Electromagnetic Navigation Bronchoscopy Localization Versus Percutaneous CT-Guided Localization for Lung Resection via Video-Assisted Thoracoscopic Surgery: A Propensity-Matched Study.

Shuenn-Wen Kuo,Kuan-Yu Dai,Yeun-Chung Chang,Ke-Cheng Chen,Ying-Fan Tseng,Jang-Ming Lee

doi:10.3390/jcm8030379

Abstract

Background: An ideal preoperative localization method is essential for the resection of small and deep-seated pulmonary nodules by video-assisted thoracoscopic surgery (VATS) in the era of low-dose computed tomography (CT) screening. This study describes a new localization method using electromagnetic navigation bronchoscopy (ENB) and compares it against conventional percutaneous CT-guided methods. Methods: Between January 2016 and May 2018, 18 consecutive patients with a total of 27 pulmonary nodules underwent ENB localization using patent blue vital dye before thoracoscopy for lung resection at the National Taiwan University Hospital. Over the same period, 268 patients had a total of 325 pulmonary nodules localized by a CT-guided method. Propensity analysis was applied to minimize bias during comparison. Results: Patients were selected using a propensity-score based process, matched for potential risk factors for localization failure, to ensure equal potential prognostic factors in both groups. After matching, the ENB group had 15 patients with a total of 24 pulmonary nodules, and the CT group had 30 patients with 48 pulmonary nodules. No major procedure-related complications occurred in either group. The target pulmonary nodule was not successfully localized for one patient in the ENB group and three in the CT group. The lesions were fully excised after conversion to mini-thoracotomy. Pathological examination confirmed the accuracy of the dye staining. Analysis found a non-significant difference in the success rate of these two localization methods. However, the following parameters were significantly different: interval between localization to surgery, global time, and rate of pneumothorax (p < 0.05). Conclusions: In the era of minimally invasive surgery, surgeons need an efficient one-step way to manage pulmonary nodules. Patent blue vital injection with ENB guidance in the operating room is a new, effective approach to localize small, deep-seated and non-palpable pulmonary lesions, comparable with CT-guided localization.

Highlights

Identifying pulmonary nodules intra-operatively by direct visualization or palpation can lead to successful resection by video-assisted thoracoscopic surgery (VATS)
Since lung cancer has emerged as a growing health issue worldwide, including in Asian countries [5,6], VATS for major lung resections has been used in the treatment of lung tumors through minimal invasive surgery, especially for early lung cancer
computed tomography (CT)-guided localization has been shown to be effective preoperatively in recent years; on the other hand, electromagnetic navigation bronchoscopy (ENB) localization of the tumor with dye injection is rapidly emerging to be applied before VATS to achieve the same goal [8,9,10,11,12,13,14,15]

Summary

Introduction

Identifying pulmonary nodules intra-operatively by direct visualization or palpation can lead to successful resection by video-assisted thoracoscopic surgery (VATS). VATS is often performed through small incision(s), increasing the difficulty of palpation, and increasing the difficulty of resecting deep-seated nodules or ground glass opacities Such cases require preoperative nodule localization for successful intraoperative guidance followed by lung resection by VATS. This study aims to provide a comparison of effectiveness of tumor localization using ENB and CT-guided localization before small pulmonary nodules resection by VATS. An ideal preoperative localization method is essential for the resection of small and deep-seated pulmonary nodules by video-assisted thoracoscopic surgery (VATS) in the era of low-dose computed tomography (CT) screening. Patent blue vital injection with ENB guidance in the operating room is a new, effective approach to localize small, deep-seated and non-palpable pulmonary lesions, comparable with CT-guided localization

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