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Original Research: Lung Cancer |

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

Chul Hwan Park, MD; Kyunghwa Han, PhD; Jin Hur, MD, PhD; Sang Min Lee, MD; Ji Won Lee, MD, PhD; Sung Ho Hwang, MD, PhD; Jae Seung Seo, MD; Kye Ho Lee, MD; Woocheol Kwon, MD, PhD; Tae Hoon Kim, MD, PhD; Byoung Wook Choi, MD, PhD
Author and Funding Information

Drs Park and Han contributed equally to this manuscript.

FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

aDepartment of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

bDepartment of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

cDepartment of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

dDepartment of Radiology, Pusan National University Hospital, Pusan, Republic of Korea

eDepartment of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea

fDepartment of Radiology, Chung-Ang University Medical Center, Chung-Ang University College of Medicine, Seoul, Republic of Korea

gDepartment of Radiology, Dankook University Hospital, Cheonan, Chungnam Province, Republic of Korea

hDepartment of Radiology, Wonju Severance Christian Hospital, Wonju, Republic of Korea

CORRESPONDENCE TO: Jin Hur, MD, PhD, Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(2):316-328. doi:10.1016/j.chest.2016.09.017
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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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