Needle localization of small pulmonary nodules: Lessons learned

Area of Science:

• Pulmonology
• Thoracic Surgery
• Interventional Radiology

Background:

• Small, deep, and semisolid lung nodules present localization challenges for video-assisted thoracoscopic surgery (VATS).
• Accurate localization is critical for successful diagnosis and surgical resection of lung nodules.

Purpose of the Study:

• To describe the cumulative experience and outcomes of using needle localization for small lung nodules prior to surgical resection.
• To report procedural details, operative results, and lessons learned from needle localization cases.

Main Methods:

• A retrospective review of 253 patients undergoing computed tomography (CT)-guided needle localization of lung nodules (0.6-1.2 cm).
• Localization involved placing coaxial needles, injecting methylene blue, and deploying two hookwires.
• Patients subsequently underwent VATS wedge resection for diagnosis and potential anatomic resection.

Main Results:

• Needle localization was successful in 96.8% of patients (245/253).
• The most common complication was asymptomatic pneumothorax (4.3%), with higher rates in patients with bullous emphysema (25.7%).
• Perioperative survival was 100%, with an average hospital stay of 1.4-4.9 days depending on the procedure.

Conclusions:

• Needle localization with hookwire and methylene blue is a safe and feasible strategy for localizing small, deep lung nodules for resection.
• Effective multidisciplinary collaboration between thoracic surgeons and interventional radiologists is essential for procedural success.