Comparison of fish-hook shaped and spiral shaped wires in CT-guided pulmonary nodule localization: Impact on complications and clinical outcomes

OBJECTIVE: In December 2020, our center transitioned from a fish-hook to a spiral wire for CT-guided pulmonary nodule localization. This study compared the effectiveness and safety of both techniques. METHODS: We retrospectively analyzed 154 consecutive patients with 157 pulmonary nodules who underwent CT-guided wire localization between November 2017 and December 2024. Demographic, lesion, procedural, surgical details, and pathology were collected. Technical success was defined as localization without wire dislodgement. Complications were categorized as minor (no intervention) or major (requiring intervention). Logistic regression identified risk factors for localization success and complications. RESULTS: Localization was performed using fish-hook wires in 79 and spiral wires in 78 procedures. Technical success rates were comparable (94.9 %, 95 %CI: 90.1 %-99.8 % vs. 94.9 %, 95 %CI: 90 %-99.8 %). Major complications were rare (two air embolisms and one drainage-requiring pneumothorax across all procedures). Minor complication rates were 34.2 % (95 % CI: 23.7 %-44.6 %) for fish-hook wires and 21.8 % (95 % CI: 12.6 %-31.0 %) for spiral wires. Pathological representativeness was similar. Wire type showed no difference in localization success (OR = 1.26, 95 % CI: 0.29-5.53). Fish-hook use (OR 2.36, 95 % CI 1.11-5.09) and longer procedure duration (OR 1.06, 95 % CI 1.02-1.10) were associated with minor complication risk. CONCLUSION: Fish-hook and spiral shaped wires achieved comparable technical success and safety profile regarding major complications for CT-guided pulmonary nodule localization. However, from a patient perspective the relevance of minor complications should also be considered.