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Retrospective Evaluation of Safety, Efficacy and Risk Factors for Pneumothorax in Simultaneous Localizations of Multiple Pulmonary Nodules Using Hook Wire System

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Abstract

Purpose

To evaluate the safety and efficacy of the hook wire system in the simultaneous localizations for multiple pulmonary nodules (PNs) before video-assisted thoracoscopic surgery (VATS), and to clarify the risk factors for pneumothorax associated with the localization procedure.

Methods

Between January 2010 and February 2016, 67 patients (147 nodules, Group A) underwent simultaneous localizations for multiple PNs using a hook wire system. The demographic, localization procedure-related information and the occurrence rate of pneumothorax were assessed and compared with a control group (349 patients, 349 nodules, Group B). Multivariate logistic regression analyses were used to determine the risk factors for pneumothorax during the localization procedure.

Results

All the 147 nodules were successfully localized. Four (2.7%) hook wires dislodged before VATS procedure, but all these four lesions were successfully resected according to the insertion route of hook wire. Pathological diagnoses were acquired for all 147 nodules. Compared with Group B, Group A demonstrated significantly longer procedure time (p < 0.001) and higher occurrence rate of pneumothorax (p = 0.019). Multivariate logistic regression analysis indicated that position change during localization procedure (OR 2.675, p = 0.021) and the nodules located in the ipsilateral lung (OR 9.404, p < 0.001) were independent risk factors for pneumothorax.

Conclusion

Simultaneous localizations for multiple PNs using a hook wire system before VATS procedure were safe and effective. Compared with localization for single PN, simultaneous localizations for multiple PNs were prone to the occurrence of pneumothorax. Position change during localization procedure and the nodules located in the ipsilateral lung were independent risk factors for pneumothorax.

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Author notes

  1. Yan Zhong, Xiao-Quan Xu, Xiang-Long Pan and Wei Zhang have contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, China

    Yan Zhong, Xiao-Quan Xu, Wei Zhang, Hai Xu, Mei Yuan, Ling-Yan Kong, Xue-Hui Pu & Tong-Fu Yu

  2. Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

    Xiang-Long Pan & Liang Chen

Authors
  1. Yan Zhong
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  2. Xiao-Quan Xu
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  4. Wei Zhang
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  5. Hai Xu
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  9. Liang Chen
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Corresponding author

Correspondence to Tong-Fu Yu.

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All authors declare that they have no conflict of interests and no grant supports for this work.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Zhong, Y., Xu, XQ., Pan, XL. et al. Retrospective Evaluation of Safety, Efficacy and Risk Factors for Pneumothorax in Simultaneous Localizations of Multiple Pulmonary Nodules Using Hook Wire System. Cardiovasc Intervent Radiol 40, 1408–1414 (2017). https://doi.org/10.1007/s00270-017-1631-3

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  • DOI: https://doi.org/10.1007/s00270-017-1631-3

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