CT-guided indocyanine green fluorescence localization demonstrates superior reliability over hook-wire for pulmonary ground-glass nodules: a retrospective cohort study

Background: Lung cancer is the leading cause of cancer-related mortality worldwide. With the widespread use of computed tomography (CT) screening, pulmonary ground-glass nodules are increasingly detected. Video-assisted thoracoscopic surgery (VATS) enables minimally invasive resection; however, the precise intraoperative localization of these non-palpable nodules remains challenging. The current commonly used preoperative CT-guided hook-wire localization, while effective, is associated with documented risks such as dislodgement (reported in up to ~10% of cases), pneumothorax requiring intervention, and rare but serious complications (e.g., air embolism). Thus, a safer and more reliable localization technique is desirable. Indocyanine green (ICG) fluorescence guidance has emerged as a promising alternative, though further validation in standardized cohorts is valuable. This study aimed to evaluate the feasibility and safety of ICG fluorescence localization and resection of pulmonary ground-glass nodules under near-infrared (NIR) fluorescence thoracoscopy. Methods: We retrospectively analyzed the data of patients with pulmonary ground-glass nodules (peripheral type, diameter