Abstract
The optimal screening or treatment strategies of solitary pulmonary nodules especially ground-glass opacities (GGOs) remain controversial. With CT-guided Hookwire localization, it is accurate to find the small lesions during video-assisted thoracoscopic surgery (VATS). In this study, we evaluate the efficiency and safety of CT-guided Hookwire localization of GGO-dominant (GGO component > 50%) pulmonary nodules before VATS and investigate the correlation between the radiologic features and pathology. From April 2008 to April 2014, a total of 273 patients with solitary GGO-dominant pulmonary nodules were included. Tumor size was 12.4 ± 5.7 mm in diameter, including 208 pulmonary adenocarcinomas and 65 benign nodules. Dislodgement occurred in six patients (2.20%) during surgery. Postoperative complications included asymptomatic needle track hemorrhage (27.1%), minimal pneumothorax (5.9%) and hemoptysis (0.4%). In 208 (76.2%) pulmonary adenocarcinomas, 82 nodules showed ≥90% GGO and 126 showed 50%≤GGO<90%, while 84 nodules staged as T1aN0M0, 96 staged as T1bN0M0, and 28 staged as T1cN0M0. The multivariable analysis demonstrated that 50%≤GGO<90% (HR=2.459, 95% CI: 1.246-4.853, P=0.010), speculation (HR=3.911, 95% CI: 1.966-7.663, P<0.001), lobulation (HR=4.582, 95% CI: 2.149-9.767, P<0.001) and vascular convergence (HR=4.096, 95% CI: 1.132-14.824, P=0.032) were the independent risk factors to identification of the malignant GGO-dominant pulmonary nodules. In conclusions,CT-guided Hookwire localizati for GGO-dominant pulmonary nodules before VATS is a safe and effective procedure for accurate diagnosis and resection of indeterminate solitary pulmonary nodules.
Highlights
With the development and popularization of lowdose spiral computer tomography (CT), more and more solitary pulmonary nodules (SPNs) especially ground-glass opacities (GGOs) are becoming a much more frequent finding on thin-section CT
We evaluate the efficiency and safety of CT-guided Hookwire localization of GGO-dominant (GGO component > 50%) pulmonary nodules before video-assisted thoracoscopic surgery (VATS) and investigate the correlation between the radiologic features and pathology
The multivariable analysis demonstrated that 50%≤GGO
Summary
With the development and popularization of lowdose spiral computer tomography (CT), more and more solitary pulmonary nodules (SPNs) especially ground-glass opacities (GGOs) are becoming a much more frequent finding on thin-section CT. A SPN which can be either solid or subsolid in attenuation at thin-section CT is defined as a round opacity of up to 3 cm diameter surrounded by lung parenchyma [1]. Recent studies have reported that the GGO components of part-solid nodules on CT usually correspond to pre-invasive components of pulmonary adenocarcinomas www.impactjournals.com/oncotarget on pathology, while solid components frequently indicate invasive components, the ratio of GGO component was important for predicting the prognosis [3,4,5,6]. There is no consensus regarding the division of part-solid GGO into two categories associated with prognosis, the GGO-dominant lesion was always defined as a tumor with GGO component ≥ 50% in most studies [7,8,9]. The optimal screening or treatment strategies of GGO-dominant lung nodules remain controversial in different regions [13]
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