Localization of Small Pulmonary Nodules Using Augmented Fluoroscopic Bronchoscopy: Experience from 100 Consecutive Cases

Abstract

We developed augmented fluoroscopic bronchoscopy (AFB) for the localization of small pulmonary nodules. Here, we review the results of 100 consecutive cases of AFB localization performed in our institute in order to evaluate its efficacy, safety, and procedural details. This study was a retrospective analysis of prospectively collected data. Between July 2018 and September 2019, a total of 100 patients with 124 small lung nodules underwent AFB localization with dye marking and/or microcoil placement. All localizations were performed in a cone-beam computed tomography examination room followed by thoracoscopic resection within 3days. The mean nodule size was 9.7mm, and the mean distance from the pleural space was 18.6mm. Sixty-three patients received dye marking only, and 37 patients received microcoil placement with/without additional dye marking. The mean bronchoscopy duration was 10.4min, and the mean fluoroscopy duration was 3.4min. The mean radiation exposure (expressed as the dose-area product) was 3140.8μGy × m2. The AFB procedures were successful in 94 patients [augmented fluoroscopy discrepancy (n = 2), incomplete C-arm confirmation (n = 3), microcoil unlooping (n = 1)]; of those, 91 received successful marker-guided resection [invisible dye (n = 2), failed nodule resection with first wedge (n = 1)]. The mean length of postoperative stay and chest drainage was 4.2 and 2.9days, respectively. The AFB technique is a safe and reproducible alternative for localizing small pulmonary nodules, and various localization strategies can be implemented for different nodule locations and resection plans.