Preoperative short hookwire placement for small pulmonary lesions: evaluation of technical success and risk factors for initial placement failure
To retrospectively evaluate the technical success of computed tomography fluoroscopy-guided short hookwire placement before video-assisted thoracoscopic surgery and to identify the risk factors for initial placement failure.
In total, 401 short hookwire placements for 401 lesions (mean diameter 9.3 mm) were reviewed. Technical success was defined as correct positioning of the hookwire. Possible risk factors for initial placement failure (i.e., requirement for placement of an additional hookwire or to abort the attempt) were evaluated using logistic regression analysis for all procedures, and for procedures performed via the conventional route separately.
Of the 401 initial placements, 383 were successful and 18 failed. Short hookwires were finally placed for 399 of 401 lesions (99.5%). Univariate logistic regression analyses revealed that in all 401 procedures only the transfissural approach was a significant independent predictor of initial placement failure (odds ratio, OR, 15.326; 95% confidence interval, CI, 5.429–43.267; p < 0.001) and for the 374 procedures performed via the conventional route only lesion size was a significant independent predictor of failure (OR 0.793, 95% CI 0.631–0.996; p = 0.046).
The technical success of preoperative short hookwire placement was extremely high. The transfissural approach was a predictor initial placement failure for all procedures and small lesion size was a predictor of initial placement failure for procedures performed via the conventional route.
• Technical success of preoperative short hookwire placement was extremely high.
• The transfissural approach was a significant independent predictor of initial placement failure for all procedures.
• Small lesion size was a significant independent predictor of initial placement failure for procedures performed via the conventional route.
KeywordsLung Video-assisted thoracoscopic surgery Pulmonary nodule Preoperative localization Interventional radiology
Video-assisted thoracoscopic surgery
Forced expiratory volume in 1 s
The authors thank Toshiharu Mitsuhashi for his assistance with the statistical analyses. The work was supported by the Center for Innovative Clinical Medicine, Okayama University Hospital.
Compliance with ethical standards
The scientific guarantor of this publication is Prof. Susumu Kanazawa, Department of Radiology, Okayama University Medical School.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
The authors state that this work did not received any funding.
Statistics and biometry
Toshiharu Mitsuhashi kindly provided statistical advice for this manuscript.
Institution: Center for Innovative Clinical Medicine, Okayama University Hospital
Address: 2-5-1 Shikata-cho, kita-ku Okayama 700-8558, Japan
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained (approval no KEN1708-002).
Study subject or cohort overlap
Our previous study investigating the safety of the short hookwire placement procedure included 267 procedures (Eur Radiol 2016;26:114–121). The purpose of this study (i.e., evaluation of the technical success and risk factors for initial placement failure) differs from that of the previous study (i.e., evaluation of safety and risk factors for procedural pneumothorax). Additionally, the complications observed in one patient have been described in a previous case report (Cardiovasc Intervent Radiol 2015;38:1346–1348).
• diagnostic or prognostic study
• performed at one institution
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