Electromagnetic navigation bronchoscopy: an optimal strategy for localizing multiple pulmonary nodules

【Backgrounds】

Lung cancer remains the leading cause of cancer-related mortality globally. The detection rate of nodules has significantly increased with the implementation of health screening using low-dose spiral computed tomography (LDCT), and it is not uncommon that small and multiple pulmonary nodules are frequently detected, demanding advancements in diagnostic technologies for accurate biopsy and precise localization of pulmonary nodules. Various preoperative localization techniques for marking target pulmonary nodules have been developed, CTPLP was the most preoperative localization procedures utilized in clinical practice, including dye marking, radiotracer labeling, hook wire or micro-coil placement, ethiodized oil injection, etc. However, for patients with multiple ipsilateral nodules, CTPLP significantly increases the radiation exposures and the risk of procedure-related complications.

In recent years, ENBDM has been widely utilized and showed reliable outcomes with minimal invasion, high accuracy and few complications. However, as of yet, no literature reports the utilization of ENBDM for preoperative localization of multiple ipsilateral lung nodules.

【Main findings】

Totally, 203 patients undergoing preoperative nodules localization were retrospectively collected (ENBDM: n=99, CTPLP: n=104). Patients characteristics were comparable between 2 groups. All patients received videoassisted thoracoscopic surgery (VATS) after localization in the same operative room. In term of the localization time, ENBDM group compared with CTPLP group consumed less time (8.00±4.66 vs. 22.00±8.82 min, P< 0.001). The results also showed that the number of localized nodules increases, the localization time of the ENBDM group is significantly lower than that of the CTPLP group, highlighting the efficacy of ENBDM. ENBDM also achieved comparable localization accuracy with CTPLP (94.9% vs. 97.4%, P = 0.48). Importantly, no related complications occurred in the ENB group, including pleural reaction [0 vs. 8 (7.7%), P=0.01], pneumothorax [0 vs. 36 (34.6%), P<0.001], and hemothorax [0 vs. 15 (14.4%), P<0.001].

【Clinical significance】

ENBDM localization and surgical resection of nodules are performed in the integrated OR, which avoids the patient’s transportation from the CT scan room to OR and simplifies the entire treatment process. For patients with multiple ipsilateral pulmonary nodules, ENBDM can achieve the similar localization accuracy as CT-guided lung puncture, with shorter localization time and no complications. ENBDM offers a safer and faster alternative to CTPLP for preoperative localization of multiple pulmonary nodules in the ipsilateral lung.