Non-Inferiority Comparison of Medical Glue and Hook-Wire for Preoperative Localization of Multiple Pulmonary Nodules

Zexin Xie ^1,2 Ran Ma ^2,3 Tao Gao ^2,3 Jingsong Liu ^2,3 Kewei Zhang ^2,3 Jun Li ^2,3 Xiaotong Zhou ^2,3* Hao Zhang ^2,4*

• ¹ Department of Thoracic Surger, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
• ² Thoracic Surgery Laboratory, Xuzhou Medical University, Xuzhou, Jiangsu Province, China
• ³ Department of Thoracic Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
• ⁴ The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China

Background: Video-assisted thoracoscopic surgery is a widely employed minimally invasive approach for resecting pulmonary nodules. However, precisely localizing deep-seated or poorly visualized nodules remains a prominent challenge. This study aims to compare the effectiveness and safety of medical glue versus hook-wire in the CT-guided localization of multiple pulmonary nodules.Methods: A prospective cohort of patients scheduled for CT-guided localization of multiple pulmonary nodules between February 2024 and August 2024 was enrolled. Patients were randomized into a medical glue group and a hook-wire group in a 1:1 ratio. The primary endpoint was the localization success rate, with the objective of conducting a non-inferiority comparison of medical glue and hook-wire for the preoperative localization of multiple pulmonary nodules at a noninferiority margin of 10%. Secondary endpoints consisted of complication incidence following localization and pain scores assessed via the Numerical Rating Scale.Results: Medical glue demonstrated non-inferior success rates versus hook-wire (97.5% vs. 95%, absolute difference=2.5%, 95%CI[-5.82%,10.82%]; P=1.00). Although overall complications were comparable (42.5% vs.55.0%, P=0.263), medical glue significantly reduced pneumothorax (22.5% vs.47.5%, P=0.019) and pulmonary hemorrhage (7.5% vs.27.5%, P=0.019). Patients receiving medical glue reported lower 2-hour pain scores (2.70±0.76 vs.3.71±1.42, P=0.007).The application of medical glue for the CT-guided localization of multiple pulmonary nodules demonstrated a non-inferior success rate comparable to that of hook-wire. Furthermore, compared to hook-wire, medical glue was associated with a lower incidence of pneumothorax and pulmonary hemorrhage, as well as reduced pain scores at 2 h post-localization.