The Correlations Between The Clinical Characteristcs, Imaging Features Of Small Pulmonary Nodules Less Than 10mm Undergone Hook-wire Localization And Pathology

Objective:To analyze the correlations between the clinical characteristcs, imaging features of small pulmonary nodules(SPNs) less than 10mm which had undergone preoperative hook-wire localization and pathology, and investigate the efficiency and safety of Hook-wire.Methods:We performed retrospective analysis of 81 SPNs less than 10mm underwent CT-guided hook-wire localizatin befrore video-assisted thoracoscopic surgery(VATS) in the First Hospital Affiliated to Zhejiang University School of Medicine from January 1 st,2010 to November 31 st,2013. We reviewed the correlations between the clinical characteristcs, imaging features and pathology of 81 SPNs.Results:A total of 81 SPNs were evaluated. There were 24 chronic inflammation,27 atypical adenomatous hyperplasia (AAH) and 30 cancerous small pulmonary nodules, respectively. The malignant rate of patients who were more than 60 years old, male, smoking was 68.8%,46.1% and 45.5%, respectively, and tended to be malignant (P<0.05,0.01). The difference of cancerous SPN occurrence rate with or without tumar history and increase level of serum CEA had no statistical significance (P>0.05). Through CT scan, the malignant rate of SPNs which had ambiguous edge, glitches, pleural indentation, location of the upper lobe and diameter more than 6mm was 50%, 61.9%,60%,48.8%and 51.1%, respectively, and tended to be malignant(P<0.01,0.05). The malignant rate of pure ground-glass opacity(PGGO,42.8%), part-solid nodules (52.6%) was much higher than solid nodules(26.8%), respectively(P<0.01). The difference of SPN malignant rate with or without leaflet, vacuoles, and vessel gathering had no statistical significance (P>0.05).21 cases of pGGO included 11 cases of AAH,8 cases of adenocarcinoma,1 case of inflammatory lesions,1 case of poorly differentiated neuroendocrine carcinoma.19 cases of part-solid nodules included 10 cases of adenocarcinoma,7 cases of AAH,2 cases of inflammatory lesions.41 cases of solid nodules included 21 cases of inflammatory lesions,9 cases of AAH,9 cases of adenocarcinoma,2 cases of squamous cell carcinomas. Eighty SPNs (98.8%) were localized successfully, the mean time of localization was 12±5min. One patient had asymptomatic minimal pneumothoraces, one patient had pulmonary hematoma, and one patient had mild chest pain. The mean time of VATS was 38±9min. Conversion thoracotomy was required in one patient.Conlusion:SPNs less than 10mm undergo hook-wire localization have imaging features including glitches, ambiguous edge, pleural indentation, locate in the upper lobe and diameter more than 6mm tend to be malignant. Sub-solid nodules are more probably be to malignant than solid nodules. PGGO is more probably be to AAH, part-solid nodule is more probably be to adenocarcinoma, solid nodule is more probably be to inflammatory lesion. VATS of SPN previously localized by a CT-guided hook-wire is related to a short operation time, a low conversion thoracotomy rate, and a good safety, and it is well suited for the clarification of SPN less than 10mm.