Comparison Of Preoperative CT-Guided Hook Wire And Methylene Blue Lung Nodule Localization Techniques

Posted on June 2014

Junior Chief Resident Mark Kleedehn, M.D., presented a lecture comparing lung nodule localization techniques as part of Resident Research Day 2014.

Pulmonary nodules that aren’t immediately subpleural can be difficult to identify intraoperatively without preoperative localization. The techniques for localization include metallic hook wires and coils, as well as a percutaneous injection of a mixture comprised of substances such as methylene blue, radiotracer, and autologous blood. However, there are many known complications with these methods, including pneumothorax, pain, coughing, and dye diffusion.

Kleedehn’s study compared the localization success rates of the hook wire method with the success rate of methylene blue injections, using a retrospective chart review of 102 patients undergoing 109 procedures. The researchers found that all 57 methylene blue injections were successfully localized, while 7/52 hook wires became dislodged. While this is statistically significant, the real-world impact is muted as surgeons were still able to identify the defects where the hook wires dislodged and subsequently target the nodules.

Comparing the common complication rates, there was only one compelling difference: pain reported by about 10% of the patients receiving the methylene blue injection, while none of the 52 hook wire subjects noted significant discomfort. In terms of major complications, one methylene blue patient suffered a moderate pneumothorax, while two hook wire patients endured the same condition. In addition, a third hook wire patient experienced a dislodged wire requiring a second procedure for removal, and a fourth hookwire patient suffered a massive systemic embolus resulting in death.

While the study was constrained by a limited number of major complications, Kleedehn concluded that hook wire localizations resulted in more major complications, including one death.