Electromagnetic Navigation Bronchoscopy Guided Transbronchial Localization For Thoraopic Resection Of Small Pulmonary Nodules
JAE WON SONG, So Young Bae, Kwon Joong Na, Samina Park, Chang Hyun Kang, Young Tae Kim, In Kyu Park
Seoul National University Hospital, Seoul, Korea, Republic of
Objective Electromagnetic navigation bronchoscopy (ENB)-guided transbronchial localization is an alternative to conventional computed tomography-guided transthoracic localization of small pulmonary nodules. The purpose of this study was to evaluate the efficacy and safety of ENB-guided localization with dye marking for thoracoscopic resection of small pulmonary nodules. Methods Consecutive 133 patients who underwent ENB-guided dye marking followed by thoracoscopic resection of small pulmonary nodules from July 2016 to November 2019 were reviewed retrospectively. Dye was injected at subpleural area near the nodules and more than one marking were performed in deeply seated nodules. Efficacies were evaluated by the success rates of marking (visible dye-mark), localization (localization only aided by dye-mark) and resection (presence of nodule confirmed pathologically). Safety was evaluated by the rate of ENB-related complications. Results ENB-guided dye marking was performed on 160 lesions in 133 patients. Twenty-two (16.5%) patients had multiple nodules. Radiologic characteristics were pure ground glass nodule (GGN) in 104 (65%), part solid GGN in 48 (30%) and solid nodule in 9 (5%) nodules. The mean size of nodules was 9.4 ± 4.9 (3-26) mm and the mean depth from visceral pleura was 10.1±7.4 (0-35) mm. Total number of dye marking was 231. The median number of marking per nodule was 2 (1-4). The mean ENB procedure time was 30±15.1 (5-78) minutes. There was no ENB-related complication. The success rate of ENB-guided dye marking was 93.5% (216/231) and the success rate of ENB-guided localization was 95.6% (153/160). All nodules except one nodule, which was intentionally unresected after localization, were resected. The success rate of resection was 99.4%. Diagnostic surgery were wedge resection in 129 (80.6%) and segmentectomy in 30 (18.7%) nodules. Curative surgery were wedge resection in 92 (57.5%), segmentectomy in 44 (27.5%), and lobectomy in 24 (15%) nodules. Pathologic diagnosis of nodules were adenocarcinoma in 62 (38.7%), minimal invasive adenocarcinoma in 46 (28.7%), atypical adenomatous hyperplasia in 16 (10%), metastatic carcinoma in 7 (4.3%) and benign in 20 (12.5%) nodules. Conclusions ENB guided dye marking was an effective and safe localization modality for VATS resection of small pulmonary nodules.
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