Preoperative computed tomography guided coil versus suture hook-wire localization for multiple pulmonary nodules

Preoperative computed tomography guided coil versus suture hook-wire localization for multiple pulmonary nodules | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Preoperative computed tomography guided coil versus suture hook-wire localization for multiple pulmonary nodules Yue Dou, Hai-Hong Song, Yi-Bing Shi, Yong-Guang Gao, Sheng-Jie Bai This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5870288/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 Jun, 2025 Read the published version in World Journal of Surgical Oncology → Version 1 posted 13 You are reading this latest preprint version Abstract Background Computed tomography (CT)-guided coil and suture hook-wire (SHW) insertion are widely employed for the preoperative localization of multiple pulmonary nodules (PNs). However, the comparative effectiveness and safety of these two techniques remain unclear. This study aimed to probe the clinical efficacy and safety of coil and SHW-based preoperative localization in patients with multiple PNs. Methods Patients with multiple PNs who underwent CT-guided coil or SHW localization prior to video-assisted thoracic surgery (VATS) resection between January 2020 and December 2024 were enrolled retrospectively. Localization outcomes and VATS-related parameters were compared. Results A total of 35 patients (76 PNs) in the coil group and 37 patients (81 PNs) in the SHW group were included. Technical success rates for localization were 100% in both groups. However, the mean duration of CT-guided localization was significantly shorter in the SHW group than in the coil group (24.0 ± 12.3 minutes vs. 29.3 ± 9.0 minutes, P = 0.042). Pneumothorax incidence rates were comparable between the coil and SHW groups (25.7% vs. 29.7%, P = 0.704). Both groups achieved 100% technical success rates for VATS limited resection, and all patients underwent successful one-stage multiple limited resections. The mean VATS duration (127.0 ± 42.2 minutes vs. 106.4 ± 66.3 minutes, P = 0.122) and median blood loss (25 ml vs. 50 ml, P = 0.152) were also similar in both groups. Conclusions Based on these results, both CT-guided coil and SHW localization strategies are safe and effective methods for the preoperative localization of multiple PNs. However, SHW localization offers a significant advantage in reducing procedure time compared to coil localization. Coil Suture hook-wire Pulmonary nodule Multiple Localization Introduction Pulmonary nodules (PNs) are frequently detected during computed tomography (CT) screenings for lung cancer [1–3]. For high-risk PNs, tissue sampling is necessary [4]. CT-guided biopsy, performed under local anesthesia, is a commonly used method diagnostic method. However, it has a misdiagnosis rate of 9–10% [5, 6], and is less effective for small PNs due to technical challenges associated with their sampling that contribute to the potential for technical failure. Video-assisted thoracic surgery (VATS) limited resection is the most accurate diagnostic and therapeutic method for PNs, particularly for those classified at or below the mini-invasive lung cancer stage [7, 8]. To enhance the technical success of VATS limited resection, preoperative CT-guided localization is often employed as an adjunctive technique [7, 8]. Hook-wire localization has traditionally been the most commonly used method due to its simplicity [9]. However, its high complication rate has limited its utility. Alternatively, coil localization has been employed, providing patients with a lower complication rate but requiring more complex procedures [9]. Recently, the development of the suture hook-wire (SHW), an innovation based on the conventional hook-wire system, has shown higher success rates, fewer complications, and improved patient tolerance [10]. Despite this advancement, comparative studies evaluating preoperative coil versus SHW localization for PNs, particularly in patients with multiple PNs, are lacking. This study compared the clinical efficacy and safety of CT-guided coil and SHW localization for preoperative management of multiple PNs. Methods Study design The Ethics Committee of The First Affiliated Hospital of Soochow University gave approval for this retrospective analysis of data from a single center. The requirement for written informed consent was waived. Between January 2020 and December 2024, consecutive patients with multiple PNs who underwent CT-guided coil or SHW localization before VATS resection were enrolled. Inclusion criteria were: (a) ≥ 2 PNs requiring localization and VATS resection; (b) multiple unilateral PNs; and (c) patient age 18–75 years. Exclusion criteria were: (a) PN-pleura distance > 4 cm; (b) PN size < 6 mm; and (c) severe cardiac, hepatic, renal, pulmonary, or coagulatory disorders. CT-guided localization All CT-guided localization procedures were conducted using a 16-row CT scanner under local anesthesia. The patient position and puncture site were determined based on the location of the target PNs. For coil localization, a 21G Chiba needle (Cook, IN, USA) was inserted into the lung parenchyma. Once the needle tip was no more than 10 mm from the target PN, a coil (Cook) was inserted through the needle. The coil was partially embedded in the lung parenchyma, with the tail positioned above the visceral pleura based on the distance from the PN to the pleura. The localization of all target PNs was achieved through a one-stage procedure. For SHW (Senscure, Ningbo, China) localization, a 20G guiding needle was used to puncture the lung parenchyma. The needle was advanced to no more than 10 mm from the target PN, after which the SHW was deployed. The anchor tip was positioned near the target PN, and the needle was remove, with the tri-colored suture remaining attached to the anchor tip in the path of the needle. The distal suture end was allowed to extend from the pleura. The localization of all target PNs was achieved through a one-stage procedure. Repeat CT scans were performed after localization to confirm placement and assess patients for any possible complications. VATS resection VATS procedures were conducted within 3 hours of localization. All target PNs were resected in a single-stage VATS procedure. The limited resection comprised wedge and segmental resections, guided by the localization markers. For coil localization, the marker was the coil tail, while for SHW localization, the tri-colored suture was used as the marker. When the resection margin exceeded 2 cm from the edge of the PN, segmental resection was performed. In all other cases, wedge resection was conducted. Resected PNs were submitted for immediate pathological examination. If a PN was confirmed as invasive lung cancer, additional lobectomy and lymphadenectomy were performed. For patients with multiple invasive lung cancers, the lobectomy targeted the PN with the highest tumor stage. Assessments Technical success of CT-guided localization was determined by the following criteria: (a) visibility of the coil tail or tri-colored suture during VATS; (b) absence of marker dislodgement; and (c) successful completion of the limited resection. Technical success of limited resection was determined based on the complete removal of the target PN within the resected lung parenchyma. The study’s primary endpoint was the technical success rate of CT-guided localization. Secondary endpoints included localization duration, localization-related complications, limited resection technical success rates, types of VATS procedures performed, VATS duration, blood loss, and final diagnoses. Statistical analysis Normally distributed data were presented as mean ± standard deviation and compared using the independent sample t-tests. Skewed data were expressed as median (Q1:Q3) and analyzed with Mann-Whitney U tests. Categorical variables were compared with χ² tests or Fisher's exact test. Risk factors for localization-related complications were identified using multivariate logistic regression analysis. P < 0.05 was deemed significant. All analyses were performed using SPSS 16.0. Results Patients A total of 35 patients (76 PNs) in the coil group and 37 patients (81 PNs) in the SHW group were included in this study. From January 2020 to December 2021, the coil was exclusively used for localization. In 2022, the suture hook-wire was introduced as a localization material. Baseline characteristics for enrolled subjects are shown in Table 1 and were comparable. Table 1 Baseline characteristics between 2 groups. Coil group Suture hook-wire group P Patients number 35 37 Age (y) 55.6 ± 9.4 55.9 ± 9.0 0.892 Gender 0.161 Male 16 11 Female 19 26 Previous malignant history 7 5 0.460 Nodule number 0.916 2 29 31 ≥ 3 6 6 Diameter (mm) 7.8 ± 3.4 7.8 ± 2.4 0.933 Nodule-pleura distance (mm) 9 (Q1: 3; Q3: 12) 10 (Q1: 5; Q3: 16) 0.153 Nature of the PNs 0.828 Solid 18 18 GGN 58 63 Sides of the lung 0.259 Left 28 23 Right 48 58 Lobes 0.497 Upper 40 47 Non-upper 36 34 GGN: ground glass nodule; PN: pulmonary nodule. Localization outcomes The technical success rate of localization was 100% in both groups (Table 2 ). The mean CT-guided localization procedural duration was significantly shorter in the SHW group than in the coil group (24.0 ± 12.3 minutes vs. 29.3 ± 9.0 minutes, P = 0.042). A total of 10 and 18 patients in the coil and SHW groups, respectively, required position changes during localization (P = 0.081). The incidence of pneumothorax was 25.7% in the coil group and 29.7% in the SHW group (P = 0.704). None of the pneumothorax cases interfered with subsequent VATS resection. Univariate logistic regression analysis indicated that position changes (P = 0.007) and longer localization duration (P = 0.019) were associated with pneumothorax. However, in the multivariate logistic analysis, neither position changes (P = 0.053) nor localization duration (P = 0.178) were statistically significant risk factors. Table 2 Comparison of localization-related data. Coil group Suture hook-wire group P Successful localization rate 100% 100% Duration of localization (min) 29.3 ± 9.0 24.0 ± 12.3 0.042 Position change 10 (28.6%) 18 (48.6%) 0.081 Localization-related pneumothorax 9 (25.7%) 11 (29.7%) 0.704 VATS Technical success rates for VATS limited resection were 100% in both groups. Successful single-stage multiple limited resections were performed for all treated patients. The types of VATS resections are detailed in Table 3 and were similar in both groups. Six patients in the coil group and 10 in the SHW group underwent additional lobectomy following limited resection. The mean duration of the VATS procedure (127.0 ± 42.2 minutes vs. 106.4 ± 66.3 minutes, P = 0.122) and median blood loss (25 ml vs. 50 ml, P = 0.152) were similar between the two groups. The final diagnoses for the sampled PNs are presented in Table 3 . Table 3 Comparison of VATS and final diagnoses related data. Coil group Suture hook-wire group P Technical success of limited resection 100% 100% Limited resection types 0.962 Wedge resection 50 53 Segmental resection 26 28 Additional lobectomy 6 10 0.313 VATS duration (min) 127.0 ± 42.2 106.4 ± 66.3 0.122 Blood loss (ml) 25 (Q1: 20; Q3: 87.5) 50 (Q1: 20; Q3: 100) 0.152 Final diagnoses 0.003 Invasive adenocarcinoma 8 12 Mini-invasive adenocarcinoma 7 26 Adenocarcinoma in situ 24 14 Precancerous lesion 14 8 Benign 23 21 VATS: video‑assisted thoracoscopic surgery. Discussion Approximately 21% of patients with PNs have multiple high-risk nodules [11]. In this study, the localization of multiple PNs was explored, comparing the safety and efficacy of coil and SHW localization. The technical success rate of localization was 100% in both groups, indicating that coil and SHW localization are equally effective for multiple PNs. Previous meta-analyses reported that coil localization outperformed conventional hook-wire localization in terms of the associated success rate (97.5% vs. 91.6%, P = 0.0001). This suggests that the SHW represents a significant improvement over the conventional hook-wire, likely due to its soft suture material, which is less prone to migration during respiratory motion. The procedure for SHW localization is far simpler than the coil localization approach [12]. While coil localization requires precise partial insertion into the lung parenchyma with the tail positioned above the pleura, the SHW involves direct insertion with the suture tail remaining outside the thoracic wall. This simplified technique contributes to reduced localization time compared to coil localization. Pneumothorax was the primary localization-related complication observed in this study. The pneumothorax rates were comparable between the coil (25.7%) and SHW (29.7%) groups, suggesting similar safety profiles. However, these rates were higher than those reported in previous studies for coil (8.3–9.7%) and SHW (5.0–9.8%) localization [12, 13]. This discrepancy may be attributed to the focus on multiple PNs in this study. Xu et al. [14] identified position changes as a risk factor for pneumothorax in patients with multiple PNs. Although position changes were a significant risk factor in univariate analyses in this study, they did not remain significant in the multivariate analysis. This may be a consequence of sample size limitations. The VATS outcomes from this study confirmed that single-stage localization effectively guided multiple limited resection procedures, benefiting patients by preserving respiratory function while preventing tumor progression compared to staged resections. There are certain study limitations. For one, as it was retrospective in design, additional prospective randomized controlled trials will be essential for validation. Secondly, the patients in the two groups were not evaluated during the same period of time. Even so, the comparable baseline data in both patient groups may contribute to a lower risk of bias. Third, the sample size was limited owing to the fact that these patients with multiple high-risk PNs were a subset of the overall PN patient population. Conclusion In summary, while additional clinical trials will be needed, these findings suggest that both CT-guided coil and SHW localization are safe and efficacious approaches to localizing multiple PNs. However, SHW localization can save procedural time relative to coil-based approaches. Abbreviations CT: computed tomography; PN: pulmonary nodule; SHW: suture hook-wire; VATS: video-assisted thoracoscopic surgery. Declarations Ethics approval and consent to participate : This study was approved by Ethics Committee of The First Affiliated Hospital of Soochow University. The need for written informed consent was waived by the Ethics Committee of The First Affiliated Hospital of Soochow University. All methods were carried out in accordance with Declaration of Helsinki. Consent for publication : Not applicable. Availability of data and materials : The data that support the findings of this study are available from the corresponding author upon reasonable request. Competing interests : None. Funding: This study was supported by the Jiangsu Important Subject Development (ZDXK202237). Authors’ contributions: YGG and SJB designed this work. YD, HHS, and YBS collected the clinical data. HHS and YD performed the statistical analyses. YD wrote this article. Final manuscript was approved by all authors. Acknowledgments: None References Lee E, Kazerooni EA. Lung Cancer Screening. Semin Respir Crit Care Med. 2022;43:839-850. doi: 10.1055/s-0042-1757885. Cramer JD, Grauer J, Sukari A, Nagasaka M. Incidence of Second Primary Lung Cancer After Low-Dose Computed Tomography vs Chest Radiography Screening in Survivors of Head and Neck Cancer: A Secondary Analysis of a Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg. 2021;147:1071-1078. doi: 10.1001/jamaoto.2021.2776. Finigan JH, Kern JA. Lung cancer screening: past, present and future. Clin Chest Med. 2013;34:365-371. doi: 10.1016/j.ccm.2013.03.004. MacMahon H, Naidich DP, Goo JM, Lee KS, Leung ANC, Mayo JR, et al. Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017. Radiology. 2017;284:228-243. doi: 10.1148/radiol.2017161659. Feng JL, Fu YF, Li Y. Computed tomography-guided biopsy for sub-centimetre pulmonary nodules: a meta-analysis. Kardiochir Torakochirurgia Pol. 2023;20:139-145. doi: 10.5114/kitp.2023.131947. Liu GS, Wang SQ, Liu HL, Liu Y, Fu YF, Shi YB. Computed Tomography-Guided Biopsy for Small (≤20 mm) Lung Nodules: A Meta-Analysis. J Comput Assist Tomogr. 2020;44:841-846. doi: 10.1097/RCT.0000000000001071. Lin J, Wang LF, Wu A, Teng F, Xian YT, Han R. Computed tomography-guided indocyanine green localization of multiple ipsilateral lung nodules. Wideochir Inne Tech Maloinwazyjne. 2023;18:305-312. doi: 10.5114/wiitm.2023.124272. Lin J, Wang LF, Wu AL, Teng F, Xian YT, Han R. Preoperative lung nodule localization: comparison of hook-wire and indocyanine green. Wideochir Inne Tech Maloinwazyjne. 2023;18:149-156. doi: 10.5114/wiitm.2022.119767. Park CH, Han K, Hur J, Lee SM, Lee JW, Hwang SH, et al. Comparative Effectiveness and Safety of Preoperative Lung Localization for Pulmonary Nodules: A Systematic Review and Meta-analysis. Chest. 2017;151:316-328. doi: 10.1016/j.chest.2016.09.017. Fan L, Ma W, Ma J, Yang L, Wang Z, Xu K, et al. The improved success rate and reduced complications of a novel localization device vs. hookwire for thoracoscopic resection of small pulmonary nodules: a single-center, open-label, randomized clinical trial. Transl Lung Cancer Res. 2022;11:1702-1712. doi: 10.21037/tlcr-22-555. Wang JL, Ding BZ, Xia FF. Preoperative computed tomography-guided localization for multiple lung nodules: a Meta-analysis. Minim Invasive Ther Allied Technol. 2022;31:1123-1130. doi: 10.1080/13645706.2022.2133965. Huang YY, Liu X, Shi YB, Wang T. Preoperative computed tomography-guided localization for lung nodules: localization needle versus coil. Minim Invasive Ther Allied Technol. 2022;31:948-953. doi: 10.1080/13645706.2022.2034647. Lv YN, Zhang WT, Wang Y, Wang G. Preoperative computed tomography-guided localization for pulmonary nodules: a randomized controlled trial of coil and anchored needle localization. Wideochir Inne Tech Maloinwazyjne. 2024;19:178-186. doi: 10.5114/wiitm.2024.139198. Xu L, Wang J, Liu L, Shan L, Zhai R, Liu H, et al. Computed tomography-guided cyanoacrylate injection for localization of multiple ipsilateral lung nodules. Eur Radiol. 2022;32:184-193. doi: 10.1007/s00330-021-08101-7. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 06 Jun, 2025 Read the published version in World Journal of Surgical Oncology → Version 1 posted Editorial decision: Revision requested 01 May, 2025 Reviews received at journal 26 Apr, 2025 Reviews received at journal 23 Apr, 2025 Reviewers agreed at journal 22 Apr, 2025 Reviewers agreed at journal 21 Apr, 2025 Reviewers agreed at journal 15 Apr, 2025 Reviewers agreed at journal 28 Mar, 2025 Reviews received at journal 29 Jan, 2025 Reviewers agreed at journal 24 Jan, 2025 Reviewers invited by journal 23 Jan, 2025 Editor assigned by journal 23 Jan, 2025 Submission checks completed at journal 21 Jan, 2025 First submitted to journal 21 Jan, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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For high-risk PNs, tissue sampling is necessary [4]. CT-guided biopsy, performed under local anesthesia, is a commonly used method diagnostic method. However, it has a misdiagnosis rate of 9\u0026ndash;10% [5, 6], and is less effective for small PNs due to technical challenges associated with their sampling that contribute to the potential for technical failure. Video-assisted thoracic surgery (VATS) limited resection is the most accurate diagnostic and therapeutic method for PNs, particularly for those classified at or below the mini-invasive lung cancer stage [7, 8].\u003c/p\u003e \u003cp\u003eTo enhance the technical success of VATS limited resection, preoperative CT-guided localization is often employed as an adjunctive technique [7, 8]. Hook-wire localization has traditionally been the most commonly used method due to its simplicity [9]. However, its high complication rate has limited its utility. Alternatively, coil localization has been employed, providing patients with a lower complication rate but requiring more complex procedures [9]. Recently, the development of the suture hook-wire (SHW), an innovation based on the conventional hook-wire system, has shown higher success rates, fewer complications, and improved patient tolerance [10]. Despite this advancement, comparative studies evaluating preoperative coil versus SHW localization for PNs, particularly in patients with multiple PNs, are lacking.\u003c/p\u003e \u003cp\u003eThis study compared the clinical efficacy and safety of CT-guided coil and SHW localization for preoperative management of multiple PNs.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy design\u003c/p\u003e \u003cp\u003e The Ethics Committee of The First Affiliated Hospital of Soochow University gave approval for this retrospective analysis of data from a single center. The requirement for written informed consent was waived.\u003c/p\u003e \u003cp\u003eBetween January 2020 and December 2024, consecutive patients with multiple PNs who underwent CT-guided coil or SHW localization before VATS resection were enrolled. Inclusion criteria were: (a)\u0026thinsp;\u0026ge;\u0026thinsp;2 PNs requiring localization and VATS resection; (b) multiple unilateral PNs; and (c) patient age 18\u0026ndash;75 years. Exclusion criteria were: (a) PN-pleura distance\u0026thinsp;\u0026gt;\u0026thinsp;4 cm; (b) PN size\u0026thinsp;\u0026lt;\u0026thinsp;6 mm; and (c) severe cardiac, hepatic, renal, pulmonary, or coagulatory disorders.\u003c/p\u003e \u003cp\u003eCT-guided localization\u003c/p\u003e \u003cp\u003eAll CT-guided localization procedures were conducted using a 16-row CT scanner under local anesthesia. The patient position and puncture site were determined based on the location of the target PNs.\u003c/p\u003e \u003cp\u003eFor coil localization, a 21G Chiba needle (Cook, IN, USA) was inserted into the lung parenchyma. Once the needle tip was no more than 10 mm from the target PN, a coil (Cook) was inserted through the needle. The coil was partially embedded in the lung parenchyma, with the tail positioned above the visceral pleura based on the distance from the PN to the pleura. The localization of all target PNs was achieved through a one-stage procedure.\u003c/p\u003e \u003cp\u003eFor SHW (Senscure, Ningbo, China) localization, a 20G guiding needle was used to puncture the lung parenchyma. The needle was advanced to no more than 10 mm from the target PN, after which the SHW was deployed. The anchor tip was positioned near the target PN, and the needle was remove, with the tri-colored suture remaining attached to the anchor tip in the path of the needle. The distal suture end was allowed to extend from the pleura. The localization of all target PNs was achieved through a one-stage procedure.\u003c/p\u003e \u003cp\u003eRepeat CT scans were performed after localization to confirm placement and assess patients for any possible complications.\u003c/p\u003e \u003cp\u003eVATS resection\u003c/p\u003e \u003cp\u003eVATS procedures were conducted within 3 hours of localization. All target PNs were resected in a single-stage VATS procedure. The limited resection comprised wedge and segmental resections, guided by the localization markers. For coil localization, the marker was the coil tail, while for SHW localization, the tri-colored suture was used as the marker. When the resection margin exceeded 2 cm from the edge of the PN, segmental resection was performed. In all other cases, wedge resection was conducted. Resected PNs were submitted for immediate pathological examination. If a PN was confirmed as invasive lung cancer, additional lobectomy and lymphadenectomy were performed. For patients with multiple invasive lung cancers, the lobectomy targeted the PN with the highest tumor stage.\u003c/p\u003e \u003cp\u003eAssessments\u003c/p\u003e \u003cp\u003eTechnical success of CT-guided localization was determined by the following criteria: (a) visibility of the coil tail or tri-colored suture during VATS; (b) absence of marker dislodgement; and (c) successful completion of the limited resection. Technical success of limited resection was determined based on the complete removal of the target PN within the resected lung parenchyma. The study\u0026rsquo;s primary endpoint was the technical success rate of CT-guided localization. Secondary endpoints included localization duration, localization-related complications, limited resection technical success rates, types of VATS procedures performed, VATS duration, blood loss, and final diagnoses.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eNormally distributed data were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation and compared using the independent sample t-tests. Skewed data were expressed as median (Q1:Q3) and analyzed with Mann-Whitney U tests. Categorical variables were compared with χ\u0026sup2; tests or Fisher's exact test. Risk factors for localization-related complications were identified using multivariate logistic regression analysis. P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was deemed significant. All analyses were performed using SPSS 16.0.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003ePatients\u003c/p\u003e \u003cp\u003eA total of 35 patients (76 PNs) in the coil group and 37 patients (81 PNs) in the SHW group were included in this study. From January 2020 to December 2021, the coil was exclusively used for localization. In 2022, the suture hook-wire was introduced as a localization material. Baseline characteristics for enrolled subjects are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and were comparable.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics between 2 groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCoil group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSuture hook-wire group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatients number\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (y)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55.6\u0026thinsp;\u0026plusmn;\u0026thinsp;9.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.9\u0026thinsp;\u0026plusmn;\u0026thinsp;9.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.892\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.161\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious malignant history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.460\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNodule number\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.916\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiameter (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.933\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNodule-pleura distance (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (Q1: 3; Q3: 12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (Q1: 5; Q3: 16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.153\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNature of the PNs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.828\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSolid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGGN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSides of the lung\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.259\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLobes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.497\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-upper\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eGGN: ground glass nodule; PN: pulmonary nodule.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eLocalization outcomes\u003c/p\u003e \u003cp\u003eThe technical success rate of localization was 100% in both groups (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The mean CT-guided localization procedural duration was significantly shorter in the SHW group than in the coil group (24.0\u0026thinsp;\u0026plusmn;\u0026thinsp;12.3 minutes vs. 29.3\u0026thinsp;\u0026plusmn;\u0026thinsp;9.0 minutes, P\u0026thinsp;=\u0026thinsp;0.042). A total of 10 and 18 patients in the coil and SHW groups, respectively, required position changes during localization (P\u0026thinsp;=\u0026thinsp;0.081). The incidence of pneumothorax was 25.7% in the coil group and 29.7% in the SHW group (P\u0026thinsp;=\u0026thinsp;0.704). None of the pneumothorax cases interfered with subsequent VATS resection. Univariate logistic regression analysis indicated that position changes (P\u0026thinsp;=\u0026thinsp;0.007) and longer localization duration (P\u0026thinsp;=\u0026thinsp;0.019) were associated with pneumothorax. However, in the multivariate logistic analysis, neither position changes (P\u0026thinsp;=\u0026thinsp;0.053) nor localization duration (P\u0026thinsp;=\u0026thinsp;0.178) were statistically significant risk factors.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of localization-related data.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCoil group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSuture hook-wire group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuccessful localization rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of localization (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.3\u0026thinsp;\u0026plusmn;\u0026thinsp;9.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.0\u0026thinsp;\u0026plusmn;\u0026thinsp;12.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePosition change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (28.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (48.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.081\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocalization-related pneumothorax\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (25.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (29.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.704\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eVATS\u003c/h3\u003e\n\u003cp\u003eTechnical success rates for VATS limited resection were 100% in both groups. Successful single-stage multiple limited resections were performed for all treated patients. The types of VATS resections are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and were similar in both groups. Six patients in the coil group and 10 in the SHW group underwent additional lobectomy following limited resection. The mean duration of the VATS procedure (127.0\u0026thinsp;\u0026plusmn;\u0026thinsp;42.2 minutes vs. 106.4\u0026thinsp;\u0026plusmn;\u0026thinsp;66.3 minutes, P\u0026thinsp;=\u0026thinsp;0.122) and median blood loss (25 ml vs. 50 ml, P\u0026thinsp;=\u0026thinsp;0.152) were similar between the two groups. The final diagnoses for the sampled PNs are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of VATS and final diagnoses related data.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCoil group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSuture hook-wire group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTechnical success of limited resection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLimited resection types\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.962\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWedge resection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSegmental resection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdditional lobectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.313\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVATS duration (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e127.0\u0026thinsp;\u0026plusmn;\u0026thinsp;42.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e106.4\u0026thinsp;\u0026plusmn;\u0026thinsp;66.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.122\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood loss (ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (Q1: 20; Q3: 87.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50 (Q1: 20; Q3: 100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.152\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFinal diagnoses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInvasive adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMini-invasive adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdenocarcinoma in situ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrecancerous lesion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBenign\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eVATS: video‑assisted thoracoscopic surgery.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eApproximately 21% of patients with PNs have multiple high-risk nodules [11]. In this study, the localization of multiple PNs was explored, comparing the safety and efficacy of coil and SHW localization. The technical success rate of localization was 100% in both groups, indicating that coil and SHW localization are equally effective for multiple PNs. Previous meta-analyses reported that coil localization outperformed conventional hook-wire localization in terms of the associated success rate (97.5% vs. 91.6%, P\u0026thinsp;=\u0026thinsp;0.0001). This suggests that the SHW represents a significant improvement over the conventional hook-wire, likely due to its soft suture material, which is less prone to migration during respiratory motion.\u003c/p\u003e \u003cp\u003eThe procedure for SHW localization is far simpler than the coil localization approach [12]. While coil localization requires precise partial insertion into the lung parenchyma with the tail positioned above the pleura, the SHW involves direct insertion with the suture tail remaining outside the thoracic wall. This simplified technique contributes to reduced localization time compared to coil localization.\u003c/p\u003e \u003cp\u003ePneumothorax was the primary localization-related complication observed in this study. The pneumothorax rates were comparable between the coil (25.7%) and SHW (29.7%) groups, suggesting similar safety profiles. However, these rates were higher than those reported in previous studies for coil (8.3\u0026ndash;9.7%) and SHW (5.0\u0026ndash;9.8%) localization [12, 13]. This discrepancy may be attributed to the focus on multiple PNs in this study. Xu et al. [14] identified position changes as a risk factor for pneumothorax in patients with multiple PNs. Although position changes were a significant risk factor in univariate analyses in this study, they did not remain significant in the multivariate analysis. This may be a consequence of sample size limitations.\u003c/p\u003e \u003cp\u003eThe VATS outcomes from this study confirmed that single-stage localization effectively guided multiple limited resection procedures, benefiting patients by preserving respiratory function while preventing tumor progression compared to staged resections.\u003c/p\u003e \u003cp\u003eThere are certain study limitations. For one, as it was retrospective in design, additional prospective randomized controlled trials will be essential for validation. Secondly, the patients in the two groups were not evaluated during the same period of time. Even so, the comparable baseline data in both patient groups may contribute to a lower risk of bias. Third, the sample size was limited owing to the fact that these patients with multiple high-risk PNs were a subset of the overall PN patient population.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, while additional clinical trials will be needed, these findings suggest that both CT-guided coil and SHW localization are safe and efficacious approaches to localizing multiple PNs. However, SHW localization can save procedural time relative to coil-based approaches.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCT: computed tomography;\u003c/p\u003e\n\u003cp\u003ePN: pulmonary nodule;\u003c/p\u003e\n\u003cp\u003eSHW: suture hook-wire;\u003c/p\u003e\n\u003cp\u003eVATS: video-assisted thoracoscopic surgery.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eThis study was approved by Ethics Committee of The First Affiliated Hospital of Soochow University. The need for written informed consent was waived by the Ethics Committee of The First Affiliated Hospital of Soochow University. All methods were carried out in accordance with \u003cstrong\u003eDeclaration of Helsinki.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e None.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This study was supported by the Jiangsu Important Subject Development (ZDXK202237).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions:\u003c/strong\u003e YGG and SJB designed this work. YD, HHS, and YBS collected the clinical data. HHS and YD performed the statistical analyses. YD wrote this article. Final manuscript was approved by all authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003eNone\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLee E, Kazerooni EA. Lung Cancer Screening. Semin Respir Crit Care Med. 2022;43:839-850. doi: 10.1055/s-0042-1757885. \u003c/li\u003e\n\u003cli\u003eCramer JD, Grauer J, Sukari A, Nagasaka M. Incidence of Second Primary Lung Cancer After Low-Dose Computed Tomography vs Chest Radiography Screening in Survivors of Head and Neck Cancer: A Secondary Analysis of a Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg. 2021;147:1071-1078. doi: 10.1001/jamaoto.2021.2776.\u003c/li\u003e\n\u003cli\u003eFinigan JH, Kern JA. Lung cancer screening: past, present and future. Clin Chest Med. 2013;34:365-371. doi: 10.1016/j.ccm.2013.03.004. \u003c/li\u003e\n\u003cli\u003eMacMahon H, Naidich DP, Goo JM, Lee KS, Leung ANC, Mayo JR, et al. Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017. Radiology. 2017;284:228-243. doi: 10.1148/radiol.2017161659. \u003c/li\u003e\n\u003cli\u003eFeng JL, Fu YF, Li Y. Computed tomography-guided biopsy for sub-centimetre pulmonary nodules: a meta-analysis. Kardiochir Torakochirurgia Pol. 2023;20:139-145. doi: 10.5114/kitp.2023.131947.\u003c/li\u003e\n\u003cli\u003eLiu GS, Wang SQ, Liu HL, Liu Y, Fu YF, Shi YB. Computed Tomography-Guided Biopsy for Small (\u0026le;20 mm) Lung Nodules: A Meta-Analysis. J Comput Assist Tomogr. 2020;44:841-846. doi: 10.1097/RCT.0000000000001071. \u003c/li\u003e\n\u003cli\u003eLin J, Wang LF, Wu A, Teng F, Xian YT, Han R. Computed tomography-guided indocyanine green localization of multiple ipsilateral lung nodules. 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Transl Lung Cancer Res. 2022;11:1702-1712. doi: 10.21037/tlcr-22-555. \u003c/li\u003e\n\u003cli\u003eWang JL, Ding BZ, Xia FF. Preoperative computed tomography-guided localization for multiple lung nodules: a Meta-analysis. Minim Invasive Ther Allied Technol. 2022;31:1123-1130. doi: 10.1080/13645706.2022.2133965.\u003c/li\u003e\n\u003cli\u003eHuang YY, Liu X, Shi YB, Wang T. Preoperative computed tomography-guided localization for lung nodules: localization needle versus coil. Minim Invasive Ther Allied Technol. 2022;31:948-953. doi: 10.1080/13645706.2022.2034647.\u003c/li\u003e\n\u003cli\u003eLv YN, Zhang WT, Wang Y, Wang G. Preoperative computed tomography-guided localization for pulmonary nodules: a randomized controlled trial of coil and anchored needle localization. Wideochir Inne Tech Maloinwazyjne. 2024;19:178-186. doi: 10.5114/wiitm.2024.139198.\u003c/li\u003e\n\u003cli\u003eXu L, Wang J, Liu L, Shan L, Zhai R, Liu H, et al. Computed tomography-guided cyanoacrylate injection for localization of multiple ipsilateral lung nodules. Eur Radiol. 2022;32:184-193. doi: 10.1007/s00330-021-08101-7.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"world-journal-of-surgical-oncology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"wjso","sideBox":"Learn more about [World Journal of Surgical Oncology](http://wjso.biomedcentral.com)","snPcode":"12957","submissionUrl":"https://submission.nature.com/new-submission/12957/3","title":"World Journal of Surgical Oncology","twitterHandle":"@OncoBioMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Coil, Suture hook-wire, Pulmonary nodule, Multiple, Localization","lastPublishedDoi":"10.21203/rs.3.rs-5870288/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5870288/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eComputed tomography (CT)-guided coil and suture hook-wire (SHW) insertion are widely employed for the preoperative localization of multiple pulmonary nodules (PNs). However, the comparative effectiveness and safety of these two techniques remain unclear. This study aimed to probe the clinical efficacy and safety of coil and SHW-based preoperative localization in patients with multiple PNs.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003ePatients with multiple PNs who underwent CT-guided coil or SHW localization prior to video-assisted thoracic surgery (VATS) resection between January 2020 and December 2024 were enrolled retrospectively. Localization outcomes and VATS-related parameters were compared.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 35 patients (76 PNs) in the coil group and 37 patients (81 PNs) in the SHW group were included. Technical success rates for localization were 100% in both groups. However, the mean duration of CT-guided localization was significantly shorter in the SHW group than in the coil group (24.0\u0026thinsp;\u0026plusmn;\u0026thinsp;12.3 minutes vs. 29.3\u0026thinsp;\u0026plusmn;\u0026thinsp;9.0 minutes, P\u0026thinsp;=\u0026thinsp;0.042). Pneumothorax incidence rates were comparable between the coil and SHW groups (25.7% vs. 29.7%, P\u0026thinsp;=\u0026thinsp;0.704). Both groups achieved 100% technical success rates for VATS limited resection, and all patients underwent successful one-stage multiple limited resections. The mean VATS duration (127.0\u0026thinsp;\u0026plusmn;\u0026thinsp;42.2 minutes vs. 106.4\u0026thinsp;\u0026plusmn;\u0026thinsp;66.3 minutes, P\u0026thinsp;=\u0026thinsp;0.122) and median blood loss (25 ml vs. 50 ml, P\u0026thinsp;=\u0026thinsp;0.152) were also similar in both groups.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eBased on these results, both CT-guided coil and SHW localization strategies are safe and effective methods for the preoperative localization of multiple PNs. However, SHW localization offers a significant advantage in reducing procedure time compared to coil localization.\u003c/p\u003e","manuscriptTitle":"Preoperative computed tomography guided coil versus suture hook-wire localization for multiple pulmonary nodules","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-23 08:40:03","doi":"10.21203/rs.3.rs-5870288/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-02T03:24:38+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-27T01:37:39+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-23T05:59:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"204333247619558405527127859600559570761","date":"2025-04-22T06:22:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"320239743378550270979371083336711582104","date":"2025-04-21T10:11:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"132926014213389490946616940878924303239","date":"2025-04-15T12:35:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"214548120098257609080841511442090611520","date":"2025-03-28T08:05:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-29T08:25:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"213685809538932841905710212693944197550","date":"2025-01-24T06:05:13+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-01-23T07:26:34+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-01-23T06:34:02+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-01-21T22:55:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"World Journal of Surgical Oncology","date":"2025-01-21T05:12:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"world-journal-of-surgical-oncology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"wjso","sideBox":"Learn more about [World Journal of Surgical Oncology](http://wjso.biomedcentral.com)","snPcode":"12957","submissionUrl":"https://submission.nature.com/new-submission/12957/3","title":"World Journal of Surgical Oncology","twitterHandle":"@OncoBioMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ec075e76-e6e5-4595-a0ac-9734d1cc20ac","owner":[],"postedDate":"January 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-06-09T16:11:36+00:00","versionOfRecord":{"articleIdentity":"rs-5870288","link":"https://doi.org/10.1186/s12957-025-03871-6","journal":{"identity":"world-journal-of-surgical-oncology","isVorOnly":false,"title":"World Journal of Surgical Oncology"},"publishedOn":"2025-06-06 15:57:17","publishedOnDateReadable":"June 6th, 2025"},"versionCreatedAt":"2025-01-23 08:40:03","video":"","vorDoi":"10.1186/s12957-025-03871-6","vorDoiUrl":"https://doi.org/10.1186/s12957-025-03871-6","workflowStages":[]},"version":"v1","identity":"rs-5870288","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5870288","identity":"rs-5870288","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}