title: Efficacy and complications of computed tomography-guided hook wire localization.
abstract: BACKGROUND
  Video-assisted thoracic surgery offers a minimally invasive method for diagnosing and treating small pulmonary lesions, although the localization of these lesions is sometimes problematic. Various localization methods have been reported but few studies have described their efficacy and adverse events.
  
  
  METHODS
  We performed computed tomography (CT)-guided localization using a hook wire in 417 patients with 500 lesions treated between January 2006 and December 2010.
  
  
  RESULTS
  We located 178 lesions with a ground-glass opacity component and 322 solid lesions. The solid lesions had smaller tumor diameters and were located further from the pleura. Tumor depth to size ratio was 0.9 ± 0.9 for the lesions with a ground-glass opacity component and 1.8 ± 1.5 for the solid lesions (p < 0.001). Pneumothorax requiring aspiration was observed in 4.6% patients, and hemoptysis and pulmonary hematoma was observed in 10.3%. Systemic air embolism with no sequelae and spontaneous resolution occurred in a patient (0.24%). The morbidity rate was 15.1%. Male patients, patients who had undergone multiple localization, and heavy smokers were at a higher risk of pneumothorax requiring aspiration. Insertion distance more than 25 mm was a risk factor for hemoptysis and pulmonary hematoma (p < 0.001). Procedure duration per lesion was 14 ± 5 minutes. Dislodgement occurred in 2 patients (0.4%).
  
  
  CONCLUSIONS
  The safety, reliability, and convenience of CT-guided hook wire localization are acceptable. Localization for lesions with a ground-glass opacity component may be performed when the lesions are relatively large and shallow. Insertion distances greater than 25 mm are associated with a risk of pulmonary hematoma and hemoptysis.
authors.affiliation: Department of Thoracic Surgery, Toranomon Hospital, Minato-ku, Tokyo, Japan. Electronic address: i_junji@ba2.so-net.ne.jp.
authors.forename: Junji
authors.initials: J
authors.lastname: Ichinose
authors.affiliation: Department of Thoracic Surgery, Toranomon Hospital, Minato-ku, Tokyo, Japan.
authors.forename: Tadasu
authors.initials: T
authors.lastname: Kohno
authors.affiliation: Department of Thoracic Surgery, Toranomon Hospital, Minato-ku, Tokyo, Japan.
authors.forename: Sakashi
authors.initials: S
authors.lastname: Fujimori
authors.affiliation: Department of Thoracic Surgery, Toranomon Hospital, Minato-ku, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Harano
authors.affiliation: Department of Thoracic Surgery, Toranomon Hospital, Minato-ku, Tokyo, Japan.
authors.forename: Souichiro
authors.initials: S
authors.lastname: Suzuki
mesh_terms: D019937:Diagnostic Techniques and Procedures / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed
keywords: 11