Preoperative CT-guided Hook Wire Localization Research Articles

A retrospective study on pre-operative CT-guided hook-wire localization of pulmonary nodules

A retrospective study on pre-operative CT-guided hook-wire localization of pulmonary nodules

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.

Reevaluation of the efficacy of preoperative computed tomography-guided hook wire localization: A retrospective analysis

BackgroundSmall pulmonary nodules (SPNs) often cannot be accurately located during video-assisted thoracoscopic (VATS) resection, and preoperative computed tomography (CT)-guided localization performed using hook wire placement can be helpful. However, recent studies revealed a trend towards more frequent and severe complications occurring in association with hook wire insertion. The aim of this study is to reevaluate the safety, and reliability of the preoperative CT-guided hook wire localization technique and also identify the risk factors for localization-related pneumothorax. MethodsThis retrospective study enrolled 95 patients (with 105 pulmonary nodules) who underwent preoperative CT-guided hook wire localization and followed VATS resection from January 2013 to September 2016. Univariate and multivariate logistic regression analyses were used to identify factors associated with localization-related pneumothorax. ResultsAll the 105 nodules were successfully localized. Two (1.9%) hook wires dislodged before VATS resection. Mean largest diameter of the nodules was 10.1 mm (range, 3–19 mm). Mean depth from the nearest pleural surface was 11.2 mm (range, 2–38 mm). Mean needle insertion depth was 24.3 mm (range, 4–49 mm), and mean procedure time was 17.3 min (range, 7–48 min). Asymptomatic pneumothorax was observed in 18 patients (18.9%) and hemorrhage in 7 patients (7.4%). Multivariate logistic regression analysis revealed the number of needle insertions (OR 8.893, p = 0.019) as the only significant independent risk factor of pneumothorax. ConclusionsCT-guided hook wire localization is a safe, reliable and convenient technique and can be applied widely to facilitate the resection of SPNs. Simultaneous localization for multiple nodules in ipsilateral lung may be associated with a higher risk of localization-related pneumothorax.

Computed Tomography Guided Hook-wire Precise Localization and Minimally Invasive Resection of Pulmonary Nodules

背景与目的肺小结节尤其是磨玻璃结节(ground glass opacity, GGO)病灶的定位是微创手术切除的难点，报道的方法很多但均有不足。本研究旨在探讨计算机断层扫描(computed tomography, CT)引导下Hook-wire术前定位在胸腔镜下(video-assisted thoracoscopic surgery, VATS)肺结节切除术中的临床应用价值，并初步探讨GGOs积极微创手术治疗的必要性和可行性。方法2013年5月-2015年6月共25例患者的26枚肺结节于术前行CT引导下Hook-wire定位，然后施行胸腔镜楔形切除术。统计Hook-wire定位时间、成功率、并发症及楔形切除时间、住院时间等，计算病灶组织学分型中的恶性几率，讨论肺部GGOs积极手术治疗的必要性。结果共25例患者26个结节(男性10例，女性15例，6个实性结节，20个GGOs)，病灶直径5 mm-20 mm(平均8 mm)，病灶距离胸膜垂直距离5 mm-30 mm(平均14 mm)，CT引导下Hook-wire定位成功率为100%。VATS楔形切除术成功率为100%。CT定位时间平均10 min(5 min-15 min)，微创切除病灶所需时间平均20 min(15 min-40 min)，平均住院时间为4 d(3 d-6 d)。4例患者定位后发生微量气胸，但无需闭式引流处理。术中定位针脱落1例，但仍于胸腔镜下观察到穿刺点脏层胸膜下血肿后，准确定位并成功切除。20个GGOs术后组织学诊断结果为：16个混合性GGOs(mixed GGO, mGGO)中，微浸润腺癌2例，腺癌5例，小细胞肺癌(small cell lung cancer, SCLC)1例，炎性病灶8例；4个纯GGOs(pure GGO, pGGO)中原位腺癌1例，非典型性腺瘤样增生(atypical adenomatoid hyperplasia, AAH)1例，炎性病灶2例。结论CT引导下Hook-wire肺结节尤其是GGOs术前定位准确率高，相关并发症轻微，是一种安全、有效的方法，能快速确定下一步诊疗方案，值得临床推广；肺部mGGOs是恶性病灶的几率很大，积极微创手术治疗是非常必要的。

Survival and Local Recurrence After Video-Assisted Thoracoscopic Lung Metastasectomy.

Pulmonary metastasectomy is increasingly performed in selected patients by video-assisted thoracic surgery (VATS) on the base of thin-slice high-resolution CT-Scan (HRCT). This study determines the overall survival and ipsilateral recurrence rate and of patients undergoing after VATS lung metastasectomy. Retrospective single institution study of all patients who underwent VATS pulmonary metastasectomy on the base of HRCT with curative intent between 2005 and 2014. Seventy-seven patients (41 males, 36 females) underwent VATS pulmonary metastasectomy for solitary (n = 63) or multiple (n = 14) lung metastases in the context of colorectal carcinoma (n = 26), sarcoma (n = 17), melanoma (n = 16), or other primaries (n = 18). Nine patients had bilateral lung metastases and underwent synchronous (n = 4) or sequential (n = 5) VATS resections. Preoperative CT-guided hook wire localization of the lesions was performed in 65 patients (84 %). The postoperative mortality and morbidity rates were 0 and 5.2 %, respectively. During a mean follow-up time of 24 months (range 1–120 months), tumor progression occurred in 46 patients. Twenty-three patients (30 %) had pulmonary recurrence only, of them, eight patients (10 %) in the operated lungs. Seven of eight patients with recurrence in the operated lungs underwent a second metastasectomy by VATS (n = 5) or thoracotomy (n = 2). The overall 5-year survival rate was 54 % and without difference between patients without tumor recurrence and those with pulmonary recurrence treated by re-metastasectomy. Ipsilateral recurrence remains low after VATS pulmonary metastasectomy guided by preoperative HRCT and can be efficiently treated by re-metastasectomy.

Application of preoperative CT-guided Hook-wire localization of pulmonary nodules in thoracoscopic lobectomy of lung

Objective To evaluate the application of preoperative CT-guided Hook-wire localization of pulmonary nodules in thoracoscopic lobectomy of lung. Method Twenty eight patients with 31 pulmonary nodules of ground-glass opacity (GGO) detected by CT scan were admitted in our hospital from December 2008 to December 2013, including 17 males and 11 females with an average age of 55. The lesions were located by CT-guided Hook-wire technique, and lobectomy plus lymphadenectomy or pulmonary wedge resection were performed according to the results of fast frozen pathology. The characteristics of pulmonary nodules and general condition of the patients were analyzed. Results Among 31 nodules, 19 were malignant and 12 benign with an average size of (1.8±0.6) cm and thickness of (1.2±0.4) cm. The vertical distance from pleural to nodules was (1.5±0.7) cm and the insert depth of needle was (2.5±0.9) cm. The time for CT-guided Hook-wire localization was (16.5±5.2) min. The operation time for pulmonary wedge resection and pulmonary lobectomy was (18.5±5.5) min and (54.7±12.5) min, respectively. Intraoperative frozen section showed malignant tumors in 18 patients (19 GGO nodules), lobectomy plus lymphadenectomy were performed in 16 cases; 2 patients did not undergo pulmonary lobectomy because of poor physical condition or 2 GGO nodules in different lobes. There were no operation complications in this series. Postoperative pathologic findings of 31 nodules showed 9 cases of adenocarcinoma, 10 bronchioloalveolar carcinoma, 5 atypical adenomatous hyperplasia, 2 epithelioid hemangioendothelioma, 2 chronic inflammation, 1 hamartoma, 1 inflammatory pseudotumor and 1 sarcoidosis. The average postoperative hospital stay was (6.6±1.9) days. Conclusions Endoscopic resection of pulmonary GGO nodules with CT-guided Hook-wire localization technique is feasible and safe, with less complications and less time consuming. Key words: Surgery, computer-assisted; Tomography, X-ray computed; Solitary pulmonary nodule; Hook-wire; Ground-glass opacity

Case of Resection for Tiny Pulmonary Metastasis of Nephroblastoma Using Preoperative CT-Guided Hook-Wire Localization

Case of Resection for Tiny Pulmonary Metastasis of Nephroblastoma Using Preoperative CT-Guided Hook-Wire Localization

CT-Guided Hookwire Placement: A Technical Innovation for Preoperative Localization of Nonpalpable Cervical Lymph Nodes

The aim is to describe the technique of preoperative CT-guided hookwire localization of small, but suspicious, cervical lymph nodes. We present 3 patients who underwent the procedure for nonpalpable cervical nodes detected on PET/CT prior to complete surgical resection of the nodes. The details of the radiological procedure, surgical outcomes, and pathologic results are described. The mean intervention time for preoperative hookwire localization was 9 minutes (range 7-14 minutes). There were no complications. All surgeons felt that the lengths of the surgical skin incision and operative times were reduced because of localization. The pathologic diagnoses were 2 benign nodes and 1 case of metastatic ovarian carcinoma. In conclusion, preoperative CT-guided hookwire localization is a useful technique for guiding surgical excision, especially when cervical nodes are small and deep in location.

CT-guided Hook Wire Localization of Subpleural Lung Lesions for Video-assisted Thoracoscopic Surgery (VATS)

Histologic diagnosis of suspicious small subpleural lung lesions is difficult and often impossible using existing image-guided needle biopsy techniques including video-assisted thoracoscopic wedge resection. Preoperative lung lesion localization provides a more obvious target to facilitate intraoperative resection. This study reviewed the indications, results and complications of CT-guided hook wire localization for subpleural lung lesions in video-assisted thoracoscopic surgery (VATS). Between February 2001 and January 2007, 41 patients (20 males, 21 females; mean age, 52.5 +/- 5.1 years) with 43 subpleural pulmonary lesions underwent preoperative CT-guided double-thorn hook wire localization prior to video-assisted thoracoscopic wedge resection. Nodule diameters ranged from 2 mm to 26 mm (mean, 9.7 +/- 1.6 mm). The distance of the lung lesions from the nearest pleural surfaces ranged from 2 mm to 30 mm (mean, 9.6 +/- 2.0 mm). Patients then received VATS within 5 hours. The efficacy of preoperative localization was evaluated in terms of procedure time, VATS success rate and associated complications of localization. Forty-three wedge resections of the lungs containing 43 subpleural lung lesions as guided or assisted by the inserted hook wires were successfully performed in 41 VATS procedures (41 of 43 procedures, 95.3%). The mean procedure time for preoperative CT-guided hook wire localization was 30.4 +/- 2.8 minutes. Eight patients had asymptomatic minimal pneumothoraces (18.6%); six patients had minimal needle tract parenchymal hemorrhages (13.9%) and one patient (2.3%) had an estimated 100 mL of hemothorax due to a small intercostal artery bleed that was cauterized during operation. The mean procedure time for VATS was 103 +/- 9.7 minutes (range, 44-198 minutes). Pathologic examination revealed seven primary lung cancers, 11 metastases, one hemangioma, 19 definite non-neoplastic pathologies, two nonspecific chronic inflammation, and three metallic foreign bodies. Diagnostic yield was 95%. No major complications related to the preoperative hook wire localization and VATS were noted. CT-guided hook wire fixation is useful, helps in precise lesion localization in VATS wedge resection, and has a low rate of minor complications.

Video‐assisted Thoracoscopic Resection of a Small Pulmonary Nodule after Computed Tomography–guided Localization with a Hook‐wire System

This study is a single-institution validation of video-assisted thoracoscopic (VATS) resection of a small solitary pulmonary nodule (SPN) previously localized by a CT-guided hook-wire system in a consecutive series of 45 patients. The records of all patients undergoing VATS resection for SPN preoperatively localized by CT-guided a hook-wire system from January 2002 to December 2004 were assessed with respect to failure to localize the lesion by the hook-wire system, conversion thoracotomy rate, duration of operation, postoperative complications, and histology of SPN. Forty-five patients underwent 49 VATS resections, with simultaneous bilateral SPN resection performed in 4. Preoperative CT-guided hook-wire localization failed in two patients (4%). Conversion thoracotomy was necessary in two patients (4%) because it was not possible to resect the lesion by a VATS approach. The average operative time was 50 min. Postoperative complications occurred in 3 patients (6%), one hemothorax and two pneumonia. The mean hospital stay was 5 days (range: 2-18 days). Histological assessment revealed inflammatory disease in 17 patients (38%), metastasis in 17 (38%), non-small-cell lung cancer (NSCLC) in 4 (9%), lymphoma in 3 (6%), interstitial fibrosis in 2 (4%), histiocytoma in one (2%), and hamartoma in one (2%). Histological analysis of resected SPN revealed unexpected malignant disease in more than 50% of the patients indicating that histological clarification of SPN seems warranted. Video-assisted thoracoscopic resection of SPN previously localized by a CT-guided hook-wire system is related to a low conversion thoracotomy rate, a short operation time, and few postoperative complications, and it is well suited for the clarification of SPN.

Video-assisted thoracoscopic surgery for pulmonary nodules: rationale for preoperative computed tomography-guided hookwire localization.

Video-assisted thoracic surgery (VATS) provides a minimally invasive means to resect pulmonary nodules (PN). Deep localization of PN may jeopardize VATS lung resection. The aim of this study was to establish the utility of preoperative computed tomography (CT)-guided hookwire localization of PN. Between January 1993 and September 2001, we performed 151 VATS resections for PN. Preoperative CT-guided hookwire localization was not performed in 98 patients (group I); it was done just before surgery in 53 patients (group II) when, at CT scan, the distance of PN from the lung surface was >15 and/or when the size was <10 mm. Pneumothorax occurred in four patients (7.5%). Hookwire dislodged in four patients, but the hematoma left on the visceral pleura made thoracoscopic localization possible in three of these. Seventeen patients (17%) in group I and 4 (7.5%) in group II required conversion to thoracotomy (P< or =0.05). The most common reason for conversion was impossibility to localize PN in group I (nine cases) and deep localization requiring local enucleation in group II (two cases). In 31 group II patients (58%) hookwire positioning led to successful VATS resection that would otherwise have been impossible because PN were neither visible nor palpable. Preoperative CT-guided hookwire localization for pulmonary nodules is an effective technique which allows VATS resection of PN <10 mm located >15 mm from the pleural surface. Even when PN are subpleural but <10 mm, hookwire localization makes VATS resection faster. Apical and diaphragmatic localization of PN are limitations to the procedure.