Targeting Pulmonary Nodules Prior to Video-Assisted Thoracic Surgery: Comparison of Two Different Techniques

Area of Science:

• Pulmonology
• Radiology
• Surgical Oncology

Background:

• Increasing CT imaging and lung cancer screening detect more pulmonary nodules.
• Accurate localization is crucial for pathological diagnosis and curative resection of nodules.

Purpose of the Study:

• To compare the diagnostic yield of hook-wire localization versus cone-beam computed tomography (CBCT)-guided detection for pulmonary nodules.
• To evaluate secondary outcomes including localization and operative times, complications, drainage duration, and hospital stay.

Main Methods:

• Retrospective analysis of 260 patients with 266 nodules across two French academic centers (January 2012-May 2019).
• Primary endpoint: diagnostic yield (proportion of successfully localized nodules).
• Secondary endpoints: localization/operative times, complications, chest tube duration, hospital stay.

Main Results:

• Diagnostic yield was 96.9% for CBCT versus 88.0% for hook-wire (p=0.053).
• Complication rates, drainage duration, and hospital stay did not differ significantly between groups.
• Localization time was significantly longer with hook-wire (p=0.001), while operative time was longer with CBCT (p=0.042).

Conclusions:

• Both hook-wire and CBCT localization provide comparable diagnostic yields and safety profiles for pulmonary nodules.
• CBCT requires longer operating room utilization, whereas hook-wire placement in radiology may conserve surgical resources.