Hookwire Localization Research Articles

Clinical Usefulness of Preoperative Computed Tomography-Guided Needle Localization of Small Pulmonary Nodules for Video-Assisted Thoracic Surgery

Objective: To evaluate the clinical usefulness of preoperative computed tomography (CT)-guided needle localization of small pulmonary nodules for video-assisted thoracic surgery (VATS). Materials and Methods: Between October 2018 and June 2021, 32 consecutive small pulmonary nodules were treated with preoperative CTguided needle localization of less than 2 cm pulmonary nodules for VATS. All basic characteristic and Procedural success, technical success, and complication rates were evaluated from the medical record. Results: The procedures were blue-dye needle localization by isosulfan blue (94%), and hook-wire needle localization (6%). The median size of the tumor was 9 mm (range 2 to 17 mm). The initial procedural success rate of the CT-guided needle localization procedure was 100%. The technical success rate was 90.6%. Approximately 73% of the resected lung nodules were pathologically proven malignancies. Minor complications, such as minimal pneumothorax (34%) and minimal parenchymal hemorrhage (13%), occurred at the needle access site. Conclusion: Preoperative CT-guided needle localization in VATS for small pulmonary nodules was feasible and safe. Keywords: Thoracic surgery; Video-assisted; Multiple pulmonary nodules; Tomography; X-Ray computed

Application of computed tomography-guided hook-wire localization technique in thoracoscopic surgery for small pulmonary nodules (≤ 10 mm)

ObjectiveThis study aimed to investigate the safety and efficacy of the computed tomography (CT)-guided hook-wire localization technique in thoracoscopic surgery for small pulmonary nodules (≤ 10 mm) and to identify the risk factors for localization-related complications.MethodsThe medical records of 150 patients with small pulmonary nodules treated from January 2018 to June 2021 were retrospectively analyzed. According to preoperative hook-wire positioning status, they were divided into the localization group (50 cases) or the control group (100 cases). The operation time, intraoperative blood loss, hospital stay, and conversion rate to thoracotomy were recorded and compared between groups. Uni- and multivariate binary logistic regression analysis was used to identify the risk factors for localization-related complications.ResultsA total of 58 nodules were localized in 50 patients in the localization group, and the localization success rate was 98.3% (57/58). In one case, the positioning pin fell off before wedge resection was performed. The mean nodule diameter was 7.05 mm (range, 2.8–10.0 mm), while the mean depth from the pleura was 22.40 mm (range, 5.47–79.47 mm). There were 8 cases (16%) of asymptomatic pneumothorax, 2 (4%) of intrapulmonary hemorrhage, and 1 (2%) of pleural reaction.The mean operation time of the localization group (103.88 ± 41.74 min) was significantly shorter than that of the control group (133.30 ± 45.42 min) (P < 0.05). The mean intraoperative blood loss of the localization group (44.20 ± 34.17 mL) was significantly lower than that of the control group (112.30 ± 219.90 mL) (P < 0.05). The mean hospital stay of the localization group (7.96 ± 2.34 days) was significantly shorter than that of the control group (9.21 ± 3.25 days).Multivariate binary logistic analysis showed that localization times of small pulmonary nodules in the localization group was an independent risk factor for localization-related pneumothorax.ConclusionsOur results suggest that the CT-guided hook-wire localization technique is beneficial for localizing small pulmonary nodules. Specifically, it is helpful for the diagnosis and treatment of early lung cancer because it can accurately remove lesions, decrease intraoperative blood loss, shorten operation time and hospitalization stay, and reduce thoracotomy conversion rate. Simultaneous positioning of multiple nodules can easily lead to positioning-related pneumothorax.

Comparison between preoperative hook-wire and liquid material localization for pulmonary nodules: a meta-analysis.

Computed tomography (CT)-guided liquid material (LM) and hook-wire (HW) are usually localized for pulmonary nodules (PNs) before video-assisted thoracic surgery (VATS) resection, but the relative advantages of these 2 techniques remain uncertain. This meta-analysis was conceived to juxtapose the efficacy and safety of HW localization (HWL) and LM localization (LML), both guided by CT, for the preoperative localization of PNs. The PubMed, Web of Science, and Wanfang databases were searched to identify relevant studies published as of March 2023, after which pooled analyses of study outcomes were conducted. A total of 7 studies were included in this meta-analysis from 142 relevant studies. These 7 studies included 551 patients (583 PNs) with CT-guided HWL and 551 patients (612 PNs) with LML. The successful localization rate was significantly higher in the LM group (LMG) than in the HW group (HWG) (p = 0.002). The LMG also exhibited significantly lower pooled total complication and lung haemorrhage rates than the HWG (p = 0.007 and 0.00001, respectively). Pooled localization duration, pneumothorax rates, and VATS procedure duration were comparable in both groups (p = 0.45, 0.15, and 0.74, respectively). Furthermore, the pooled postoperative hospital stay was significantly shorter in the LMG than in the HWG (p = 0.009). Significant heterogeneity was detected in the endpoints of localization duration and pneumothorax rate (I2 = 93% and 66%, respectively). CT-guided LML is safer and more successful than HWL for patients with PNs before VATS resection.

Does Preoperative Hookwire Localization Influence Postoperative Acute and Chronic Pain After Video-Assisted Thoracoscopic Surgery: A Prospective Cohort Study

This study aimed to investigate whether preoperative computerized tomography-guided hookwire localization-associated pain could affect acute and chronic postsurgical pain (CPSP) in patients undergoing video-assisted thoracoscopic surgery (VATS). We enrolled 161 adult patients who underwent elective VATS; sixty-nine patients experienced hookwire localization (Group A) and 69 did not (Group B). Group A was further subdivided into the multiple localization group (n=35, Group Amultiple) and the single localization group (n=34, Group Asingle) according to the number of hookwires. The numerical rating scale (NRS) was used preoperatively, during recovery at the post-anesthesia care unit (PACU), and the first two days, 3 and 6 months postoperatively. Furthermore, multivariate regression analysis was used to identify the risk factors associated with CPSP. The postoperative adverse events, length of hospital stay, and satisfaction in pain management were also recorded. The incidence and severity of acute postoperative pain were similar between Group A and Group B (p > 0.05). The incidence (56.5% vs 30.4%, p = 0.002) and the NRS scores (2.0 [2.0-3.0] vs 1.0 [1.0-2.0], p = 0.011) for CPSP were significantly higher in Group A than in Group B at 3 months postoperatively. On subgroup analysis, compared with Group Asingle, the intensity of CPSP (2.0 [2.0-3.0] vs 2.0 [1.0-2.0], p = 0.005) in Group Amultiple was slightly higher at 3 months postoperatively. Conversely, the CPSP incidence (60.0% vs 29.4%, p = 0.011) was significantly higher at 6 months postoperatively in Group Amultiple. The multivariate regression analysis further validated hookwire localization as a risk factor for CPSP (odds ratio: 6.199, 95% confidence interval 2.049-18.749, p = 0.001). Patient satisfaction relating to pain management at 3 months postoperatively was lower in Group A (p = 0.034). The preoperative pain stress of hookwire localization increased the incidence and intensity of CPSP rather than acute pain at 3 months postoperatively, especially in patients with multiple hookwires.

Hook Wire Localization Failure of Peripheral Pulmonary Nodules during Perioperative Video-Assisted Thoracoscopic Surgery Period

Hook Wire Localization Failure of Peripheral Pulmonary Nodules during Perioperative Video-Assisted Thoracoscopic Surgery Period

Comparative study of the effect of preoperative hookwire and methylene blue localization techniques on post-operative hospital stay and complications in thoracoscopic pulmonary nodule surgery

BackgroundDirect localization of small and deep pulmonary nodules before thoracoscopic surgery using the hookwire or methylene blue techniques has been recently attempted for better surgical outcomes. In this study, we compare the outcomes of the above two techniques.MethodsTwo hundred and nineteen patients undergoing 135 hookwire and 151 methylene blue techniques in our University Hospital between July 2020 and January 2022 were compared for localization and hospitalization durations, and the complication risk. Other confounders included patients’ age, gender, localization position, nodules location, count, diameter, and depth.ResultsAfter adjustment of all predictors, the methylene blue technique was associated with a significant 0.6-min (parameter estimate (PE) = −0.568, p value = 0.0173) and an 0.7-day shorter localization and hospitalization time (PE = −0.713, p value = < 0.0001) as compared to using the hookwire technique. The hookwire technique was significantly associated with 5 times the risk of developing a post-localization complication (Adjusted Odds Ratio (Adj OR) = 4.52, 95% CI 1.53–13.33) and 3.6 times the risk of developing a pneumothorax (Adj OR = 3.57, 95% CI 1.1–11.62) as compared to adopting the methylene blue technique.ConclusionsCompared to the hook wire technique, the methylene blue technique offers a shorter procedure and hospitalization stay, as well as a safer post-operative experience.

The Effect of CT Imaging Technology in the Diagnosis of Thoracic and Cardiac Surgery Diseases.

In order to increase doctors' cognition of the three-dimensional anatomical structure of cardiothoracic and cardiothoracic surgery and increase the diagnosis rate and cure rate of cardiothoracic surgery diseases, the authors propose a method of CT imaging technology for diagnosing cardiothoracic surgery diseases. Through the joint Hookwire positioning of 3D-CTBA, application in thoracoscopic segmentectomy and CT energy spectrum curve, retrospective analysis of diagnosis of intrathoracic lymph node metastasis in non-small-cell lung cancer, 3D-CTBA and CT-guided Hookwire localization, and preoperative CT-enhanced scanning were performed using two methods. The experimental results showed that the chest tube placement time, postoperative thoracic drainage volume, and postoperative hospital stay after the first operation all showed a good trend. The diagnostic sensitivity was 87.1%. The specificity was 92.6%. The correct index was 79.7%. The accuracy was 91.3%. The positive predictive value was 79.4%. And the negative predictive value was 95.7%. These data prove that CT imaging technology has high diagnostic value for thoracic and cardiac surgery diseases and can effectively help the formulation and implementation of thoracic and cardiac surgery diseases.

A hook wire dislodged into the subglottic area as a rare complication following computed tomography-guided hook wire localization: a case report

BackgroundComputed tomography-guided hook wire localization (CT-GHWL) was used to localize the small pulmonary nodules before video-assisted thoracic surgery (VATS). Its associated complications included hook wire dislodgement, pulmonary hemorrhage, and pneumothorax. This is the first report of a patient with a hook wire sliding into the subglottic area after CT-GHWL.Case presentationA 27-year-old female had productive cough for 8 days. A high-resolution CT scan showed a 12 mm part-solid nodule in the number 8 segment of the left lung. Prior to VATS, she received CT-GHWL to localize the nodule. During VATS, the hook wire unexpectedly slid away. A chest computed tomography was immediately performed and the sagittal reconstructed images showed the needle at the subglottic area. Finally, the needle was extracted by biopsy forceps under bronchoscope evaluation. The patient was eventually recovered and discharged.ConclusionsDislodge of the hook wire into the subglottic area is an extremely rare but serious complication following CT-GHWL. Attention should be paid to securing the needle on the lung surface during VATS.

Comparison of hook-wire and medical glue for CT-guided preoperative localization of pulmonary nodules.

BackgroundPreoperative localization is challenging due to the small diameter of pulmonary nodules or their deep location in the lung parenchyma during VATS surgery. The purpose of this study was to compare the efficacy and safety of both hook-wire and medical glue for pre-operative localization of pulmonary nodules.MethodsIn the current study, 158 patients were retrospectively analyzed (January 2019 and January 2020). The patients underwent hook-wire or medical glue for pre-operative localization of pulmonary nodules. Among them, 74 patients in the hook-wire group and 84 patients in the medical glue group underwent VATS anatomic segmentectomy or wedge resection after localization of pulmonary nodules. Pre-operative localization data from all patients were compiled. Moreover, the efficacy and safety of the two methods were evaluated according to localization success rates and localization-related complications.ResultsThe success rate of localization in the medical glue group was 100% while 97.3% in the hook-wire group. After localization of the pulmonary nodules, the incidence of minor pneumothorax in the medical glue group (11.9%) was lower than that in the hook-wire group (37.8%) (p=0.01). The incidence of mild pulmonary parenchymal hemorrhage in the medical glue group (13.1%) was also lower than that in the hook-wire group (24.3%) (p=0.000). The mean time from the completion of localization to the start of surgery was also longer in the medical glue group than in the hook-wire group (p=0.000). The mean visual analog scale (VAS) scores after localization were higher in the hook-wire group than in the medical glue group (p=0.02). In both groups, parenchymal hemorrhage was significantly associated with the needle length in hook-wire localization and the depth of the medical glue in the lung parenchyma (p = 0.009 and 0.001, respectively).ConclusionThese two localization methods are safe and effective in pre-operative pulmonary nodule localization. The medical glue localization method had a lower risk of complications, a higher localization success rate, less pain after localization and more flexibility in the arrangement of operation time.

The incidence and risk factors of acute pain after preoperative needle localization of pulmonary nodules: a cross-sectional study.

BackgroundThe incidence, severity and associated risk factors of acute pain after preoperative needle localization of pulmonary nodules are poorly characterized. We therefore conducted a cross-sectional study to quantify the acute pain induced by preoperative needle localization of small pulmonary nodules before video-assisted thoracoscopic surgery (VATS).MethodsWe conducted this study at Shanghai Chest Hospital from September 2021 through December 2021. Eligible patients were between 18 and 75 years old and had small pulmonary nodules requiring preoperative CT-guided needle localization. The intensity of acute pain was assessed using the visual analogue scale (VAS) after preoperative needle localization. A VAS score ≥4 cm indicated moderate to severe pain. Patient demographics and CT-guided localization factors were collected to identify significant predictors associated with moderate to severe pain.ResultsA total of 300 patients were included in the final analysis, with a mean (SD) age of 51 (SD =12) years old; 63% were female. Moderate to severe pain occurred in 50.8% of patients during deep breathing and 45.7% of patients during movement. Multivariate logistic regression analysis showed that multiple localization needles [multiple needle localizations vs. single needle localization, odds ratio (OR): 2.363, 95% confidence interval (CI): 1.157–4.825, P=0.018] and the specific location of needle puncture on the chest wall were significant predictors of moderate to severe pain after CT-guided needle localization (lateral chest wall vs. anterior chest wall OR: 2.235, 95% CI: 1.106–4.518, P=0.025; posterior chest wall vs. anterior chest wall OR: 1.198, 95% CI: 0.611–2.349, P=0.599).ConclusionsIn adult patients receiving hookwire CT-guided localization, moderate to severe pain was common. Avoiding the localization route through lateral chest wall may be helpful and pharmacological medications or regional blockade is necessitated in high-risk population.

The risk factors for the failure of hook wire localization of ground glass nodules prior to thoracoscopic surgery

ObjectivesTo retrospectively analyse the potential influencing factors of CT-guided hook wire localization failure prior to thoracoscopic resection surgery of ground glass nodules (GGNs), and determine the main risk elements for localization failure.MethodsIn all, 372 patients were included in this study, with 21 patients showing localization failure. The related parameters of patients, GGNs, and localization were analysed through univariate and multiple logistic regression analysis to determine the risk factors of localization failure.ResultsUnivariate logistic regression analysis indicated that trans-fissure (odds ratio [OR] 4.896, 95% confidence interval [CI] 1.489–13.939); trans-emphysema (OR 3.538, 95% CI 1.343–8.827); localization time (OR 0.956, 95% CI 0.898–1.019); multi-nodule localization (OR 2.597, 95% CI 1.050–6.361); and pneumothorax (OR 10.326, 95% CI 3.414–44.684) were risk factors for localization failure, and the p-values of these factors were < 0.05. However, according to the results of multivariate analysis, pneumothorax (OR 5.998, 95% CI 1.680–28.342) was an exclusive risk factor for the failure of preoperative localization of GGNs.ConclusionCT-guided hook wire localization of GGNs prior to thoracoscopic surgery is often known to fail; however, the incidence is low. Pneumothorax is an independent risk factor for failure in the localization process.

Clinical value and application of preoperative CT-guided hookwire localization of solitary pulmonary nodules for video-assisted thoracic surgery.

BACKGROUND: Video-assisted thoracic surgery (VATS) is a minimally invasive technique for the diagnosis and management of small pulmonary nodular lesions However, the identification of some lung nodules remains difficult.OBJECTIVE: This research aimed to investigate the clinical value of preoperative computed tomography (CT)-guided hookwire localization of solitary pulmonary nodules (SPNs) for thoracoscopic resection.METHODS: Seventy-one patients with 74 SPNs underwent VATS wedge resection after CT-guided hookwire localization. The mean diameter of the SPNs was 8.50 4.53 mm,,besides, the mean distance from the SPNs to the parietal pleura was 16.81 5.23 mm.RESULTS: Sixty-nine of the 74 nodules were successfully localized using a CT-guided hookwire. The success rate of CT-guided localization was 93.2%. The average localization time was 15.23 7.21 min per lesion. Seven patients (9.5%) had asymptomatic pneumothorax and 10 (13.5%) had minimal needle tract parenchymal hemorrhages after localization no clinical intervention was required for these patients. The rate of success for VATS wedge resection of the SPNs was 100%. Histological analysis of the SPNs revealed malignant disease in 67.4% of the patients.CONCLUSIONS: Preoperative CT-guided hookwire localization for thoracoscopic resection is a safe and effective operation for the identification and stable fixation of SPNs.

Comparison between coil and hook-wire localization before video-assisted thoracoscopic surgery for lung nodules: a systematic review and meta-analysis.

IntroductionBoth coil and hook-wire localization techniques are commonly employed prior to video-assisted thoracic surgery (VATS) resection in patients with lung nodules (LNs), but the relative advantages of each remain uncertain.AimThis meta-analysis was performed to explore the relative safety and efficacy of coil localization (CL) and hook-wire localization (HWL) for patients with LNs.Material and methodsThe PubMed, Embase, Cochrane Library, Wanfang, and CINK databases were searched to identify relevant studies published as of February 2022, after which pooled analyses of study outcomes were conducted.ResultsIn total, 8 studies met the inclusion criteria for the present meta-analysis. Successful localization rates were higher for the CL group relative to the HWL group (p = 0.0001). The CL group additionally exhibited significantly lower pooled total complication, pneumothorax, and lung hemorrhage rates relative to the HWL group (p = 0.01, p = 0.0001, p = 0.0009). Pooled duration of localization, VATS procedure duration, and wedge resection duration values were comparable in both groups (p = 0.69, p = 0.16, p = 0.76), as were chest pain scores (p = 0.06). When specifically analyzing the subset of patients with ground-glass LNs, pooled pneumothorax rates were significantly lower in the CL group relative to the HWL group (p = 0.03). Significant publication bias was detected with respect to rates of lung hemorrhage (Egger test, p = 0.029), but was not evident for other analyzed variables.ConclusionsThese results suggest that the coil-based localization of LNs before VATS resection is safer and more effective than hook-wire localization.

Visualization positioning-guided biopsy of suspicious breast microcalcifications: a retrospective cohort study.

BackgroundAt present, most histological evaluations of microcalcifications without a mass are performed using X-ray guided hook wire localization or vacuum-assisted stereotactic biopsy (VASB), but there are still several limitations to these techniques. Therefore, we designed a visualization positioning technique based on three directions of mammography to accurately locate suspected microcalcifications to guide the biopsy.MethodsWe retrospectively analyzed consecutive patients with suspicious microcalcifications who underwent visualization positioning-guided biopsy (VPB) from June 1, 2016, to June 1, 2021. The visualization positioning technique was performed using an electronic ruler to measure the vertical distance from the microcalcification core to the vertical lines on mammography.ResultsA total of 133 patients (median age 46 years; range, 22–87 years) who underwent VPB were included in our study. Among the 133 cases of microcalcifications based on pathological results, 104 were benign, 14 were high risk, and 15 were malignant. In 124 (93.2%) patients, microcalcification was confirmed during the first round of VPB specimen analysis. Only 6 (4.5%) and 3 (2.3%) patients underwent second and third extended resections, respectively, as the resected specimens did not contain microcalcifications. Four patients (3.0%) with malignant biopsy results underwent a subsequent operation. Two patients with DCIS underwent mastectomy and sentinel lymph node biopsy because of diffuse calcification. One patient had no residual cancer, and the other was upgraded to invasive ductal carcinoma (IDC). Two patients with IDC underwent breast-conserving surgery and mastectomy with sentinel lymph node biopsy.ConclusionsVPB can be used to evaluate breast microcalcifications when a mass is not present, making it an effective diagnostic technique.

Targeted Near-Infrared Fluorescence Imaging With Iodized Indocyanine Green in Preoperative Pulmonary Localization: Comparative Efficacy, Safety, Patient Perception With Hook-Wire Localization

BackgroundPrecise preoperative localization is of great importance to improve the success rate and reduce the operation time of VATS surgery. This study aimed to assess the efficacy, safety, patient perception between CT-guided indocyanine green (ICG) preoperative localization of lung nodule and hook-wire localization.Methods65 patients with 85 clinically suspicious pulmonary nodules underwent ICG preoperative localization in this study, and 92 patients with 95 nodules localized by conventional hook-wire served as controls. Both hook-wire localization and ICG injection were performed under CT guidance. Successful targeting rate, success rate in the operative field, incidence rate of complications and respiratory pain score were recorded and compared.ResultsThe successful targeting rate for both groups is 100%, however, due to hook-wire dislodgement, the success rate in the VATS operation field of the hook-wire group (95.6%) is lower than that of the ICG group (100%), with no significant difference(p=0.056). The overall complication rate of the hook-wire group (37.0%) is significantly higher than the ICG group (35.4%) (p=0.038). The mean respiratory pain score of the hook-wire group is 3.70 ± 1.25, which is significantly higher than that of the ICG group (2.85 ± 1.05) (p<0.001).ConclusionsICG composed with contrast mixture are superior to the conventional hook-wire preoperative lung nodule localization procedure, with a lower complication rate, lower pain score, and relatively higher success rate. ICG is a promising alternative method for pulmonary nodule preoperative localization.

CT-guided hook-wire localization of pulmonary nodules in children prior to atypical resection by thoracoscopy: Practical aspects

In the multidisciplinary treatment of pediatric oncologic patients, multiple imaging tests, biopsies, and resections are required for diagnosis, initial staging, and posterior restaging. In these patients, pulmonary nodules are not always metastases, so the correct diagnosis of these lesions affects their treatment and the patient’s survival. Percutaneous localization of pulmonary nodules is key for two reasons: it enables the surgeon to resect the smallest amount of lung tissue possible and it guarantees that the nodule will be included in the resected specimen. Without percutaneous localization, it can be impossible to accomplish these two objectives in patients with very small nodules that are separated from the pleural surface and therefore impossible to see by thoracoscopy. This article reviews the technique for hook-wire localization of pulmonary nodules and the keys to ensuring the best results.

Localización de nódulos pulmonares con arpón guiado con TC para resección atípica por toracoscopia en pacientes pediátricos: aspectos prácticos

In the multidisciplinary treatment of pediatric oncologic patients, multiple imaging tests, biopsies, and resections are required for diagnosis, initial staging, and posterior restaging. In these patients, pulmonary nodules are not always metastases, so the correct diagnosis of these lesions affects their treatment and the patient's survival. Percutaneous localization of pulmonary nodules is key for two reasons: it enables the surgeon to resect the smallest amount of lung tissue possible and it guarantees that the nodule will be included in the resected specimen. Without percutaneous localization, it can be impossible to accomplish these two objectives in patients with very small nodules that are separated from the pleural surface and therefore impossible to see by thoracoscopy. This article reviews the technique for hook-wire localization of pulmonary nodules and the keys to ensuring the best results.

Image-guided marking techniques in interventional radiology: A review of current evidence

Precise marking of lesions using image-guided techniques is essential, as imprecise targeting of a tumor can result in either insufficient excision/treatment with an increased risk of recurrence, or excessive removal of healthy tissue. Most frequent indications include localization of nonpalpable lesions before surgical resection (i.e., hook-wire localization of pulmonary nodules before video-assisted thoracoscopy) and definite marking of liver metastasis before neoadjuvant therapy. Other indications include marking of hepatocellular carcinomas that are not visible on ultrasound and unenhanced computed tomography before thermal ablation, of bone lesions before surgical excision, and of different visceral tumors before stereotactic radiotherapy. This review presents the different existing indications, assesses their usefulness, gives systematic details on the technique and lastly analyzes the current literature with emphasis on results and complications.

Cosmetic outcomes following wide local excision of impalpable breast cancer: is radioguided occult lesion localization using iodine-125 seeds better than hookwire localization?

Hookwire localization (HWL) is the gold standard for localizing impalpable tumours for breast conserving surgery. An alternative technique, radioguided occult lesion localization using iodine-125 seeds (ROLLIS), has been associated with lower re-excision rates. This paper investigates if cosmetic outcomes differ in women undergoing breast conserving surgery with HWL or ROLLIS. Women who had ROLLIS or HWL guided excision for impalpable breast cancer within a multicentre randomized controlled trial (RCT) (ANZCTR 12613000655741) were recruited. Exclusions were level 2 oncoplasty and mastectomy. Cosmetic outcome was calculated using BCCT.core, the Hopwood Body Image Scale and estimated percentage breast volume excised. Chi-squared analysis was used to determine the difference between the intervention groups. Analysis was performed for 123 participants (66 ROLLIS and 57 HWL). The cosmetic outcome determined by BCCT.core for all participants was good with no significant difference between the ROLLIS and HWL groups. When reviewing the number of patients who experienced either a good or excellent result, there was a significantly higher number of patients in the ROLLIS group (n=53, 82%) compared to the HWL group (n=42, 74%, P=0.02. There were no differences in Hopwood Body Image Scale or estimated percentage breast volume excised between groups. There was a reduction in the frequency of re-excision in the ROLLIS group (n=3, 4.5%) versus HWL group (n=8, 14%); however, this was not significant (P=0.06). Pre-operative localization of impalpable breast lesions using either ROLLIS or HWL resulted in a good cosmetic outcome with no significant difference between localization techniques.

Cerebral arterial air embolism with anterior spinal cord syndrome after CT-guided hook-wire localization of Lung mass and pulmonary nodule

Systemic arterial air embolism (SAAE) is a rare but serious complication of CT-guided hook wire localization of pulmonary nodule usually with catastrophic and poor outcome. Hook wire needle localization is done pre-operatively by placing wire around or into the pulmonary nodule to provide the thoracic surgeon accurate location guidance of the target nodule for Video-Assisted Thoracoscopic Surgery (VATS) wedge resection with safety margins. Physicians should be aware of this possible complication during the procedure in order to rescue the patient promptly as it requires rapid diagnosis and management. We describe a 55-year-old male who underwent a CT-guided hook wire needle localization of left upper lobe lung cancer and left lower lobe pulmonary nodule prior to planned VATS wedge resection who developed altered mental status and bilateral lower extremities paralysis after wire placement was completed. His CT head demonstrated small air embolism in the left occipital area, confirming the diagnosis of cerebral air embolism and follow up CT and MRI of the head revealed multiple areas of brain infarction. In addition, he was diagnosed with anterior spinal cord syndrome (ACS), most likely due to anterior spinal artery ischemia from micro air embolism on the basis of clinical findings but with negative ischemic changes on MRI of the spinal cord. His mental status recovered but he remained paraplegic and transferred to inpatient rehabilitation service.