Electromagnetic Navigation Bronchoscopy-Guided Dye Marking for Localization of Pulmonary Nodules

Electromagnetic navigation bronchoscopy (ENB)-guided dye marking is a useful localization method for small pulmonary nodules. This study evaluated the efficacy and safety of intraoperative full virtual ENB-guided dye marking.

Patients who underwent full virtual ENB-guided dye marking without adjunct intraoperative imaging (fluoroscopy or cone-beam computed tomography) for small pulmonary nodules were investigated retrospectively. Efficacy was evaluated on the basis of the success rates of dye marking (visible dye mark) and nodule localization, and safety was evaluated on the basis of the rate of ENB-related complications.

ENB-guided dye marking was performed on 164 nodules in 134 patients. Twenty-seven patients (20.1%) had multiple nodules. The total number of dye marking attempts was 241, and the mean number of markings per nodule was 1.5 ± 0.7. The mean ENB procedure duration was 29.4 ± 15.7 minutes. No ENB-related complications were observed. The success rate of dye marking was 86.7% (209 of 241) and that of localization was 94.5% (155 of 164). Among 63 nodules with multiple dye marking attempts, 62 (98.4%) were successfully localized. In 101 nodules with a single dye marking attempt, 87 (86.1%) were localized with the visceral pleural dye mark. In addition, 6 nodules (5.9%) could be localized with the needle hole on the visceral pleura. The number of dye marking attempts was a significant factor in the success of localization (1.5 ± 0.7 vs 1.1 ± 0.3, P = .01).

Full virtual ENB-guided dye marking was effective and safe for the localization of small pulmonary nodules. A multiple dye marking strategy is recommended to achieve a high success rate.