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

Abstract

Background and objective Localization of pulmonary ground glass nodule is the technical difficulty of minimally invasive operation resection. The aim of this study is to evaluate the value of computed tomography (CT)-guided Hook-wire precise localization in resection of pulmonary nodules by video-assisted thoracoscopic surgery (VATS) as well as to discuss the necessity and feasibility of surgical resection of GGOs through a minimally invasive approach. Methods CT-guided Hook-wire precise localization and wedge resection was done on 25 cases with 26 pulmonary nodules by VATS from May 2013 to June 2015. The efficacy of localization was evaluated in terms of procedure time, VATS success rate, and associated complications of localization. Results All the 26 pulmonary nodules (6 solid nodules and 20 GGOs ) of 25 patients (10 males and 15 females) were preoperatively detected and localized with Hook-wire under CT guidance. Nodule diameters ranged from 5 mm-20 mm (mean: 8 mm). The distance of lung lesions from the nearest pleural surfaces ranged within 5 mm-30 mm (mean: 14 mm). All resections of lesions guided by the Hook-wire were successfully performed by VATS (success rate: 100%). The mean procedure time for the CT-guided Hook-wire localization was 10 min (range: 5 min-10 min). The mean procedure time for VATS wedge resection was 20 min (range: 15 min-40 min). The mean hospital time was 4 d (range: 3 d-6 d). The major complication of CT-guided Hook-wire localization was mild pneumothorax in 4 patients, but no one needed chest tube drainage. Wedge resection was performed successfully in all cases. The dislocation of Hook-wire was found in only one patient during the operation, but the lesion was still successfully resected under VATS. Results of pathological examination of 16 mGGOs revealed 8 primary lung cancers and 8 nonspecific chronic inflammations. Results of pathological examination of 4 pGGOs revealed 1 primary lung cancers, 1 atypical adenomatous hyperplasia (AAH), and 2 nonspecific chronic inflammations. Conclusion The preoperative CT-guided Hook-wire localization for pulmonary nodules particularly for GGOs is an effective and safe technique to assist VATS resection of the nodules. It can increase the ratio of lung wedge resection with little complications and may be better used in clinical diagnosis and treatment of small pulmonary nodules with VATS. Lung mGGOs carry a high risk of malignancy. Aggressive surgical resection of these mGGOs is necessary and feasible.

Keywords

• Ground glass opacity
• Video-assisted thoracic surgery
• CT-guided Hook-wire localization