Umakoshi Noriyuki, Iguchi Toshihiro, Ujike Hiroyuki, Mitsuhashi Toshiharu, Matsui Yusuke, Tomita Koji, Okamoto Soichiro, Munetomo Kazuaki, Sugimoto Seiichiro, Toyooka Shinichi, Hiraki Takao
Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-Cho, Kitaku, Okayama, 700-8558, Japan.
Department of Radiological Technology, Faculty of Health Sciences, Okayama University, Okayama, Japan.
Jpn J Radiol. 2025 May 29. doi: 10.1007/s11604-025-01807-4.
Although preoperative marking is often required to accurately locate the targets for video-assisted thoracic surgery, target lesions can be identified intraoperatively without marking in some cases; however, the frequency and characteristics of these lesions remain unclear. Therefore, we aimed to retrospectively evaluate the need for a short hookwire for preoperative localization of small pulmonary lesions.
Computed tomography (CT)-guided short hookwire placement was performed for 176 lesions (mean diameter, 7.9 ± 3.5 mm) in 171 sessions prior to video-assisted thoracoscopic surgery. Placement was performed if one or more of the following CT findings were present: lesions (1) ≤ 10 mm in diameter; (2) ≥ 5 mm from the pleural surface, and (3) predominantly consisting of ground-glass opacity. The need for a hookwire for intraoperative lesion detection was retrospectively assessed based on surgical records. Factors associated with the absence of a hookwire for lesion detection were determined using univariate and multivariate analyses.
Placement was successful in all cases; however, the hookwire was dislodged at the time of surgery in four lesions (2%). Among the remaining 172 lesions, thoracoscopic resection was performed using a hookwire as a landmark in 101 lesions (58.7%), whereas 71 lesions (41.3%) were detectable without a hookwire. Previous ipsilateral lung resection significantly increased the odds of not needing a hook wire (OR 4.24; P = 0.005). Larger target lesions (mean, 8.4 vs. 7.1 mm) and those located further from the pleura (mean, 13.3 vs. 8.0 mm) were associated with an increased need for hook wires. Multivariate analysis revealed that experienced surgeons required more hookwires compared to trainees (P = 0.029). Solid nodules did not require hookwires (P = 0.032).
Shallow solid lesions in patients with a history of ipsilateral lung resection may not require hookwire placement during resection, even if they are small.
尽管电视辅助胸腔镜手术通常需要术前标记以准确定位目标，但在某些情况下，目标病变可在术中无需标记即可识别；然而，这些病变的发生率和特征仍不清楚。因此，我们旨在回顾性评估短钩丝用于小肺病变术前定位的必要性。
在电视辅助胸腔镜手术前，对171例患者的176个病变（平均直径7.9±3.5mm）进行了计算机断层扫描（CT）引导下的短钩丝置入。如果出现以下一项或多项CT表现，则进行置入：病变（1）直径≤10mm；（2）距胸膜表面≥5mm，以及（3）主要由磨玻璃影组成。根据手术记录回顾性评估术中病变检测对钩丝的需求。使用单因素和多因素分析确定与未使用钩丝进行病变检测相关的因素。
所有病例置入均成功；然而，有4个病变（2%）在手术时钩丝移位。在其余172个病变中，101个病变（58.7%）使用钩丝作为标志物进行了胸腔镜切除，而71个病变（41.3%）无需钩丝即可检测到。既往同侧肺切除术显著增加了不需要钩丝的几率（OR 4.24；P=0.005）。较大的目标病变（平均8.4 vs. 7.1mm）和距胸膜较远的病变（平均13.3 vs. 8.0mm）对钩丝的需求增加。多因素分析显示，与实习生相比，经验丰富的外科医生需要更多的钩丝（P=0.029）。实性结节不需要钩丝（P=0.032）。
有同侧肺切除史患者的浅表实性病变在切除时可能不需要放置钩丝，即使病变较小。
