Electromagnetic bronchoscopy versus computed tomography for pulmonary nodule localization

Electromagnetic navigational bronchoscopy (NAVIB) and CT-guided transthoracic marking (CTI) are two possible methods for preoperative marking. We have conducted a study to determine whether one technique performs better in a selected patient population.

In a single-center, 1:1 randomized controlled trial we compared NAVIB using indocyanine green and CTI with Technetium-99m during uniportal wedge resections of lung nodules. Primary endpoint was the duration of surgery. Secondary endpoints included wedge resection time, complication rates, surgical margin, and surgeon satisfaction questionnaires.

63 patients were randomized, with 32 assigned to the NAVIB and 31 to the CTI group. Surgeries' duration was similar, with a median of 52.5 minutes (IQR:40-70) for NAVIB and 45 minutes for CTI (IQR:30-60;p= 0.664). The median wedge time for NAVIB was 15.5 minutes (IQR: 13-20), while for CTI it was 12 minutes (IQR: 9-15;p=0.0007). Grade II or higher complication rates were 9.4% for NAVIB vs 12.9% for CTI; (p = 0.144) and lesion's distance to staple line was 5.7mm (CI:4.2-7.2) vs. 7.0mm (CI:4.3-9.9) respectively (p = 0.355). In the questionnaire from 0 (not helpful) to 3 (very helpful), CTI received a median score of 3 (IQR;3-3), while NAVIB's was 2.5 (IQR;2-3;p = 0.045). After Bonferroni correction, questionnaire differences were not significant.

The randomized trial failed to demonstrate a significant difference in overall surgery duration between electromagnetic navigational bronchoscopy and computed tomography-guided transthoracic marking.