Three‐dimensional printed navigational template for localizing small pulmonary nodules: A case‐controlled study

Abstract

Background Localization of small pulmonary nodules is an inevitable challenge for the thoracic surgeon. This study aimed to investigate the accuracy of three‐dimensional (3D) printing technology for localizing small pulmonary nodules, especially ground‐glass nodules (GGNs). Methods This study enrolled patients with peripheral small pulmonary nodules (≤ 2 cm) who required preoperative localization. In the comparison period, patients underwent both computed tomography‐guided (CT‐G) and 3D‐printing template guided (3D‐G) localization to compare the accuracies of the two methods. In the testing period, the 3D‐printing technique was implemented alone. The 3D‐printing physical navigational template was designed based on data from perioperative CT images. Clinical data, imaging data, surgical data, and evaluation index were collected for further analysis. The learning curve of the 3D‐printing localization technique was assessed using cumulative sum (CUSUM) analysis and multiple linear regression analysis. Results In the comparison period (n = 14), the success rates of CT‐G and 3D‐G were 100% and 92.9% (P = 0.31), respectively; in the testing period (n = 23), the success rate of 3D‐G was 95.6%. The localization times of CT‐G, 3D‐G (comparison), and 3D‐G (testing) were 23.6 ± 5.3, 19.3 ± 6.8, and 9.8 ± 4.6 minutes, respectively. The CUSUM learning curve was modeled using the equation: Y = 0.48X2 − 0.013X − 0.454 (R2 = 0.89). The learning curve was composed of two phases, phase 1 (the initial 20 patients) and phase 2 (the remaining 17 patients). Conclusions 3D printing localization has adequate accuracy and is a feasible and accessible strategy for use in localizing small pulmonary nodules, especially in right upper lobe. The use of this technique could facilitate lung nodule localization prior to surgery.

Artificial intelligence assisted display in thoracic surgery: development and possibilities

“…Since 3D printing is an extension of 3D reconstruction, it also has the clinical applications of 3D reconstruction. A previous study used a 3D printed model to help identify small lung nodules with a success localization rate of 95.6% (39).…”

“…Furthermore, the combined application of 3D-VATS provides surgeons with a good sense of depth in the operative field, and intraoperative navigation by comparing the virtual lung anatomical structures with the real, reducing the operational difficulty, blood loss, and length of operation (30,(39)(40)(41)(42)(43). In addition to preoperative planning and intraoperative navigation, 3D reconstruction/3D printing is helpful in doctor-patient communication, disease interpretation, and clinical teaching (44).…”

A novel technique for preoperative localization of pulmonary nodules using a mixture of tissue adhesive and iohexol under computed tomography guidance: A 140 patient single‐center study

“…Localization of radiotracers requires specialized equipment and radiation protection. Some new methods other than CT‐guided localization have been reported in recent years including electromagnetic navigation bronchoscopy (ENB) localization, 27,28 3‐D printing localization, 29‐31 and virtual‐assisted lung mapping (VAL‐MAP) 32 . Although these methods have reportedly achieved satisfactory success rates, their complexity may prevent general use, and studies with larger sample sizes are needed to validate them.…”

Advances in the localization of pulmonary nodules: a comprehensive review

“…Rui Fu's study also showed that the 3D-printed template navigation localization has a good effect, especially for accurate localization of nodules in the upper lobe of the right lung. However, this technology is affected by respiration and body position, and patients with excessively high BMI may compromise the template fit, thereby affecting the positioning accuracy [ 50 , 51 ]. Another type of 3D-printed template-assisted localization is noninvasive.…”