Evaluation of Radiofrequency Identification for Accurate Wedge Resection of Small Lung Lesions With Reference to Dye...

We developed a radiofrequency identification (RFID) marking system to improve localization of small, deeply situated pulmonary lesions during thoracoscopic surgery. This study was conducted to evaluate RFID marking efficacy with reference to indocyanine green (ICG)-virtual-assisted lung mapping (VAL-MAP).

We retrospectively compared clinical outcomes of wedge resections using RFID (prospectively collected) and ICG-VAL-MAP (historical cohort, January 2017 to December 2024). The primary outcome of successful resection without additional resection was assessed by multivariate logistic regression with Firth's penalized likelihood correction.

Among the 101 lesions (RFID: 45; ICG-VAL-MAP: 56), lesions with RFID were smaller (0.97 ± 0.45 vs 1.19 ± 0.57 cm) and had greater pleural depth (1.21 ± 0.85 vs 0.81 ± 0.70 cm). The RFID procedure time was longer (42 vs 34 minutes), with a computed tomography marker-to-lesion distance of 0.66 ± 0.61 cm. One mild pneumothorax occurred with ICG-VAL-MAP. Radiofrequency identification reduced intraoperative palpation (11/45 vs 37/56) and achieved a higher primary success rate (100% vs 95%). Multivariate analysis showed reduced postoperative complications with RFID (adjusted odds ratio [OR] 0.33, 95% confidence interval 0.07-1.24).

RFID marking achieved 100% successful resection for small/deep lesions and reduced palpation needs and complications (adjusted OR 0.33), outperforming the ICG-VAL-MAP historical reference (95%). However, the retrospective design, selection bias, and limited power warrant cautious, exploratory interpretation, and prospective validation is needed.