CT-guided Preoperative Localization of Impalpable Pulmonary Nodules: Comparison Between Two Devices

To compare two different devices for computed tomography (CT)-guided preoperative localization of impalpable pulmonary nodules in terms of effectiveness, technical and clinical success and complications rate.

CT-guided preoperative localization procedures of small or ground glass (i.e., impalpable) pulmonary nodules performed in our center from April 2018 to December 2021 before lung resection with video-assisted thoracic surgery (VATS) were retrospectively analyzed. Two different markers were used: spiral-wire (SpW) and hydrogel plug (HyP). For each nodule the density, size and pleural distance were evaluated. Technical (correct CT-guided positioning of the marker) and clinical (its correct localization in VATS) success were assessed for each device. Complications as displacement, pneumothorax and parenchymal hemorrhage (PH) were registered. Statistical analysis was made by Chi-square, Wilcoxon and Fisher tests.

Eighty-five consecutive patients (46/39 males/female; mean age 42 years, range=4-80 years) with 85 pulmonary nodules (maximum diameter: 8.5±6.4 mm in the SpW group and 17.0±4.2 mm in the HyP group) underwent preoperative CT-guided localization with SpW (65/85, 76.5%) or HyP (20/85, 23.5%) device. Correct CT-guided landmark positioning was obtained in 100% of cases. VATS revealed 4/65 (6.2%) cases of marker displacement in the SpW group and 3/17 (17.6%) cases in the HyP group (p=0.0353). Pneumothorax occurred in 40/65 (61.5%) cases in the SpW group and in 11/20 (55.0%) cases in the HyP group (p=0.602); no drainage tube was needed. PH occurred in 34/65 (52.3%) cases in SpW group and in 14/20 (70.0%) cases in HyP group (p=0.0163).

Both markers are effective for the preoperative localization of impalpable pulmonary nodules in VATS. SpW seems to be slightly more stable and safer than HyP lung marker in relation to the displacement and PH rate.