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

 Chul Hwan Park  ;  Kyunghwa Han  ;  Jin Hur  ;  Sang Min Lee  ;  Ji Won Lee  ;  Sung Ho Hwang  ;  Jae Seung Seo  ;  Kye Ho Lee  ;  Woocheol Kwon  ;  Tae Hoon Kim  ;  Byoung Wook Choi 
 CHEST, Vol.151(2) : 316-328, 2017 
Journal Title
Issue Date
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
hook-wire ; lipiodol ; localization ; lung nodule ; microcoil
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.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Tae Hoon(김태훈) ORCID logo https://orcid.org/0000-0003-3598-2529
Park, Chul Hwan(박철환) ORCID logo https://orcid.org/0000-0002-0004-9475
Choi, Byoung Wook(최병욱) ORCID logo https://orcid.org/0000-0002-8873-5444
Hur, Jin(허진) ORCID logo https://orcid.org/0000-0002-8651-6571
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