Analysis of pleural reaction following CT-guided hookwire localization for pulmonary nodules

Computed tomography (CT)-guided hookwire localization for pulmonary nodules is widely applied in clinical practice; however, it may be complicated by pleural reaction (an acute syndrome of hemodynamic and respiratory instability), seriously affecting patient safety and prognosis. This study aimed to investigate the risk factors for pleural reaction following CT-guided hookwire localization, thereby providing a reference for the early identification of high-risk patients.

A retrospective case-control study was conducted of patients who underwent CT-guided hookwire localization for pulmonary nodules between October 2021 and March 2024. The case group comprised 66 patients with postoperative pleural reactions, while the control group comprised 258 patients without pleural reactions, matched at an approximate 1:4 ratio. Demographic data, pulmonary nodule characteristics, procedural parameters, and procedure-related complications were compared between the two groups. Univariate and multivariate logistic regression analyses were used to identify risk factors for pleural reaction, and a prediction model was developed based on these factors.

Among the cases with pleural reactions, most cases were mild (n=9, 13.6%) or moderate (n=54, 81.8%), while severe cases were less common (n=2, 3.0%). The incidence rates of pneumothorax (39.4% vs. 22.5%, P=0.005) and pulmonary parenchymal hemorrhage (66.7% vs. 29.8%, P<0.001) were significantly higher in the pleural reaction group than in the non-pleural reaction group. Additionally, three cases of air embolism and two severe adverse events (cardiac arrest and delayed hemothorax) were observed. The multivariate analysis revealed that younger age [odds ratio (OR) =0.940, P<0.001), shorter nodule-to-pleura distance (OR =0.653, P=0.048), concurrent pneumothorax (OR =4.209, P<0.001), and pulmonary parenchymal hemorrhage (OR =7.131, P<0.001) were independent risk factors for pleural reaction. The predictive model constructed based on these factors demonstrated good predictive performance, with an area under the curve (AUC) of 0.814 for the receiver operating characteristic (ROC) curve [95% confidence interval (CI): 0.751-0.876, P<0.001].

Younger age, shorter nodule-to-pleura distance, concurrent pneumothorax, and pulmonary parenchymal hemorrhage were significantly associated with pleural reaction following CT-guided hookwire localization of pulmonary nodules. The predictive model constructed based on these factors demonstrated good predictive performance (AUC =0.814), providing an important basis for preoperative risk assessment.