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Original Research |

Comparative effectiveness and safety of pre-operative 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
Author and Funding Information

Summary conflict of interest statement: Nothing to declare

Funding information: None

1Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

2Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

3Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

4Department of Radiology, Pusan National University Hospital, Pusan, Republic of Korea

5Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea

6Department of Radiology, Chung-Ang University Medical Center, Chung-Ang University College of Medicine, Seoul, Republic of Korea

7Department of Radiology, Dankook University Hospital, Cheonan, Chungnam Province, Republic of Korea

8Department of Radiology, Wonju Severance Christian Hospital, Wonju, Republic of Korea

Address 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, . All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.09.017
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Abstract

Background  An optimal method of pre-operative 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.

Materials and Methods  We searched the PubMed, MEDLINE, and EMBASE databases for prospective or retrospective English language studies of VATS localization in adult patients. A non-comparative, 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 (95% confidence interval [CI]) for hook wire, microcoil, and lipiodol localization were 0.98 (0.97,0.99), 0.98 (0.96,0.99), and 0.99 (0.98,1.00), respectively, with corresponding successful operative field targeting rates (95% CI) of 0.94 (0.91,0.96), 0.97 (0.95,0.98), and 0.99 (0.98,1.00), respectively. In addition, the successful VATS rates (95% CI) with hook wire, microcoil, and lipiodol localization were 0.96 (0.94,0.97), 0.97 (0.94,0.99), and 0.99 (0.98,1.00), respectively. Regarding complications, hook wire, microcoil, and lipiodol localization were associated with pneumothorax rates (95% CI) of 0.35 (0.28,0.43), 0.16 (0.07,0.34), and 0.27 (0.19,0.37), respectively and hemorrhage rates (95% CI) of 0.16 (0.11,0.23), 0.06 (0.03,0.11), and 0.10 (0.06,0.15), respectively.

Conclusion  All three localization methods yielded similarly high 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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