Page 59 - JCTR-11-2

Journal of Clinical and
Translational Research CT-guided needle versus glue localization

1. Introduction Medical University from July 2023 to April 2024. Patients
were divided into two groups: the localization needle
Lung cancer, despite its global incidence ranking as the group (n=64) and the medical glue group (n=22).
second highest among cancers, remains the leading The allocation was based on specific medical criteria,
cause of cancer-related mortality worldwide. In China, including the nodule’s size, location, and imaging
1
lung cancer is the most prevalent cancer in terms of both characteristics, all of which could impact the feasibility
incidence and mortality. Advances in low-dose spiral
2
computed tomography (CT) and routine health screenings and safety of the localization technique. The preoperative
have improved early detection of lung cancer, increasing surgeon evaluated these factors and determined the most
the identification of small pulmonary nodules (SPNs), appropriate method for each patient in order to optimize
many of which represent early-stage cancer. SPNs can procedural outcomes. All cases involved solitary nodules,
3
be classified into solid and subsolid types, with the latter meaning only one pulmonary nodule was localized in
subclassified into pure and mixed ground-glass nodules. 4 each patient. The research received ethics committee
approval, and informed consent was obtained from all
Early-stage lung cancer is generally treated with participants.
surgical intervention, and video-assisted thoracoscopic
surgery (VATS) has become the preferred method for 2.2. Inclusion and exclusion criteria
resecting high-risk nodules due to its advantages over The inclusion criteria of this study were as follows:
open thoracotomy, including reduced trauma, faster (1) Lung nodule with a maximum diameter of ≤30 mm;
recovery, fewer complications, and the ability to obtain (2) A high likelihood of malignancy in the lung nodule,
definitive pathological diagnoses. However, accurately as indicated by nodule enlargement or an increase
5
localizing small or deeply situated nodules during VATS in solid components during follow-up and imaging
remains a significant challenge. Traditional methods using features such as lobulation, cavitation, or spiculation;
preoperative CT have a low success rate of approximately (3) The preoperative surgeon determined that accurate
30%, which can lead to extended surgical times,
6,7
conversion to open thoracotomy, or even surgical failure. localization via visual inspection or palpation during
surgery would be challenging (here, “palpation” refers
This highlights the need for more reliable preoperative to the intraoperative use of a single finger during
localization methods. 8,9
VATS to approximate the nodule’s location);
Accurate preoperative localization is crucial for (4) The nodule does not involve the pleura, hilum, or
achieving successful VATS outcomes, reducing the need mediastinum; and
for conversion to open thoracotomy, and improving (5) The patient is in a suitable condition for thoracoscopic
resection rates. Various techniques have been developed surgery.
to aid in preoperative localization, including the use of
medical glue, localization needles, iodized oil, indocyanine The exclusion criteria of this study were as follows:
green, and autologous blood. Among there, medical glue (1) Lung nodule with a maximum diameter of <5 mm or
10
and localization needles are commonly used due to their >30 mm;
simplicity, high success rates, and low complication rates. (2) Lesion located more than 40 mm from the visceral
However, there is limited comparative research evaluating pleura;
the efficacy and safety of these two methods. (3) Contraindications to puncture or surgical intervention;
(4) Patients with a history of thoracic surgeries, pleural
This study aims to comprehensively evaluate and effusion, or suspected pleural malignancy; and
compare CT-guided needle localization and CT-guided (5) Patients have a poor general condition, inability to
medical glue localization in terms of success rates, tolerate surgery, or other severe illnesses.
localization times, and complication rates. The goal is
to provide insights into selecting optimal preoperative 2.3. Puncture equipment
localization techniques for SPNs, ultimately improving the
safety and success of VATS. The puncture equipment used in this study included:
GE Lightspeed VCT 64-slice spiral CT scanner (GE
2. Materials and methods Healthcare, IL, USA), lung nodule localization needle
(20G × 100 mm, model SS50-10) (Ningbo Shengjiekang
2.1. Study subjects Biotechnology Co., Ltd, China), medical glue (endoscopic
This retrospective study analyzed 86 patients who type/1.5 mL) (Compont, China); TSK semi-automatic
underwent preoperative lung nodule localization prior percutaneous lung biopsy needle (18G × 160 mm) (Tokyo
to VATS at the First Affiliated Hospital of Guangxi Seimitsu Kogyo K.K., Japan).

Volume 11 Issue 2 (2025) 53 doi: 10.36922/JCTR025070007