CT-guided hookwire placement: A technical innovation for preoperative localization of nonpalpable cervical lymph nodes

The aim is to describe the technique of preoperative CT-guided hookwire localization of small, but suspicious, cervical lymph nodes. We present 3 patients who underwent the procedure for nonpalpable cervical nodes detected on PET/CT prior to complete surgical resection of the nodes. The details of the radiological procedure, surgical outcomes, and pathologic results are described. The mean intervention time for preoperative hookwire localization was 9 minutes (range 7-14 minutes). There were no complications. All surgeons felt that the lengths of the surgical skin incision and operative times were reduced because of localization. The pathologic diagnoses were 2 benign nodes and 1 case of metastatic ovarian carcinoma. In conclusion, preoperative CT-guided hookwire localization is a useful technique for guiding surgical excision, especially when cervical nodes are small and deep in location.