Comparison of computed tomographic imaging-guided hook wire localization and electromagnetic navigation bronchoscope localization in the resection of pulmonary nodules: a retrospective cohort study

Abstract

The resection of nodules by thoracoscopic surgery is difficult because the nodules may be hard to identify. Preoperative localization of pulmonary nodules is widely used in the clinic. In this study, we retrospectively compared CT-guided hook wire localization and electromagnetic navigation bronchoscopy (ENB) localization of small pulmonary nodules before resection. Patients who underwent localization with CT-guided hook wire or ENB followed by video-assisted thoracoscopic surgery (VATS) at Qilu Hospital of Shandong University between January 2016 and December 2019 were retrospectively included. Clinical parameters, complication and failure rate, and localization time were compared between two groups. A total of 157 patients underwent the localization procedure successfully. Pulmonary nodules were localized by CT-guided hook wire in 105 patients and by ENB in 52 patients. The nodule size in ENB group was smaller than that in CT-guided localization group (P < 0.001). Both CT-guided localization and ENB localization were well tolerated in all patients, while ENB localization leaded to less complications (P = 0.0058). In CT-guided localization group, 6 patients failed to be located while none failed in ENB group (P = 0.079). The procedure time was 15.15 ± 3.70 min for CT-guided localization and 21.29 ± 4.00 min for ENB localization (P < 0.001). CT-guided localization is simple and feasible for uncertain pulmonary nodules before surgery. ENB localization could identify small lung nodules with high accuracy and achieve lower incidence of complications.

Computed Tomography-Guided Methylene Blue Localization: Single vs. Multiple Lung Nodules

“…Non-radiopaque marker such as ICG requires special near-infrared fluorescence ( 29 ), with limited tissue penetration at depths within 24 mm ( 30 ), which is not applicable in deeper nodule localization. Executing dye labeling via bronchoscopic approach takes more time than the percutaneous approach ( 31 ). Pneumothorax after needle puncture could be aggravated by positive airway pressure ( 32 ).…”

The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives—State of the Art

“…The technical challenge of segmentectomy is to perform a true anatomical and oncologic resection with safe margins. A multimodality imaging approach [89,90] to segmentectomy, using a combination of colored or fluoroscopic endoscopic [91][92][93] or physical X-ray [94,95] markings and 3D reconstructions of segmental vessels and bronchus, segments and tumor [89,96,97], helps surgeons to identify small, non-visible, and non-palpable tumors, and to anticipate individual anatomy in the surgical space and expected oncologic margins to perform oncologically effective and safe personalized tailored segmentectomy (Figure 4). These imaging tools are helpful for open segmentectomy, and even more for minimally invasive approaches, using indocyanine green and near-infrared angiography [98][99][100] to identify the intersegment plan.…”

3D localization based on anatomical LANDmarks in the treatment of pulmonary nodules

“…Various positioning methods can be used, such as preoperative CT-guided hookwire positioning and coil positioning as well as lipiodol positioning, electromagnetic navigation bronchoscopeguided positioning, and intraoperative ultrasound-assisted positioning. The success rate of these positioning methods is 89.6% to 100% (21)(22)(23)(24)(25)(26). However, these methods have their own advantages and disadvantages.…”