Skip to main content

Advertisement

SpringerLink
Log in

Computed tomography–guided cyanoacrylate injection for localization of multiple ipsilateral lung nodules

  • Chest
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To retrospectively assess the clinical effectiveness of CT-guided cyanoacrylate localization for multiple ipsilateral small pulmonary nodules (SPNs) and to determine the independent predictors for pneumothorax.

Methods

In total, 81 patients with 169 lesions undergoing CT-guided cyanoacrylate localization for multiple ipsilateral SPNs between September 2016 and July 2020 were enrolled (group M). Another 284 patients who received single SPN localization during the same period served as the control group (group S). Propensity score analysis was performed to minimize selection bias. Possible independent predictors for pneumothorax were evaluated using multivariate logistic regression analysis.

Results

Multiple ipsilateral SPN localization was successfully performed in all 81 patients. The incidences of successful targeting during localization and surgery were 100% and 98.8%, respectively. Seventy-seven patients (95.1%) underwent the procedure on the day before the surgery. Propensity matching created 81 pairs of patients. There were no significant differences in the incidence of successful targeting during localization and surgery, localization-related pain score, and additional morphine use between the two groups. However, group M was associated with a significant longer localization procedural time (p < 0.001) and a higher incidence of pneumothorax (p < 0.001). In multivariate analysis, position change was significantly associated with a sevenfold increase in the risk for pneumothorax (p = 0.001).

Conclusions

CT-guided cyanoacrylate injection for multiple ipsilateral SPN localization was safe and reliable, and allowed a flexible surgical schedule, despite a lengthy procedure and an increased incidence of pneumothorax. Avoiding position change may help to reduce the occurrence of pneumothorax.

Key Points

• Compared to single SPN localization, multiple ipsilateral SPN localization using cyanoacrylate injection achieved comparable safety, reliability, and comfort.

• CT-guided cyanoacrylate localization for multiple ipsilateral SPNs allowed a flexible surgical schedule.

• Position change was the only independent risk factor for pneumothorax during the multiple ipsilateral SPN localization.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

BMI:

Body mass index

CI:

Confidence interval

FEV1:

Forced expiratory volume in 1 s

IQR:

Interquartile range

OR:

Odds ratio

SD:

Standard deviations

SPN:

Small pulmonary nodule

VAS:

Visual analogue scale

VATS:

Video-assisted thoracoscopic surgery

References

  1. National Lung Screening Trial Research Team, Aberle DR, Adams AM et al (2011) Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 365:395–409. https://doi.org/10.1056/nejmoa1102873

    Article  Google Scholar 

  2. Aberle DR, Abtin F, Brown K (2013) Computed tomography screening for lung cancer: has it finally arrived? Implications of the national lung screening trial. J Clin Oncol 31:1002–1008

    Article  Google Scholar 

  3. Congregado M, Merchan RJ, Gallardo G et al (2008) Video-assisted thoracic surgery (VATS) lobectomy: 13 years’ experience. Surg Endosc Other Interv Tech 22:1852–1857. https://doi.org/10.1007/s00464-007-9720-z

    Article  Google Scholar 

  4. Suzuki K, Nagai K, Yoshida J et al (1999) Video-assisted thoracoscopic surgery for small indeterminate pulmonary nodules: indications for preoperative marking. Chest 115:563–568. https://doi.org/10.1378/chest.115.2.563

    Article  CAS  PubMed  Google Scholar 

  5. McDermott S, Fintelmann FJ, Bierhals AJ et al (2019) Image-guided preoperative localization of pulmonary nodules for video-assisted and robotically assisted surgery. Radiographics 39:1264–1279. https://doi.org/10.1148/rg.2019180183

    Article  PubMed  Google Scholar 

  6. Yao F, Yao J, Xu L, Wang J, Gao L, Wang J (2019) Computed tomography-guided cyanoacrylate localization of small pulmonary nodules: feasibility and initial experience. Interact Cardiovasc Thorac Surg 28:387–393. https://doi.org/10.1093/icvts/ivy277

  7. Wang J, Yao J, Xu L et al (2019) Comparison of cyanoacrylate and hookwire for localizing small pulmonary nodules: a propensity-matched cohort study. Int J Surg 71:49–55. https://doi.org/10.1016/j.ijsu.2019.09.001

    Article  PubMed  Google Scholar 

  8. Heuvelmans MA, Walter JE, Peters RB et al (2017) Relationship between nodule count and lung cancer probability in baseline CT lung cancer screening: the NELSON study. Lung Cancer 113:45–50. https://doi.org/10.1016/j.lungcan.2017.08.023

    Article  PubMed  Google Scholar 

  9. Jensen MP, Karoly P, O’Riordan EF, Bland Jr F, Burns RS (1989) The subjective experience of acute pain. An assessment of the utility of 10 indices. Clin J Pain 5:153–159. https://doi.org/10.1097/00002508-198906000-00005

  10. Dai L, Gao M, Gu C, Zhang F, Yu Y (2016) Perivenous application of cyanoacrylate tissue sealants reduces intimal and medial thickening of the vein graft and inflammatory responses in a rabbit model of carotid artery bypass grafting. Eur J Cardiothorac Surg 49:675–681. https://doi.org/10.1093/ejcts/ezv111

  11. li CR, Cui F, Wan Q et al (2018) Preoperative localisation of pulmonary ground-glass opacity using medical adhesive before thoracoscopic resection. Eur Radiol 28:4048–4052. https://doi.org/10.1007/s00330-018-5394-2

    Article  PubMed  Google Scholar 

  12. Yoshida J, Nagai K, Nishimura M, Takahashi K (1999) Computed tomography-fluoroscopy guided injection of cyanoacrylate to mark a pulmonary nodule for thoracoscopic resection. Jpn J Thorac Cardiovasc Surg 47:210–213. https://doi.org/10.1007/BF03217996

    Article  CAS  PubMed  Google Scholar 

  13. Huang Y, Zhao Z, Wang T et al (2018) A comparison between prethoracoscopy localization of small pulmonary nodules by means of medical adhesive versus hookwire. J Vasc Interv Radiol 29:1547–1552. https://doi.org/10.1016/j.jvir.2018.05.013

    Article  PubMed  Google Scholar 

  14. Ichinose J, Kohno T, Fujimori S, Harano T, Suzuki S (2013) Efficacy and complications of computed tomography-guided hook wire localization. Ann Thorac Surg 96:1203–1208. https://doi.org/10.1016/j.athoracsur.2013.05.026

  15. Zhong Y, Xu XQ, Pan XL et al (2017) Retrospective evaluation of safety, efficacy and risk factors for pneumothorax in simultaneous localizations of multiple pulmonary nodules using hook wire system. Cardiovasc Intervent Radiol 40:1408–1414. https://doi.org/10.1007/s00270-017-1631-3

    Article  PubMed  Google Scholar 

  16. Iguchi T, Hiraki T, Gobara H et al (2015) Simultaneous multiple preoperative localizations of small pulmonary lesions using a short hook wire and suture system. Cardiovasc Intervent Radiol 38:971–976. https://doi.org/10.1007/s00270-014-1028-5

    Article  PubMed  Google Scholar 

  17. Tseng YH, Lee YF, Hsieh MS et al (2016) Preoperative computed tomography-guided dye injection to localize multiple lung nodules for video-assisted thoracoscopic surgery. J Thorac Dis 8:S666–S671 https://doi.org/10.21037/jtd.2016.09.46

    Article  Google Scholar 

  18. Chao YK, Fang HY, Pan KT, Wen CT, Hsieh MJ (2020) Preoperative versus intraoperative image-guided localization of multiple ipsilateral lung nodules. Eur J Cardiothorac Surg 57:488–495. https://doi.org/10.1093/ejcts/ezz292

  19. Fu YF, Gao YG, Zhang M, Tao Wang, Shi YB, Huang YY (2019) Computed tomography-guided simultaneous coil localization as a bridge to one-stage surgery for multiple lung nodules: a retrospective study. J Cardiothorac Surg 14:43. https://doi.org/10.1186/s13019-019-0870-6

  20. Sun W, Zhang L, Wang L et al (2019) Three-dimensionally printed template for percutaneous localization of multiple lung nodules. Ann Thorac Surg 108:883–888. https://doi.org/10.1016/j.athoracsur.2019.03.060

    Article  PubMed  Google Scholar 

  21. Rafailidis V, Robbie H, Tran S, Stefanidis K (2020) Glue pulmonary embolism and pulmonary oedema as a rare complication after endovascular embolisation of oesophageal varices. BMJ Case Rep 13:e233654. https://doi.org/10.1136/bcr-2019-233654

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Bilin Tao for his assistance with the statistical analyses.

Funding

The authors state that this work has not received any funding.

Author information

Author notes

  1. Lei Xu and Jian Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, No. 168, Gushan Road, Jiangning District, Nanjing, Jiangsu Province, 211100, China

    Lei Xu, Jian Wang, Limei Shan, Rong Zhai, He Liu & Fei Yao

  2. Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China

    Liang Liu

Authors
  1. Lei Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jian Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Liang Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Limei Shan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rong Zhai
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. He Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fei Yao
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fei Yao.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Fei Yao.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Bilin Tao kindly provided statistical advice for this manuscript.

Department of Epidemiology and Biostatistics, Center for Global Health, School of Public Health, Nanjing Medical University, 101 Longmian Ave. Nanjing, 211166, China.

Email:411055654@qq.com

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

  • retrospective

  • observational

  • performed at one institution

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Xu, L., Wang, J., Liu, L. et al. Computed tomography–guided cyanoacrylate injection for localization of multiple ipsilateral lung nodules. Eur Radiol 32, 184–193 (2022). https://doi.org/10.1007/s00330-021-08101-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-021-08101-7

Keywords

Search

Navigation