Response

Abstract

This is in response to the letter by Drs Hsu and Wu, which added a new perspective to our article1Park C.H. Han K. Hur J. et al.Comparative effectiveness and safety of preoperative lung localization for pulmonary nodules: a systematic review and meta-analysis.Chest. 2017; 151: 316-328Abstract Full Text Full Text PDF PubMed Scopus (157) Google Scholar comparing three preoperative lung localization methods. We read with interest the letter, which proposed a “dual localization technique using indocyanine green (ICG) and a microcoil,” guided by an electromagnetic navigation system, as an optimal preoperative localization method for small lung nodules. The suggested procedure is a technical adaptation of electromagnetic navigational transthoracic lung biopsy,2Yarmus L.B. Arias S. Feller-Kopman D. et al.Electromagnetic navigation transthoracic needle aspiration for the diagnosis of pulmonary nodules: a safety and feasibility pilot study.J Thorac Dis. 2016; 8: 186-194PubMed Google Scholar and dual localization is performed with a microcoil (lesion) and ICG (pleural surface) under electromagnetic navigational guidance. As they mentioned, this technique seems to have strengths, including a one-stage workflow that minimizes the duration between localization and surgery, and convenience in that it does not need interdepartmental cooperation. We think that the workflow seems to be a good option. However, because electromagnetic navigational transthoracic lung localization is a relatively new technique, we believe it is necessary to first verify it in terms of accuracy and safety. In addition, we think that localization under guidance by the electromagnetic navigation system could have the following issues3Arias S. Lee H. Semaan R. et al.Use of electromagnetic navigational transthoracic needle aspiration (E-TTNA) for sampling of lung nodules.J Vis Exp. 2015; 99: e52723Google Scholar, 4Arias S. Yarmus L. Argento A.C. Navigational transbronchial needle aspiration, percutaneous needle aspiration and its future.J Thorac Dis. 2015; 7: S317-S328PubMed Google Scholar: First, during the procedure, the exact needle pathway and final needle tip location cannot be evaluated because the transthoracic needle insertion is performed not under the guidance of real-time CT imaging, but by referring to preacquired CT images and electromagnetic navigation. Second, the relationship between the microcoil and lung lesion cannot be confirmed accurately, and three-dimensional surgical margins after resection could be problematic. In our study,1Park C.H. Han K. Hur J. et al.Comparative effectiveness and safety of preoperative lung localization for pulmonary nodules: a systematic review and meta-analysis.Chest. 2017; 151: 316-328Abstract Full Text Full Text PDF PubMed Scopus (157) Google Scholar we reported the results of a meta-analysis and systematic review that compared the accuracy and complications among hook-wire, microcoil, and lipiodol localization. Among these three methods, lipiodol localization showed the highest accuracy and microcoil localization showed the lowest complication rate. However, we do not insist that lipiodol localization is the optimal method. Instead, we suggest that effort to identify the better localization method is mandatory because hook-wire localization showed the worst results among the three techniques in terms of procedure success and complication rates, despite being the most widely used.5Chen S. Zhou J. Zhang J. et al.Video-assisted thoracoscopic solitary pulmonary nodule resection after CT-guided hookwire localization: 43 cases report and literature review.Surg Endosc. 2011; 25: 1723-1729Crossref PubMed Scopus (107) Google Scholar Technology continues to progress. Localization methods also should be improved continuously. We are pleased that they have described the development of a new localization technique. However, the accuracy and complication rates of electromagnetic navigational transthoracic lung localization have not been established yet. We hope that sufficient data will be collected to compare various localization methods, including electromagnetic navigational transthoracic lung localization, in the near future. Electromagnetic Navigation-Guided One-Stage Dual Localization of Small Pulmonary NodulesCHESTVol. 154Issue 6PreviewWe read with interest the study by Park and colleagues1 in a previous issue of CHEST (February 2017) investigating the optimal method for preoperative localization of pulmonary nodules. The study concluded that hook-wire localization had lower successful operative field targeting rates, lipiodol localization had the highest overall success rates, and microcoil localization had the lowest complication rates.1 From a surgeon’s perspective, there are other concerns when determining the optimal method of localization, in addition to success rates and complication rates. Full-Text PDF Comparative Effectiveness and Safety of Preoperative Lung Localization for Pulmonary Nodules: A Systematic Review and Meta-analysisCHESTVol. 151Issue 2PreviewAn optimal method of preoperative localization for pulmonary nodules has yet to be established. This systematic review and meta-analysis aimed to compare the success and complication rates associated with three pulmonary nodule localization methods for video-assisted thoracoscopic surgery (VATS): hook-wire localization, microcoil localization, and lipiodol localization. Full-Text PDF