Vein watershed analysis locational method versus computed tomography-guided percutaneous localization for detecting non-palpable peripheral pulmonary nodules: a real-world study of non-inferiority

Objectives: In recent years, with the advancement of sublobar resection, A safe, painless method for locating peripheral pulmonary nodules is required. Previously, an alternative method of arterial watershed localization was been introduced to remedy the shortcomings of preoperative CT-guided localization or other methods for locating pulmonary nodules, but its technical limitations were discovered during clinical application. Therefore, we innovated a technique to localize non-subpleural nodules using basin analysis of the target vein and validated its feasibility and safety.

Methods: Retrospective analysis of surgical cases of pulmonary nodules smaller than 2 cm in our center. Comparison of vein watershed locational method (V-WALM) and CT-guided percutaneous puncture localization wedge dissection based on locating success rate, mean operation duration, mean intraoperative bleeding and median postoperative stay, mean postoperative drainage and mean drainage tube indwelling time.

Results: V-WALM and CT-guided localization were used for localized resection of pulmonary nodules in 50 patients each. The localization success rates were 94.0% for V-WALM and 90.0% for CT-guided localization, respectively, with no statistical difference. There was also no statistical difference in patient population distribution between the two groups. The operation time was 95.5 ± 26.4 min for V-WALM and 94.3 ± 37.5 min for CT-guided with no statistical difference, and there was no statistical difference in intraoperative bleeding, postoperative drainage and drainage tube indwelling time. And the lymph node simpling rate of V-WALM was 48.0% much higher than 24% in the localization group.

Conclusions: This study demonstrates that the V-WALM is a safe and feasible intraoperative localization method for peripheral lung nodules. It provides a high-precision, fast and minimally invasive approch of intraoperative localization.