Long-term outcomes of virtual-assisted lung mapping compared with CT-guided percutaneous marking

Virtual-assisted lung mapping (VAL-MAP) is a preoperative bronchoscopic multi-spot dye-marking technique that utilizes virtual bronchoscopy images to aid in the resection of pulmonary nodules that are difficult to identify intraoperatively. In this study, we compared the long-term oncologic outcomes of VAL-MAP with those of historical computed tomography (CT)-guided percutaneous marking.

This retrospective observational study included 213 consecutive patients who underwent curative pulmonary resection from 1998 to 2018 at our institute. Patients who underwent VAL-MAP were compared with those who underwent CT-guided localization. The local recurrence rate and local recurrence-free survival were evaluated.

In total, 163 patients underwent sublobar pulmonary resection. Age and surgical procedure were significantly different between the VAL-MAP and CT-guided localization groups. The local recurrence rate was significantly lower in the VAL-MAP group than in the CT-guided localization group [2.9% vs. 11.1% at 5 years; subdistribution hazard ratio (HR) =0.22; 95% confidence interval (CI): 0.06-0.82; P=0.02]. Local recurrence occurred in three patients with metastatic lung tumors and in no patients with primary lung cancer in the VAL-MAP group. Among patients with metastatic lung tumors undergoing sublobar resection, VAL-MAP was associated with a lower local recurrence rate (subdistribution HR =0.23; 95% CI: 0.06-0.92; P=0.03) and higher local recurrence-free survival rate (65.5% vs. 36.4% at 5 years; P=0.04) compared with historical CT-guided localization.

VAL-MAP demonstrated favorable long-term outcomes for both local recurrence and local recurrence-free survival compared with CT-guided percutaneous marking.