Page 64 - JCTR-11-2

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

high success rates, and low complication rates, CT-guided carefully controlling the injection volume and speed to
pulmonary nodule localization needle and medical glue minimize glue diffusion; refining the glue formulation to
localization are commonly used in clinical practice. reduce its irritative properties; administering antitussive
However, comparative analyses of these two methods or anti-inflammatory medications preoperatively; and
are currently limited. This study included 86 cases, with providing prophylactic nebulization with budesonide post-
64 cases using the pulmonary nodule localization needle procedure to reduce glue-induced bronchial inflammation.
and 22 cases using medical glue. No pleural reactions or Moreover, for patients with chronic obstructive pulmonary
severe complications were observed in either group post- disease (COPD) or asthma, preoperative localization using
localization. Even when complications such as coughing the pulmonary nodule localization needle is preferred to
or pneumothorax occurred, the symptoms were mild and minimize the risk of exacerbating primary diseases due to
did not require intervention, suggesting that both the medical adhesive-induced coughing.
pulmonary nodule localization needle and medical glue Literature indicates that postlocalization with a needle
are safe and effective preoperative localization methods for may limit patient mobility; insufficient immobilization,
pulmonary nodules. However, significant differences were excessive movement during transfer, or prolonged lung
observed between the two groups in terms of localization collapse can increase the risk of dislodgement. A longer
time and complication rates (p<0.05). In analyzing the interval between localization and VATS resection is
complications, 1 case of pneumothorax occurred in associated with a higher rate of localization-related
the medical glue group, while 15 cases were reported in complications. In contrast, medical adhesive offers better
the localization needle group, indicating a statistically safety and stability, allowing for a longer interval between
significant difference (p<0.05). The medical glue, primarily localization and surgery, thereby providing more flexible
composed of cyanoacrylate, rapidly solidifies upon scheduling. 28,29 Patients also tolerate cyanoacrylate markers
injection into the lung parenchyma. When the puncture well following medical glue localization. Thus, medical
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needle is withdrawn, the solidified adhesive seals the glue is preferred when there is a long interval between
puncture tract, preventing air entry into the pleural cavity localization and surgery.
and reducing the incidence of pneumothorax. Therefore,
medical glue is recommended for elderly patients with Furthermore, a potential area for future improvement
conditions such as emphysema, bullae, or compromised involves the development of a decision-making algorithm
lung function. that integrates patient-specific pulmonary comorbidities
and anatomical factors to optimize the choice of localization
In this study, patients in the medical glue group reported
lower pain scores than those in the localization needle technique. For example, needle localization may be prone
to marker displacement due to lung mobility, particularly
group, with a statistically significant difference (p<0.05). in patients with conditions such as COPD or asthma.
This difference is likely attributed to the localization Recent advances in respiratory monitoring and control, as
needle moving with the patient’s breathing, coughing, or illustrated by a portable, noninvasive ventilator system
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positional changes, causing traction and stimulation of the demonstrate that incorporating sophisticated algorithms
lung tissue and pleura, which leads to pain. In contrast,
medical glue, being a liquid material, rapidly forms a solid and real-time monitoring into medical devices is feasible.
mass upon injection into the lung parenchyma, securing Such technological innovations could be adapted to refine
firmly without direct pleural contact, resulting in less pain. pulmonary nodule localization by tailoring the choice
Studies have shown that the pain associated with medical between needle and medical glue based on individual
patient characteristics. Future studies should explore the
glue localization is primarily due to the puncture injury and clinical utility of these decision-making tools to further
gradually diminishes over time. Reducing pain can help enhance the safety and efficacy of localization procedures.
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prevent pleural reactions, which is particularly beneficial
for patients with low pain tolerance. If a pulmonary nodule Analysis of this study suggests significant differences
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localization needle is used, adequate analgesia should between the pneumothorax and non-pneumothorax
be provided. In this study, 5 patients in the medical glue groups in terms of lung disease history, nodule size,
group experienced coughing, compared to 1 patient in the localization method, and puncture attempts. Patients
localization needle group, showing a significant difference with a history of pulmonary diseases, such as COPD
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(p<0.05). Researchers such as Tao et al. noted that the and emphysema, may exhibit compromised pleural
strong odor of medical glue could trigger irritation-induced integrity due to the destruction of alveolar elastic fibers
coughing, and rapid injection may also cause coughing. and the formation of pulmonary bullae. 32,33 Consequently,
Our findings are consistent with previous published these patients are more susceptible to pleural rupture
report. Potential strategies to mitigate this issue include: and subsequent pneumothorax during puncture or

Volume 11 Issue 2 (2025) 58 doi: 10.36922/JCTR025070007