Comparative Effectiveness and Safety of Preoperative Lung Localization for Pulmonary Nodules: A Systematic Review and Meta-analysis

Chest. 2017 Feb;151(2):316-328. doi: 10.1016/j.chest.2016.09.017. Epub 2016 Oct 4.

Abstract

Background: An optimal method of preoperative localization for pulmonary nodules has yet to be established. This systematic review and meta-analysis aimed to compare the success and complication rates associated with three pulmonary nodule localization methods for video-assisted thoracoscopic surgery (VATS): hook-wire localization, microcoil localization, and lipiodol localization.

Methods: We searched the PubMed, MEDLINE, and EMBASE databases for prospective or retrospective English language studies of VATS localization in adult patients. A noncomparative, random effects model-based meta-analysis was performed to obtain pooled success and complication rates for the three localization methods.

Results: A total of 46 clinical studies were enrolled, including 30, 9, and 7 studies of hook-wire, microcoil, and lipiodol localization, respectively. The successful targeting rates for hook-wire, microcoil, and lipiodol localization were 0.98 (95% CI, 0.97-0.99), 0.98 (95% CI, 0.96-0.99), and 0.99 (95% CI, 0.98-1.00), respectively, with corresponding successful operative field targeting rates of 0.94 (95% CI, 0.91-0.96), 0.97 (95% CI, 0.95-0.98), and 0.99 (95% CI, 0.98-1.00), respectively. In addition, the successful VATS rates with hook-wire, microcoil, and lipiodol localization were 0.96 (95% CI, 0.94-0.97), 0.97 (95% CI, 0.94-0.99), and 0.99 (95% CI, 0.98-1.00), respectively. Regarding complications, hook-wire, microcoil, and lipiodol localization were associated with pneumothorax rates of 0.35 (95% CI, 0.28-0.43), 0.16 (95% CI, 0.07-0.34), and 0.31 (95% CI, 0.20-0.46), respectively and hemorrhage rates of 0.16 (95% CI, 0.11-0.23), 0.06 (95% CI, 0.03-0.11), and 0.12 (95% CI, 0.05-0.23), respectively.

Conclusions: All three localization methods yielded similarly highly successful targeting rates. However, hook-wire localization had a relatively lower successful operative field targeting rate because of dislodgement or migration. Lipiodol localization had the highest overall success rate, and microcoil localization yielded the lowest complication rates.

Keywords: hook-wire; lipiodol; localization; lung nodule; microcoil.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Contrast Media
  • Ethiodized Oil
  • Humans
  • Pneumothorax / epidemiology
  • Postoperative Complications / epidemiology
  • Postoperative Hemorrhage / epidemiology
  • Solitary Pulmonary Nodule / diagnostic imaging
  • Solitary Pulmonary Nodule / pathology
  • Solitary Pulmonary Nodule / surgery*
  • Surgery, Computer-Assisted
  • Surgical Instruments
  • Thoracic Surgery, Video-Assisted / methods*
  • Tomography, X-Ray Computed

Substances

  • Contrast Media
  • Ethiodized Oil