CT Guided Hook-Wire Localization For Small Pulmonary Nodules:Clinical Application,Occurrence And Prevention Of Complications

Purpose:To retrospectively evaluate CT guided Hook-wire localization technique in patients with clinical and imaging data,aiming to explore the risk factors of complications,improving the clinical application of detail process.Materials and methods:Retrospectively,we analyzed retrospectively from January 2016 to December 2016,143 patients data with small SPNs needing CT-guided hook-wire localization.105 Female and 38 male is included,The age range is from 29 to 82(mean age,57.31±11.07).Including 121 patients with a single location,with multiple location 22 people,166 lesions were positioned.Hook-wire positioning technique process:First,preoperative patients with recent Lung thin slice image is acquired,using Lung VCAR 3D Lung Analysis software of GE ADW4.6 for post-processing reconstruction.Analyzing the characteristics of the nodules to determine the plan of CT-guided hook-wire localization technique.Intraoperative under CT guidance,according to the established plan for patients with puncture positioning.Then,acquiring the axial CT imaging of the location zone,the 3D reconstruction Imaging are send to the doctor for surgery.Finally,the patient's clinical data and imaging data are collected and analyzed.Multiple variables related to the patients,lesions,and procedures were assessed to determine the risk factors for complications.clinical indicators include:gender,age,height,weight,BMI(body mass index)and Fevl%,tumor pathology type.Imaging acquisition of data include:patient position,lesion lobar location,number of the hook wires used,size,distance to the nearest pleura of nodule,needle depth in the subcutaneous tissue,the intrapulmonary depth of the puncture needle,the intrapulmonary depth of the Hook-wire,and whether or not the needle is close to the ribs.Combining Hook-wire positioning postoperative complications such as pneumothorax,pulmonary hemorrhage,drop out happening using spss19.0 software for statistical analysis,P values are less than 0.05 was considered statistically significant results.Results:1.2 cases of Wire dislocation occurred before the operation,with a success rate of 98.8%.2.The incidence of pneumothorax and pulmonary hemorrhage was 37.34%(62 of 166 sessions),31.32%(52 of 166 sessions),respectively.3.Surgical pathology results:5 cases of hamartoma,2 cases of pulmonary lymph nodes,1 cases of tuberculous nodule and 14 cases of inflammatory.12 cases of AAH(atypical adenomatous hyperplasia),36 cases of AIS(adenocarcinoma in situ)36 cases,67 cases of MIA(micro infiltrating adenocarcinoma),28 cases of IA(infiltrating adenocarcinoma)and 1 cases of metastatic tumor.4.For pneumothorax,risk factors included the distance to pleura from the front edge(p = 0.002),the back edge(p=0.006),the center(p = 0.003)of lesion,patient position(p=0.014),number of the hook wires used(p = 0.001,OR=4.81),the needle close to the ribs(p=0,OR=6.146).5.For pulmonary hemorrhage,risk factors included the intrapulmonary depth of the puncture needle(p = 0.003)and the intrapulmonary depth of the Hook-wire(p = 0.044).Conclusion:According to the results we can draw a conclusion:The risk factors of pneumothorax included the distance to pleura from the front edge,the back edge,the center of lesion.The risk factors of pulmonary hemorrhage associated with the intrapulmonary depth of the puncture needle or the intrapulmonary depth of the Hook-wire.Above all,CT guided Hook-wire Localization technique is a safe and effective preoperative localization method.Complications related to CT guided preoperative Hook-wire placement often occurred,but all complications were minor.