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Intraoperative Nodule Localization in Non-Small-Cell Lung Cancer: Existing and Emerging Techniques.

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  • 1Division of Thoracic Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.

Cancers
|June 26, 2026
PubMed
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Thoracic surgeons increasingly use lung nodule localization techniques for precise resection of small lung lesions. This review categorizes and evaluates preoperative and intraoperative methods for improved lung-sparing surgeries.

Area of Science:

  • Thoracic surgery
  • Pulmonary medicine
  • Medical imaging

Background:

  • Increasing trend in thoracic surgery towards smaller lung resections.
  • Need for precise localization of small and occult lung nodules.
  • Growing utilization of perioperative lung nodule localization techniques.

Purpose of the Study:

  • To review and classify current and emerging lung nodule localization techniques.
  • To analyze the efficacy, safety, benefits, and hazards of various modalities.
  • To provide evidence-based appraisal of different localization approaches.

Main Methods:

  • Categorization of techniques into preoperative and intraoperative modalities.
  • Review of published data on computed tomography (CT)-guided localization, virtual-assisted lung mapping, electromagnetic navigation bronchoscopy, robotic-assisted bronchoscopy, fiducial markers.
Keywords:
intraoperative molecular imaginglung cancernodule localization

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  • Evaluation of intraoperative cone-beam CT, fluorescence-guided surgery, and intraoperative molecular imaging (IMI), including early-stage clinical trials and preclinical models.

    • Main Results:

    • Detailed analysis of preoperative localization methods including CT-guided, VLM, ENB, RABC, and fiducial markers.
    • Comprehensive review of intraoperative techniques such as classical methods, iCBCT, FGS, and IMI.
    • Assessment of emerging IMI agents and preclinical models for future applications.

    Conclusions:

    • Lung nodule localization techniques are crucial for adequate resection and lung-sparing surgery.
    • A wide array of preoperative and intraoperative modalities exist, each with specific benefits and risks.
    • Ongoing research in intraoperative molecular imaging promises further advancements in targeted lung lesion resection.