Comparative Effectiveness and Safety of Preoperative Lung Localization for Pulmonary Nodules: A Systematic Review and Meta-analysis

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An optimal method of preoperative localization for pulmonary nodules has yet to be established. This systematic review and meta-analysis aimed to compare the success and complication rates associated with three pulmonary nodule localization methods for video-assisted thoracoscopic surgery (VATS): hook-wire localization, microcoil localization, and lipiodol localization.


We searched the PubMed, MEDLINE, and EMBASE databases for prospective or retrospective English language studies of VATS localization in adult patients. A noncomparative, random effects model–based meta-analysis was performed to obtain pooled success and complication rates for the three localization methods.


A total of 46 clinical studies were enrolled, including 30, 9, and 7 studies of hook-wire, microcoil, and lipiodol localization, respectively. The successful targeting rates for hook-wire, microcoil, and lipiodol localization were 0.98 (95% CI, 0.97–0.99), 0.98 (95% CI, 0.96–0.99), and 0.99 (95% CI, 0.98–1.00), respectively, with corresponding successful operative field targeting rates of 0.94 (95% CI, 0.91–0.96), 0.97 (95% CI, 0.95–0.98), and 0.99 (95% CI, 0.98–1.00), respectively. In addition, the successful VATS rates with hook-wire, microcoil, and lipiodol localization were 0.96 (95% CI, 0.94–0.97), 0.97 (95% CI, 0.94–0.99), and 0.99 (95% CI, 0.98–1.00), respectively. Regarding complications, hook-wire, microcoil, and lipiodol localization were associated with pneumothorax rates of 0.35 (95% CI, 0.28–0.43), 0.16 (95% CI, 0.07–0.34), and 0.31 (95% CI, 0.20–0.46), respectively and hemorrhage rates of 0.16 (95% CI, 0.11–0.23), 0.06 (95% CI, 0.03–0.11), and 0.12 (95% CI, 0.05–0.23), respectively.


All three localization methods yielded similarly highly successful targeting rates. However, hook-wire localization had a relatively lower successful operative field targeting rate because of dislodgement or migration. Lipiodol localization had the highest overall success rate, and microcoil localization yielded the lowest complication rates.

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