulmonary nodule and were performed in the direction of hook wire. The success rate and utility of the localization, hook wire related complications, the histopathology of SPN are analyzed.ResultsThe semi-rigid hook wire was performed successfully in all 81 small pulmonary nodules within mean time of 10 min (8–13 min, SD: 1.58 min). Compared with solid nodules, GGOs (ground-glass opacity) were more frequently malignant (p < 0.05), with an OR (odds ratio) 8.59 (95%CI, 0.967, 412.845). Of the pure GGOs, 9 (25%) nodules were classified as AIS, 10 (27.8%) nodules were classified as MIA and 22 (57.9%) of the mGGOs were lung cancer. According to multivariate analysis, the malignant hazard was as high as 6.533-fold higher in nodules with a size larger than 10 mm compared with those smaller than 10 mm. GGOs with tiny blood vessels showed a statistically significant correlation with malignancy. Surprisingly, no statistically significant difference in the incidence of lung cancer in age. No major complication occurred.ConclusionsPreoperative localization of small pulmonary nodules using semi-rigid single hook wire was found to be practical and safe, which allows for proper diagnosis. Incidental small pulmonary nodule, especially GGO larger than 10 mm needs to be taken seriously.
Highlights
Despite the fact that the death rate of lung cancer declined 38% between 1990 and 2012 among males and 13% between 2002 and 2012 among females [1], lung cancer remains as the most common incident cancer and is the leading cause of deaths among cancer patients around the world, including China [2, 3]
Of the pure ground glass opacities (GGO), 9 (25%) nodules were classified as AIS, 10 (27.8%) nodules were classified as MIA and 22 (57.9%) of the mGGOs were lung cancer
Preoperative localization of small pulmonary nodules using semi-rigid single hook wire was found to be practical and safe, which allows for proper diagnosis
Summary
Despite the fact that the death rate of lung cancer declined 38% between 1990 and 2012 among males and 13% between 2002 and 2012 among females [1], lung cancer remains as the most common incident cancer and is the leading cause of deaths among cancer patients around the world, including China [2, 3]. Due to the lack of clinical symptoms in early stage, most lung cancer has been. Low dose spiral CT (computed tomography) screening is emerging as a promising strategy in improving lung cancer survival rates due to its advantage in earlier detection. Nonsolid nodules may develop into an internal solid component and may change from being nonsolid to becoming part-solid, which refers to mixed GGO [6]. It can be a manifestation of inflammation, infection, fibrosis or other benign lesions, but it can be adenocarcinoma in situ, adenocarcinoma or a precursor of adenocarcinoma (atypical adenomatous hyperplasia). A more reliable diagnosis and treatment of uncertain pulmonary nodules is still needed
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