Risk and protective factors of higher-grade intrapulmonary hemorrhage in patients undergoing percutaneous computed tomography-guided microcoil localization before video-assisted thoracoscopic surgery.

BACKGROUND

Computed tomography (CT)-guided microcoil localization before video-assisted thoracoscopic surgery (VATS), while generally safe, carries non-negligible risks of intrapulmonary hemorrhage. This study identifies independent predictors of higher-grade hemorrhage (≥ Grade 2) caused by CT-guided microcoil localization to optimize patient selection and procedural planning.

METHODS

In this retrospective study, 432 consecutive patients [2016-2020] undergoing microcoil localization prior to VATS for solitary pulmonary nodules were analyzed. Hemorrhage severity was graded radiologically (Grade 0-4). Univariate and multivariate logistic regression identified the independent factors associated with higher-grade hemorrhage (≥ Grade 2), with P<0.05 considered significant.

RESULTS

Intrapulmonary hemorrhage occurred in 161 of the 432 CT-guided microcoil localizations (37.27%), and higher-grade hemorrhage occurred in 41 of all procedures (9.49%). The logistic regression revealed that repeat insertion [odds ratio (OR) =9.712, P<0.001] was the only risk factor for higher-grade intrapulmonary hemorrhage, while procedure-related pneumothorax (OR =0.159, P=0.005), nodule size (>5-10 mm, OR =0.216, P=0.002; >10 mm, OR =0.349, P=0.04), pleura-microcoil distance (>20-30 mm, OR =0.365, P=0.02), and lung radiodensity along the needle passage [>-900 to -850 Hounsfield unit (HU), OR =0.426, P=0.03; ≤-900 HU, OR =0.273, P=0.009] were protective factors for higher-grade intrapulmonary hemorrhage.

CONCLUSIONS

Repeat insertion during microcoil localization significantly increases hemorrhage risk, while pneumothorax, larger nodule size (>5 mm), longer pleura-microcoil distance (>20-30 mm) and lower lung density (≤-850 HU) are protective. These findings enable risk-stratified patient management.