Computed Tomography-Guided Methylene Blue Localization: Single vs. Multiple Lung Nodules

Abstract

<b>Background:</b> Preoperative localization for small invisible and impalpable pulmonary nodules is important in single-port video-assisted thoracoscopic surgery (VATS). Localization of multiple pulmonary nodules during VATS resection remains challenging. The aim of our study is to elucidate the efficacy of preoperative CT-guided methylene blue localization of both single and multiple pulmonary nodules. <b>Methods:</b> Consecutive patients undergoing preoperative CT-guided methylene blue dye localization for lung nodules, followed by VATS resection, were retrospectively analyzed between January 2014 and November 2019. Chi-square tests, Fisher's exact test and independent <i>T-</i>test were used to compare variables between the groups. Logistic regression was used to identify risk factors for procedure-related complications. <b>Results:</b> A total of 388 patients, including 337 with single nodule and 51 with multiple nodules, were analyzed. The success rate of preoperative CT-guided methylene blue localization for both single and multiple pulmonary nodules were comparable as 98.8% (333/337) vs. 100% (108/108). The procedure time was longer (23.2 ± 9.4 vs. 7.6 ± 4.8 min, <i>p</i> < 0.001) and risk of pneumothorax was higher (47.1 vs. 25.5%, <i>p</i> = 0.002) in the multiple nodule group. The procedure time (OR 1.079; 95% CI = 1.041-1.118; <i>p</i> < 0.001) was an independent risk factor for pneumothorax. Nodule depth (OR 2.829; 95% CI = 1.259-6.356; <i>p</i> = 0.011) was an independent risk factor for pulmonary hemorrhage. <b>Conclusions:</b> Preoperative CT-guided methylene blue localization for both single and multiple pulmonary nodules is safe, feasible, and effective.