Clinical Analysis of Percutaneous Computed Tomography-Guided Hook Wire Localization of 168 Small Pulmonary Nodules

The aim of this study was to evaluate the correlation of clinical and radiologic characteristics and pathologic features in small pulmonary nodules and to evaluate the success rate and safety of a computed tomography (CT)-guided hook wire system.

One hundred sixty-eight pulmonary nodules that were 20 mm or less in diameter in 161 patients were percutaneously localized by a CT-guided hook wire system, followed by pulmonary resection. The general clinical data, computed tomographic characteristics, and pathologic findings were evaluated, and the major side effects during the localization procedure were reviewed.

Of the targeted nodules, 71 (42.3%) nodules were pure ground-glass opacities (GGOs), 59 (35.1%) nodules were partially solid GGOs, and 38 (22.6%) nodules were solid lesions. Pathologically, 49.3% of the pure GGOs were atypical adenomatous hyperplasia (AAH), 54.2% of the partially solid GGOs were lung cancer, and 65.8% of the solid nodules were benign lesions. Lung cancer tended to develop in older patients with larger nodule diameters. Subsolid nodules greater than 10 mm showed a statistically significant correlation with malignancy (p < 0.001). The hook wires were successfully placed in 164 (97.6%) nodules, and no serious complications occurred.

In resected specimens with a CT-guided hook wire, pulmonary subsolid nodules tend to be AAH or lung cancer, whereas small solid nodules tend to be benign lesions. Pulmonary subsolid nodules larger than 10 mm are more frequently malignant. Preoperative localization of small pulmonary nodules with a hook wire system has a high success rate and acceptable utility.