Effectiveness and safety of different wire types for preoperative localization of pulmonary nodules: A systematic review and meta-analysis.

Objectives: Wire localization systems are widely used for perioperative lung nodule localization. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of five wire types (barb-thorn, double-thorn, four-hook, spiral, and Q-type) for preoperative localization.

Materials And Methods: PubMed, Embase, Web of Science, and Cochrane databases were searched to December 2024 to retrieve data and assess risk of bias. Meta-analysis used a random effects model to obtain pooled estimates and prediction intervals (PI) for success rates, complication rates, and pain scores. Heterogeneity was explored in stratified analyses.

Results: 80 studies involving 9,996 procedures across 9,049 patients were included. The pooled technical success rate for localization was 98% (95% CI: 0.98-0.99; PI: 96%-100%), while VATS success reached 100% (95% CI: 1.00-1.00; PI: 99%-100%). Major and minor complications were 0% (95% CI: 0.00-0.00; PI: 0%-1%) and 43% (95% CI: 0.36-0.50; PI: 0%-100%) (75 studies). However, Q-type wire demonstrated lower success rates and a higher risk of major complications compared to other wire types. Studies with low/some concerns showed lower minor complication rates (21%; 95% CI: 0.08-0.34) compared to moderate (44%; 95% CI: 0.35-0.52) and high-quality studies (46%; 95% CI: 0.31-0.61). Pain scores (7 studies) averaged 3.41 (95% CI: 2.60-4.22; PI: 0.32-6.50) on a 0-10 scale.

Conclusions: Different wire types demonstrated high localization and VATS success rates with comparable safety profiles. However, Q-type wire demonstrated lower success rates and higher complication risks, though based on limited data. Further studies are required to confirm its efficacy and safety.