Electromagnetic navigational bronchoscopy-directed dye marking for locating pulmonary nodules

Area of Science:

• Pulmonology
• Thoracic Surgery
• Medical Imaging

Background:

• Small peripheral pulmonary nodules are challenging to locate surgically due to their deep-seated nature and lack of pleural markers.
• Current CT-guided percutaneous techniques for nodule localization have significant limitations.
• There is a need for improved methods to accurately localize these nodules prior to surgery.

Purpose of the Study:

• To evaluate the accuracy and feasibility of using electromagnetic navigational bronchoscopy (ENB) combined with pleural dye injection.
• To assess the efficacy of ENB-guided localization for small peripheral pulmonary nodules before video-assisted thoracic surgery (VATS).

Main Methods:

• The ENB localization procedure was conducted under general anesthesia.
• A locatable guide wire was advanced to the target nodule, followed by injection of methylene blue or indocyanine green dye.
• Air was instilled to disperse the dye, marking the pleura near the nodule for immediate VATS.

Main Results:

• The study included 25 patients with 28 nodules; mean nodule size was 11.8 mm.
• Dye visualization during VATS was achieved in 82.1% (23/28) of nodules.
• The average ENB-guided pleural dye marking procedure time was 12.6 minutes, with negative resection margins in all malignant nodules.

Conclusions:

• Electromagnetic navigational bronchoscopy (ENB) with pleural dye is a safe and accurate method for locating small peripheral pulmonary nodules.
• This technique effectively guides surgical resection in VATS procedures.
• ENB offers a promising alternative for the localization of challenging pulmonary nodules.