Related Experiment Video
Updated: Jun 27, 2026
Electromagnetic Navigation Transthoracic Nodule Localization for Minimally Invasive Thoracic Surgery
Published on: May 4, 2022
Intraoperative Nodule Localization in Non-Small-Cell Lung Cancer: Existing and Emerging Techniques
Aidan Aicher1, Jerica Tidwell1, Sunil Singhal1
1Division of Thoracic Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.
Abstract:
As thoracic surgeons more frequently address smaller lung lesions and perform lung-sparing resections, their objective is to resect an adequate specimen and margin without removing excess healthy lung tissue. Although perioperative lung nodule localization has been in practice for decades, the existing and emerging techniques used for the identification of targeted and occult lesions are more widely utilized today than they were in the past. In this review, we detail the logic behind this increase in use, classify the techniques into preoperative and intraoperative categories, and define the specific modalities available. Where applicable, we review the published data comparing techniques, detailing efficacy and safety. In the preoperative space, we describe standard computed tomography (CT)-guided localization, virtual-assisted lung mapping, electromagnetic navigation bronchoscopy, robotic-assisted bronchoscopy, and novel fiducial markers. In the intraoperative space, we describe classical localization techniques, novel applications of intraoperative cone-beam CT, and fluorescence-guided surgery and intraoperative molecular imaging (IMI). Lastly, we review emerging approaches for intraoperative molecular imaging including a report on agents in early-stage clinical trials and a brief survey of promising preclinical models. With each approach mentioned, we analyze the potential benefits and hazards, and appraise the evidence for (or against) the use of any specific modality.
Insights
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.
- 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.
