Safety and efficacy of a novel four-hook needle versus hook wire for CT-guided preoperative localization of pulmonary nodules: a propensity score-matched analysis

Background To compare the safety and effectiveness of a novel four-hook needle with conventional Hook wire for CT-guided preoperative localization of pulmonary nodules and to identify factors associated with localization-related complications. Methods A retrospective study was conducted in patients who underwent CT-guided localization followed by video-assisted thoracoscopic surgery between January 2024 and June 2025. Propensity score matching yielded 248 matched pairs. Post-matching comparisons were performed using paired statistical methods. Generalized estimating equation models with the same reduced set of clinically relevant covariates were used for pulmonary hemorrhage and pneumothorax, with matched pair specified as the clustering variable. Results Technical localization success was achieved in all patients. Tip-to-nodule distance was comparable between the Hook wire and four-hook needle groups (4.82 ± 4.91 mm vs. 4.74 ± 4.22 mm, P = 0.842). The four-hook needle shortened localization time (7.69 ± 3.18 min vs. 8.76 ± 3.22 min, P < 0.001). Pulmonary hemorrhage (8.1% vs. 13.7%, P = 0.054) and pneumothorax (10.1% vs. 16.1%, P = 0.067) occurred less frequently in the four-hook group, although the differences did not reach statistical significance. Marker dislodgement was significantly less frequent with the four-hook needle (0.4% vs. 3.2%, P = 0.039), and post-localization VAS pain scores were lower (2.56 ± 1.28 vs. 4.00 ± 1.21, P < 0.001). In matched-pair clustered multivariable analyses, greater distance from the pleura, greater puncture depth, and more needle adjustments were associated with pulmonary hemorrhage, while more needle adjustments and prone positioning were associated with pneumothorax. Conclusions Both localization techniques provided accurate preoperative localization of pulmonary nodules. The four-hook needle shortened localization time, reduced marker dislodgement, and was associated with lower post-localization VAS pain scores. Pulmonary hemorrhage and pneumothorax were numerically less frequent with the four-hook needle, but these differences were not statistically significant after accounting for the matched-pair structure.