Computed tomography-guided suture anchor placement for preoperative localization for multiple pulmonary nodules

Abstract Background Preoperative computed tomography (CT)-guided suture anchor (SA) localization is an established technique for pulmonary nodules (PNs). However, there is limited evidence on its use for the simultaneous localization of multiple PNs. This study evaluated the safety and clinical effectiveness of CT-guided SA localization for patients with multiple PNs undergoing surgical resection. Methods This retrospective study included consecutive cases of CT-guided preoperative SA localization of multiple PNs before sublobar resection using video-assisted thoracoscopic surgery (VATS) between January 2021 and June 2024. Two groups, Group A (two localized PNs) and Group B (three or more localized PNs) were established and localization- and surgery-related outcomes were compared between groups. Results A total of 142 patients with 317 PNs underwent localization. Of these, 112 patients had two localized nodules (Group A), whereas 30 had three or more localized nodules (Group B). Successful localization was achieved for all target nodules. The localization procedure required significantly more time in Group B than in Group A (33.2 ± 13.0 min vs. 18.6 ± 6.5 min, P < 0.001). The incidences of pneumothorax (24.1% vs. 26.7%, P = 0.773) and pulmonary hemorrhage (33.9% vs. 36.7%, P = 0.779) were comparable between groups. Needle passage through the fissural pleura was identified as the only independent predictor of pneumothorax (P = 0.014). VATS sublobar resection was successfully completed for 221 of 224 nodules (98.7%) and all 93 nodules (100%) in Groups A and B, respectively (P = 0.558). Conclusions CT-guided SA placement appears to be a safe and effective technique for preoperatively localizing multiple PNs. Increasing the number of localized nodules did not compromise localization success or increase complication rates. Avoiding transfissural needle trajectories may reduce the risk of pneumothorax.