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

• Published in: Chest Vol. 151; no. 2; pp. 316 - 328
• Main Authors: Park, Chul Hwan, Han, Kyunghwa, Hur, Jin, Lee, Sang Min, Lee, Ji Won, Hwang, Sung Ho, Seo, Jae Seung, Lee, Kye Ho, Kwon, Woocheol, Kim, Tae Hoon, Choi, Byoung Wook
• Format: Journal Article
• Language: English
• Published: United States 01-02-2017
• Subjects: 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; localization; microcoil; hook-wire; lung nodule; lipiodol
• ISSN: 1931-3543
• DOI: 10.1016/j.chest.2016.09.017

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.
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.
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.
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.