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

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.