Application Of Hook-wire Localization Technology In The Simultaneous Localization Of Two Lung Lesions

Objective: To evaluate the safety and efficacy of preoperative CT-guided Hookwire localization puncture in the simultaneous localization of both lung lesions before the performance of video-assisted thoracic surgery(VATS)resection.Meanwhile,to analyze the risk factors of pneumothorax associated with the localization puncture procedure and to evaluate the imaging risk factors of malignant lesions in the pulmonary nodules.Methods: This study collected the clinical and pathological data of 568 pulmonary nodules from 500 patients(218 males and 282 females aged 24 to 86 with an average age of 56.3 ±11.2 years)who underwent CT-guided Hook-wire localization before the performance of VATS between January 2015 and July 2017 in the first Affiliated Hospital of Dalian University.Of all the 500 patients,97 patients were go to see a doctor because of varying degrees of cough,expectoration,chest distress and other symptoms.Chest CT examination revealed pulmonary nodules.After systemic anti-inflammatory therapy,76 patients showed no obvious changes in chest HRCT.The other patients had no obvious symptoms,and the pulmonary nodules were found at the time of physical examination.Of all the 500 patients,36 had a history of cancer and received surgical treatment,including 23 cases of lung cancer,4 cases of thyroid cancer,7 cases of breast cancer,1 case of renal carcinoma and 1 case of rectal cancer.Among them,group A which represent double lesions include 136 nodules in 68 patients and group B which represent single lesions include 432 nodules in 432 patients.The incidence of pneumothorax associated with Hook-wire puncture in group A and B was calculated.The risk factors of pneumothorax associated with localization procedure was evaluated by multivariate logistic regression analysis.Meanwhile,The imaging features of HRCT which include type of lesion,maximum lesion size,lesion morphology and clinical data which include gender,age,etc were evaluated by univariate analysis and then the imaging risk factors of malignant pulmonary nodules were evaluated by logistic regression analysis.Results: All 136 thoracic nodules were successfully located before the performance of VATS and no serious complications occurred.Among them,twelve puncture needles were detached,but all the twelve lesions were successfully resected according to the location of the puncture needle during the operation and the bleeding point on the surface of the lung pleura and 136 nodules eventually acquired pathological diagnosis.Compared with group B,the average puncture location time of group A was significantly longer(P<0.001),the incidence of pneumothorax was higher(incidence rate was 33.8%,P=0.003),and univariate analysis showed that the number of positioning needle insertion(P=0.006),posture change(P=0.023)and lesion location(P=0.003)are risk factors that may lead to a relatively high incidence of pneumothorax in the simultaneous positioning of lung lesions.Multivariate logistic regression analysis showed that posture changes during the positioning process(OR: 2.632,P = 0.023)and bilateral lesions located in the same side of the lung(OR: 9.387,P<0.001)were the independent risk factors of pneumothorax.In the univariate analysis of clinical imaging findings and postoperative pathology of pulmonary nodules,the type of lesion(P<0.001),maximum diameter greater than or equal to 8 mm(P<0.001),with vascular access(P <0.001)and central high density(P <0.001),the possibility of malignant lesions with these imaging features is relatively high.Multivariate logistic regression analysis showed that: hybrid ground glass lesions(OR: 1.632,P = 0.014),lesion maximal diameter ? 8 mm(OR: 4.316,P = 0.002),with vascular access(OR: 3.927,P=0.001)and central high-density lesions(OR: 12.516,P<0.001)were imaging risk factors for malignant nodules of the lungs.Conclusions:(1)CT-guided Hook-wire localization in the simultaneous localization of two lung lesions before the performance of VATS is safe and effective.Postural changes and double lesions located in the ipsilateral lung are independent risk factors for pneumothorax in the simultaneous localization of two lung lesions.(2)Imaging features mixed ground glass lesions,lesion maximum diameter ? 8 mm,with vascular access and central high-density lesions were imaging risk factors for malignant nodules of the lungs.