title: Usefulness of CT-guided hookwire marking before video-assisted thoracoscopic surgery for small pulmonary lesions.
abstract: OBJECTIVE
  The aim of this study was to evaluate the technical and clinical efficacy and safety of CT-guided hookwire marking before video-assisted thoracoscopic surgery (VATS) for small pulmonary lesions.
  
  
  METHODS
  This procedure was performed on 161 lesions in 154 patients (75 men and 79 women; median age, 62 years; age range 23-89 years). Medical records and images were reviewed, and the technical success rate, surgical success rate and complications were evaluated. Technical success was defined as successful hookwire marking at the target site without marker dropping before VATS. Surgical success was defined as negative surgical margins on pathological examination after VATS.
  
  
  RESULTS
  There were 97 nodules and 64 ground-glass opacities, and their mean size was 9.8 mm (range 2-34). The technical success rate was 97.5% (157/161). In three of the four failed cases, another hookwire marker was placed, and in the remaining case, VATS was performed without a marker. The surgical success rate was 98.1% (158/161). In the three failed cases, the margin was positive, so lung lobectomy was performed in one case, and the other two cases were observed carefully. Complication rates were as follows: pneumothorax, 37.9% (61/161); focal intrapulmonary haemorrhage, 34.8% (58/139); haemoptysis, 0.6% (1/161); haemothorax, 0% (0/161); air embolism, 0.6% (1/161); dissemination, 0% (0/161); and death, 0% (0/161).
  
  
  CONCLUSIONS
  CT-guided hookwire marking appears to be useful for VATS, but the procedure may, although rarely, cause severe complications such as air embolism.
authors.affiliation: Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Kazushi
authors.initials: K
authors.lastname: Suzuki
authors.forename: Masashi
authors.initials: M
authors.lastname: Shimohira
authors.forename: Takuya
authors.initials: T
authors.lastname: Hashizume
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Ozawa
authors.forename: Ryoji
authors.initials: R
authors.lastname: Sobue
authors.forename: Mikio
authors.initials: M
authors.lastname: Mimura
authors.forename: Yuji
authors.initials: Y
authors.lastname: Mori
authors.forename: Hidenori
authors.initials: H
authors.lastname: Ijima
authors.forename: Kenichi
authors.initials: K
authors.lastname: Watanabe
authors.forename: Motoki
authors.initials: M
authors.lastname: Yano
authors.forename: Hiromu
authors.initials: H
authors.lastname: Yoshioka
authors.forename: Yuta
authors.initials: Y
authors.lastname: Shibamoto
mesh_terms: D000328:Adult; D000368:Aged; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D057918:Fiducial Markers; D006801:Humans; D007089:Image Enhancement / Q000295:instrumentation; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000295:instrumentation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted / Q000295:instrumentation* / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
keywords: CT-guided marking; air embolism; hookwire; video-assisted thoracic surgery