Targeting Pulmonary Nodules Prior to Video-Assisted Thoracic Surgery: Comparison of Two Different Techniques.

[OBJECTIVES] The increasing use of CT imaging and the implementation of lung cancer screening have led to a rising detection of pulmonary nodules. Accurate management requires reliable localization techniques enabling pathological diagnosis and potential curative resection. This study compared hook-wire localization and cone-beam computed tomography (CBCT)-guided detection in terms of diagnostic yield.

[METHODS] A retrospective analysis was performed in 2 French academic centres, including 260 patients with 266 nodules (January 2012-May 2019). The primary end-point was diagnostic yield, defined as the proportion of successfully localized nodules. Secondary end-points included localization and operative times, peri- and postoperative complications, chest tube duration, and hospital stay.

[RESULTS] Diagnostic yield was 88.0% with hook-wire localization and 96.9% with CBCT, corresponding to an absolute difference of 8.9% (95% CI, -0.2 to 17.9; P = .053). Complication rates (P = .63), drainage duration (P = .13), and hospital stay (P = .16) did not differ between groups. Operative time (P = .042) and localization time (P = .001) were significantly longer with CBCT and hook-wire, respectively.

[CONCLUSIONS] Hook-wire and CBCT localization demonstrated comparable diagnostic yields and acceptable safety profiles. CBCT required longer operative room utilization, whereas hook-wire placement was performed in the radiology department, saving resources for other surgeries.