title: Preoperative Pulmonary Nodule Localization: A Comparison of Methylene Blue and Hookwire Techniques.
abstract: OBJECTIVE
  Small pulmonary nodules are often difficult to identify during thoracoscopic resection, and preoperative CT-guided localization performed using either hookwire placement or methylene blue injection can be helpful. The purpose of this study is to compare the localization success and complication rates of these two techniques.
  
  
  METHODS
  One hundred two consecutive patients who underwent a total of 109 localization procedures performed with CT fluoroscopic guidance were analyzed. The procedures included 52 hookwire insertions and 57 methylene blue injections. The localization success and complication rates associated with the two groups were compared.
  
  
  RESULTS
  All nodules in both groups were identified intraoperatively, except for those in two patients in the hookwire group who did not proceed to undergo same-day surgery, including one with a massive systemic air embolus that resulted in death. Hookwires were dislodged in seven of 52 cases (13%), but the surgeons were still able to locate the nodules through visualization of the parenchymal puncture sites. The total number of complications was higher in the hookwire insertion group than in the methylene blue injection group, but this trend was not statistically significant, with all types of complications occurring in 28 cases (54%) versus 26 cases (46%) (p = 0.45), major complications noted in four cases (8%) versus one case (2%) (p = 0.19), pneumothorax observed in 20 cases (38%) versus 14 cases (25%) (p = 0.15), and perilesional hemorrhage occurring in six cases (12%) versus two cases (4%) (p = 0.15), respectively.
  
  
  CONCLUSIONS
  The present study suggests that methylene blue injection and hookwire insertion are statistically equivalent for preoperative pulmonary nodule localization; however, seven of 52 hookwires dislodged, and trends toward more frequent and severe complications were noted in the hookwire insertion group.
authors.affiliation: 1 Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave, E3/311, Madison, WI 53792.
authors.forename: Mark
authors.initials: M
authors.lastname: Kleedehn
authors.affiliation: 1 Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave, E3/311, Madison, WI 53792.
authors.forename: David H
authors.initials: DH
authors.lastname: Kim
authors.affiliation: 1 Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave, E3/311, Madison, WI 53792.|2 Department of Medical Physics, University of Wisconsin-Madison, Madison, WI.
authors.forename: Fred T
authors.initials: FT
authors.lastname: Lee
authors.affiliation: 1 Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave, E3/311, Madison, WI 53792.
authors.forename: Meghan G
authors.initials: MG
authors.lastname: Lubner
authors.affiliation: 1 Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave, E3/311, Madison, WI 53792.
authors.forename: Jessica B
authors.initials: JB
authors.lastname: Robbins
authors.affiliation: 1 Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave, E3/311, Madison, WI 53792.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Ziemlewicz
authors.affiliation: 1 Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave, E3/311, Madison, WI 53792.|3 Department of Urology, University of Wisconsin-Madison, Madison, WI.
authors.forename: J Louis
authors.initials: JL
authors.lastname: Hinshaw
mesh_terms: D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008751:Methylene Blue; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D013194:Staining and Labeling / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods; D013906:Thoracoscopy / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D008751:Methylene Blue
keywords: CT-guided; air embolism; hookwire; lung nodule localization; methylene blue