A meta-analysis of preoperative bronchoscopic marking for pulmonary nodules

Abstract

OBJECTIVES Recent studies have suggested the usefulness of preoperative bronchoscopic marking techniques for the localization of pulmonary nodules in thoracic surgery. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of preoperative bronchoscopic marking. METHODS The PubMed and Cochrane Library databases were searched for clinical studies evaluating preoperative bronchoscopic marking for pulmonary resection. Non-comparative and random effects model-based meta-analyses were conducted to calculate the pooled success and complication rates of bronchoscopic marking. RESULTS Twenty-five eligible studies were included. Among these, 15 studies conducted dye marking under electromagnetic navigation bronchoscopy, 4 used virtual-assisted lung mapping and 7 used other marking methods. The overall pooled successful marking rate, successful resection rate and complete resection rate were 0.97 [95% confidence interval (CI) 0.95–0.99], 0.98 (95% CI 0.96–1.00) and 1.00 (95% CI 1.00–1.00), respectively. The overall pooled rates of pleural injury and pulmonary haemorrhage were 0.02 (95% CI 0.01–0.05) and 0.00 (95% CI 0.00–0.00), respectively. CONCLUSIONS This meta-analysis demonstrated that bronchoscopic marking is very safe and effective. Bronchoscopic marking should be considered, especially if there are concerns about the safety of other localization methods.

Hybrid technique of virtual-assisted lung mapping and systemic indocyanine green injection for extended segmentectomy

“…The second is the need for special equipment [ 6 ]. VAL-MAP requires a catheter and virtual bronchoscopic navigation, and the ICG injection requires near-infrared thoracoscopy [ 6 , 13 ]. Although the hybrid technique is relatively costly, we believe that accomplishing an ideal extended segmentectomy is worth the cost of special equipment.…”

“…VAL-MAP is a safe, efficacious, bronchoscopic, multiple pulmonary dye-marking technique that uses virtual bronchoscopic navigation [ 7 , 13 ]. It can be used to create multiple marks near the tumor that allow accurate identification of the tumor during subsequent surgery [ 14 – 16 ].…”

The role of virtual-assisted lung mapping 2.0 combining microcoils and dye marks in deep lung resection

“…Among localization techniques, virtualassisted lung mapping (VAL-MAP), a bronchoscopic preoperative multi-spot dye marking technique, 1 is highly safe and reproducible. [2][3][4][5] Notably, the multiple dye marks of VAL-MAP are designed to indicate sufficient resection margins, 1,6 which have a significant impact on local recurrence and patient survival in sublobar lung resection. 7,8 However, because the information provided by the dye marks is limited to the pleural surface, acquiring deep resection margins is a major concern.…”

Navigational Bronchoscopy with Interventional Pulmonologists and Thoracic Surgeons

“…A recent meta-analysis by Yanagiya et al showed success rates of dye marking, intraoperative localization and complete resection of over 95% with the use of ENB. 15 Although most studies have been done using the superDimension system, the SPiN platform can be used in a similar fashion for this purpose with the potential advantage of using the SPiN Perc tool for peripheral lesions abutting the pleural surface or those that are not reached with the endobronchial approach.…”