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.
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.
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.