title: CT-guided percutaneous hookwire localization increases the efficacy and safety of VATS for pulmonary nodules.
abstract: OBJECTIVE
  The diagnosis of pulmonary nodules of unknown origin is challenging, and such nodules are not always suitable for transthoracic needle biopsy. With the advent of video assisted thoracic surgery (VATS) and CT-guided percutaneous hookwire localization (CT-PHL) we hypothesized that the combination of these two procedures will improve early diagnosis.
  
  
  METHODS
  Selection criteria were a nodule not well approachable with fine needle biopsy and the therapeutic consequences of a diagnosis as assessed by the multidisciplinary oncology board. Efficacy and safety of the combination of CT-PHL prior to VATS was studied in terms of, histological diagnosis, complete resection rate, complications, conversion rate to thoracotomy, and duration of procedures.
  
  
  RESULTS
  A total of 150 pulmonary nodules were located and resected in 150 patients. The median nodule diameter was 9 mm (range 4-24) and located within 30 mm of the pleural surface (median 7, range 0-29). The resection was complete in 96%, and in 100% a definitive histological diagnosis was obtained. Complications requiring intervention during the CT-procedure occurred in 11 patients (7.3%). Complications of VATS consisted of major complications (2.0%) and minor complications (4.0%). The 30 Day mortality was 1.4% and in hospital mortality 0.7%. Conversion to thoracotomy occurred in 4.7% patients. Median CT-localization time was 25 min (range 5-72), median VATS time was 49 min (range 14-169).
  
  
  CONCLUSIONS
  CT-PHL is a very efficient and safe procedure prior to VATS for pulmonary nodules and allows in 96% radical resection with a diagnostic accuracy of 100%.
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Theo J
authors.initials: TJ
authors.lastname: Klinkenberg
authors.affiliation: Department of Pulmonary Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Lars
authors.initials: L
authors.lastname: Dinjens
authors.affiliation: Department of Pulmonary Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.|Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Rienhart F E
authors.initials: RFE
authors.lastname: Wolf
authors.affiliation: Department of Pulmonary Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Anthonie J
authors.initials: AJ
authors.lastname: van der Wekken
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Caroline
authors.initials: C
authors.lastname: van de Wauwer
authors.affiliation: Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Geertruida H
authors.initials: GH
authors.lastname: de Bock
authors.affiliation: Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Wim
authors.initials: W
authors.lastname: Timens
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Massimo A
authors.initials: MA
authors.lastname: Mariani
authors.affiliation: Department of Pulmonary Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Harry J M
authors.initials: HJM
authors.lastname: Groen
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008171:Lung Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D055613:Multiple Pulmonary Nodules / Q000000981:diagnostic imaging* / Q000601:surgery*; D061646:Operative Time; D011183:Postoperative Complications; D011446:Prospective Studies; D015641:Radiography, Interventional / Q000295:instrumentation*; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy
keywords: VATS; hookwire localization; lung cancer; metastasectomy; pulmonary nodule; wedge resection