A nomogram model for predicting pneumothorax after CT-guided localization of pulmonary nodules using autologous blood and methylene blue.

BACKGROUND

The widespread use of low-dose chest computed tomography (CT) has significantly increased the early detection rate of small nodules. Existing localization methods have certain limitations. Preoperative localization using autologous blood combined with methylene blue has garnered attention due to its dual advantages. This study aims to evaluate the safety and pneumothorax risk of CT-guided preoperative localization using this technique and explore the risk factors associated with pneumothorax occurrence.

METHODS

This retrospective study included 112 patients who underwent CT-guided preoperative lung nodule localization using autologous blood and methylene blue between November 2019 and November 2024 at The First Hospital of Putian. Patient demographics, imaging characteristics, procedural details, and post-localization complications were collected. Logistic regression was used to analyze the independent risk factors for pneumothorax.

RESULTS

The localization success rate was 90.2%, and the pneumothorax incidence was 16.1%. Multivariate analysis identified white blood cell (WBC) count [odds ratio (OR) 1.43, 95% confidence interval (CI): 1.06-1.96, P=0.02] and the needle-tip-to-visceral-pleura distance (OR 2.36, 95% CI: 1.07-5.44, P=0.04) as independent risk factors for pneumothorax. A predictive nomogram model with an area under the receiver operating characteristic (ROC) curve (AUC) of 0.762 was developed, demonstrating good predictive performance.

CONCLUSIONS

Autologous blood combined with methylene blue is a safe and effective localization method for lung nodules. WBC count and needle-tip-to-visceral-pleura distance are independent risk factors for pneumothorax. The nomogram model provides valuable assistance for preoperative risk assessment.