Clinical effectiveness and safety of electromagnetic navigation-guided localization and CT-guided percutaneous localization for pulmonary nodules: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHENG Zaixing ,  MEI Peiyuan , WAN Li , JIANG Ke

Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, P.R.China;

Corresponding author：

MEI Peiyuan, Email: M13260630812@163.com

Keywords：

Electromagnetic navigation-guided localization; CT-guided percutaneous localization; pulmonary nodules; surgery; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202102051

Video：

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Objective To compare the effectiveness and safety of electromagnetic navigation-guided localization and CT-guided percutaneous localization for pulmonary nodules.Methods The literature published from the inception to January 2021 about the comparison between electromagnetic navigation-guided localization and CT-guided percutaneous localization for pulmonary nodules in the PubMed, The Cochrane Library, Web of Science, EMbase, Chinese Wanfang database and CNKI database was searched. RevMan (version 5.4) software was used for meta-analysis. Nonrandomized controlled trials were evaluated using methodological index for nonrandomized studies (MINORS).Results A total of six retrospective studies (567 patients) were included in this meta-analysis. MINORS scores of all studies were all 17 points and above. There were 317 patients in the CT-guided percutaneous localization group and 250 patients in the electromagnetic navigation-guided localization group. The complication rate of the CT-guided percutaneous localization group was significantly higher than that in the electromagnetic navigation-guided localization group (OR=11.08, 95%CI 3.35 to 36.65, P<0.001). There was no significant difference in the success rate of localization (OR=0.48, 95%CI 0.16 to 1.48, P=0.20), localization time (MD=0.30, 95%CI –6.16 to 6.77, P=0.93) or nodule diameter (MD=–0.07, 95%CI –0.19 to 0.06, P=0.29) between the two groups.Conclusion Electromagnetic navigation can be used as an effective preoperative positioning method for pulmonary nodules, which has the advantage of lower complication rate compared with the traditional CT positioning method.

Citation： CHENG Zaixing, MEI Peiyuan, WAN Li, JIANG Ke. Clinical effectiveness and safety of electromagnetic navigation-guided localization and CT-guided percutaneous localization for pulmonary nodules: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(1): 23-29. doi: 10.7507/1007-4848.202102051 Copy

1.	邹小农, 贾漫漫, 王鑫, 等. 《2020全球癌症报告》要点解读. 中国胸心血管外科临床杂志, 2021, 28(1):11-18.
2.	Sato M. Precise sublobar lung resection for small pulmonary nodules: Localization and beyond. Gen Thorac Cardiovasc Surg, 2020, 68(7): 684-691.
3.	Slim K, Nini ED, Forestier D, et al. Methodological index for non-randomized studies (minors): Development and validation of a new instrument. ANZ J Surg, 2003, 73(9): 712-716.
4.	Yang YL, Li ZZ, Huang WC, et al. Electromagnetic navigation bronchoscopic localization versus percutaneous CT-guided localization for thoracoscopic resection of small pulmonary nodules. Thorac Cancer, 2021, 12(4): 468-474.
5.	Hung CT, Chen CK, Chang YY, et al. Electromagnetic navigation-guided versus computed tomography-guided percutaneous localization of small lung nodules before uniportal video-assisted thoracoscopic surgery: A propensity score-matched analysis. Eur J Cardiothorac Surg, 2020, 58(Suppl_1): i85-i91.
6.	Kuo SW, Tseng YF, Dai KY, et al. Electromagnetic navigation bronchoscopy localization versus percutaneous CT-guided localization for lung resection via video-assisted thoracoscopic surgery: A propensity-matched study. J Clin Med, 2019, 8(3): 379.
7.	Tian Y, Wang C, Yue W, et al. Comparison of computed tomographic imaging-guided hook wire localization and electromagnetic navigation bronchoscope localization in the resection of pulmonary nodules: A retrospective cohort study. Sci Rep, 2020, 10(1): 21459.
8.	宋桂松. CT引导Hook-wire穿刺定位与电磁导航支气管镜引导的定位在肺结节切除术中的比较. 青岛大学, 2019.
9.	Bolton WD, Cochran T, Ben-Or S, et al. Electromagnetic navigational bronchoscopy reduces the time required for localization and resection of lung nodules. Innovations (Phila), 2017, 12(5): 333-337.
10.	肺小结节术前辅助定位技术专家共识(2019版)专家组. 肺小结节术前辅助定位技术专家共识(2019版). 中国胸心血管外科临床杂志, 2019, 26(2): 109-113.
11.	Liu B, Gu C. Expert consensus workshop report: Guidelines for preoperative assisted localization of small pulmonary nodules. J Cancer Res Ther, 2020, 16(5): 967-973.
12.	仲艳, 许晓泉, 陈亮, 等. CT引导下Hookwire与亚甲蓝联合定位对胸腔镜下肺内多发结节切除术的指导价值. 医学影像学杂志, 2017, 27(4): 667-669, 676.
13.	Park CH, Han K, Hur J, et al. Comparative effectiveness and safety of preoperative lung localization for pulmonary nodules: A systematic review and meta-analysis. Chest, 2017, 151(2): 316-328.
14.	Xu Y, Ma L, Sun H, et al. CT-guided microcoil localization for pulmonary nodules before VATS: A retrospective evaluation of risk factors for pleural marking failure. Eur Radiol, 2020, 30(10): 5674-5683.
15.	Xu Y, Ma L, Sun H, et al. The utility of simultaneous CT-guided localization for multiple pulmonary nodules using microcoil before video-assisted thoracic surgery. BMC Pulm Med, 2021, 21(1): 39.
16.	Chen J, Pan X, Gu C, et al. The feasibility of navigation bronchoscopy-guided pulmonary microcoil localization of small pulmonary nodules prior to thoracoscopic surgery. Transl Lung Cancer Res, 2020, 9(6): 2380-2390.
17.	Abbas A, Kadakia S, Ambur V, et al. Intraoperative electromagnetic navigational bronchoscopic localization of small, deep, or subsolid pulmonary nodules. J Thorac Cardiovasc Surg, 2017, 153(6): 1581-1590.
18.	宋桂松, 邱桐, 玄云鹏, 等. 电磁导航支气管镜矢量定位法在肺小结节手术中的应用. 中国肺癌杂志, 2019, 22(11): 709-713.
19.	Hsu PK, Chuang LC, Wu YC. Electromagnetic navigation-guided preoperative localization of small malignant pulmonary tumors. Ann Thorac Surg, 2020, 109(5): 1566-1573.
20.	Furukawa BS, Pastis NJ, Tanner NT, et al. Comparing pulmonary nodule location during electromagnetic bronchoscopy with predicted location on the basis of two virtual airway maps at different phases of respiration. Chest, 2018, 153(1): 181-186.
21.	Hsu PK, Wu YC. The feasibility of electromagnetic navigation-guided percutaneous microcoil localization for thoracoscopic resection of small pulmonary nodules. J Thorac Cardiovasc Surg, 2019, 157(4): e211-e214.
22.	Rouchy RC, Moreau-Gaudry A, Chipon E, et al. Evaluation of the clinical benefit of an electromagnetic navigation system for CT-guided interventional radiology procedures in the thoraco-abdominal region compared with conventional CT guidance (CTNAV Ⅱ): Study protocol for a randomised controlled trial. Trials, 2017, 18(1): 306.
23.	Marino KA, Sullivan JL, Weksler B. Electromagnetic navigation bronchoscopy for identifying lung nodules for thoracoscopic resection. Ann Thorac Surg, 2016, 102(2): 454-457.
24.	Qi H, Wan C, Zhang L, et al. Early effective treatment of small pulmonary nodules with video-assisted thoracoscopic surgery combined with CT-guided dual-barbed hookwire localization. Oncotarget, 2017, 8(24): 38793-38801.
25.	Ito K, Shimada J, Shimomura M, et al. Safety and reliability of computed tomography-guided lipiodol marking for undetectable pulmonary lesions. Interact Cardiovasc Thorac Surg, 2020, 30(4): 546-551.
26.	Hasegawa T, Kuroda H, Sato Y, et al. The utility of indigo carmine and lipiodol mixture for preoperative pulmonary nodule localization before video-assisted thoracic surgery. J Vasc Interv Radiol, 2019, 30(3): 446-452.
27.	Piao Z, Han SJ, Cho HJ, et al. Feasibility of electromagnetic navigation bronchoscopy-guided lung resection for pulmonary ground-glass opacity nodules. J Thorac Dis, 2020, 12(5): 2467-2473.
28.	Bowling MR, Folch EE, Khandhar SJ, et al. Pleural dye marking of lung nodules by electromagnetic navigation bronchoscopy. Clin Respir J, 2019, 13(11): 700-707.
29.	Lee HJ, Lerner AD, Coleman B, et al. Learning electromagnetic navigational bronchoscopy and percutaneous transthoracic needle biopsy (LEAP): A pilot study. J Bronchology Interv Pulmonol, 2019, 26(1): 55-61.
30.	Shiekh Y, Haseeb WA, Feroz I, et al. Evaluation of various patient-, lesion-, and procedure-related factors on the occurrence of pneumothorax as a complication of CT-guided percutaneous transthoracic needle biopsy. Pol J Radiol, 2019, 84: e73-e79.
31.	刘君, 唐平, 赵艳军, 等. 超声对经皮肺穿刺活检后气胸的检测效能及其对降低患者辐射中的价值. 中国医学计算机成像杂志, 2019, 25(4): 396-399.
32.	Folch EE, Labarca G, Ospina-Delgado D, et al. Sensitivity and safety of electromagnetic navigation bronchoscopy for lung cancer diagnosis: Systematic review and meta-analysis. Chest, 2020, 158(4): 1753-1769.
33.	McGuire AL, Myers R, Grant K, et al. The diagnostic accuracy and sensitivity for malignancy of radial-endobronchial ultrasound and electromagnetic navigation bronchoscopy for sampling of peripheral pulmonary lesions: Systematic review and meta-analysis. J Bronchology Interv Pulmonol, 2020, 27(2): 106-121.
34.	Madariaga MLL, Lanuti M. Sampling of suspicious solitary pulmonary nodules: Electromagnetic navigational bronchoscopy and video-assisted thoracoscopic surgery. Semin Roentgenol, 2017, 52(3): 178-184.
35.	Dale CR, Madtes DK, Fan VS, et al. Navigational bronchoscopy with biopsy versus computed tomography-guided biopsy for the diagnosis of a solitary pulmonary nodule: A cost-consequences analysis. J Bronchology Interv Pulmonol, 2012, 19(4): 294-303.
36.	Atkins NK, Marjara J, Kaifi JT, et al. Role of computed tomography-guided biopsies in the era of electromagnetic navigational bronchoscopy: A retrospective study of factors predicting diagnostic yield in electromagnetic navigational bronchoscopy and computed tomography biopsies. J Clin Imaging Sci, 2020, 10: 33.
37.	Sato T, Yutaka Y, Ueda Y, et al. Diagnostic yield of electromagnetic navigational bronchoscopy: Results of initial 35 cases in a Japanese institute. J Thorac Dis, 2018, 10(Suppl 14): S1615-S1619.
38.	Folch EE, Bowling MR, Gildea TR, et al. Design of a prospective, multicenter, global, cohort study of electromagnetic navigation bronchoscopy. BMC Pulm Med, 2016, 16(1): 60.
39.	Folch EE, Pritchett MA, Nead MA, et al. Electromagnetic navigation bronchoscopy for peripheral pulmonary lesions: One-year results of the prospective, multicenter NAVIGATE study. J Thorac Oncol, 2019, 14(3): 445-458.
40.	Bhatt KM, Tandon YK, Graham R, et al. Electromagnetic navigational bronchoscopy versus Ct-guided percutaneous sampling of peripheral indeterminate pulmonary nodules: A cohort study. Radiology, 2018, 286(3): 1052-1061.
41.	Jiang N, Zhang L, Hao Y, et al. Combination of electromagnetic navigation bronchoscopy-guided microwave ablation and thoracoscopic resection: An alternative for treatment of multiple pulmonary nodules. Thorac Cancer, 2020, 11(6): 1728-1733.

1. 邹小农, 贾漫漫, 王鑫, 等. 《2020全球癌症报告》要点解读. 中国胸心血管外科临床杂志, 2021, 28(1):11-18.
2. Sato M. Precise sublobar lung resection for small pulmonary nodules: Localization and beyond. Gen Thorac Cardiovasc Surg, 2020, 68(7): 684-691.
3. Slim K, Nini ED, Forestier D, et al. Methodological index for non-randomized studies (minors): Development and validation of a new instrument. ANZ J Surg, 2003, 73(9): 712-716.
4. Yang YL, Li ZZ, Huang WC, et al. Electromagnetic navigation bronchoscopic localization versus percutaneous CT-guided localization for thoracoscopic resection of small pulmonary nodules. Thorac Cancer, 2021, 12(4): 468-474.
5. Hung CT, Chen CK, Chang YY, et al. Electromagnetic navigation-guided versus computed tomography-guided percutaneous localization of small lung nodules before uniportal video-assisted thoracoscopic surgery: A propensity score-matched analysis. Eur J Cardiothorac Surg, 2020, 58(Suppl_1): i85-i91.
6. Kuo SW, Tseng YF, Dai KY, et al. Electromagnetic navigation bronchoscopy localization versus percutaneous CT-guided localization for lung resection via video-assisted thoracoscopic surgery: A propensity-matched study. J Clin Med, 2019, 8(3): 379.
7. Tian Y, Wang C, Yue W, et al. Comparison of computed tomographic imaging-guided hook wire localization and electromagnetic navigation bronchoscope localization in the resection of pulmonary nodules: A retrospective cohort study. Sci Rep, 2020, 10(1): 21459.
8. 宋桂松. CT引导Hook-wire穿刺定位与电磁导航支气管镜引导的定位在肺结节切除术中的比较. 青岛大学, 2019.
9. Bolton WD, Cochran T, Ben-Or S, et al. Electromagnetic navigational bronchoscopy reduces the time required for localization and resection of lung nodules. Innovations (Phila), 2017, 12(5): 333-337.
10. 肺小结节术前辅助定位技术专家共识(2019版)专家组. 肺小结节术前辅助定位技术专家共识(2019版). 中国胸心血管外科临床杂志, 2019, 26(2): 109-113.
11. Liu B, Gu C. Expert consensus workshop report: Guidelines for preoperative assisted localization of small pulmonary nodules. J Cancer Res Ther, 2020, 16(5): 967-973.
12. 仲艳, 许晓泉, 陈亮, 等. CT引导下Hookwire与亚甲蓝联合定位对胸腔镜下肺内多发结节切除术的指导价值. 医学影像学杂志, 2017, 27(4): 667-669, 676.
13. Park CH, Han K, Hur J, et al. Comparative effectiveness and safety of preoperative lung localization for pulmonary nodules: A systematic review and meta-analysis. Chest, 2017, 151(2): 316-328.
14. Xu Y, Ma L, Sun H, et al. CT-guided microcoil localization for pulmonary nodules before VATS: A retrospective evaluation of risk factors for pleural marking failure. Eur Radiol, 2020, 30(10): 5674-5683.
15. Xu Y, Ma L, Sun H, et al. The utility of simultaneous CT-guided localization for multiple pulmonary nodules using microcoil before video-assisted thoracic surgery. BMC Pulm Med, 2021, 21(1): 39.
16. Chen J, Pan X, Gu C, et al. The feasibility of navigation bronchoscopy-guided pulmonary microcoil localization of small pulmonary nodules prior to thoracoscopic surgery. Transl Lung Cancer Res, 2020, 9(6): 2380-2390.
17. Abbas A, Kadakia S, Ambur V, et al. Intraoperative electromagnetic navigational bronchoscopic localization of small, deep, or subsolid pulmonary nodules. J Thorac Cardiovasc Surg, 2017, 153(6): 1581-1590.
18. 宋桂松, 邱桐, 玄云鹏, 等. 电磁导航支气管镜矢量定位法在肺小结节手术中的应用. 中国肺癌杂志, 2019, 22(11): 709-713.
19. Hsu PK, Chuang LC, Wu YC. Electromagnetic navigation-guided preoperative localization of small malignant pulmonary tumors. Ann Thorac Surg, 2020, 109(5): 1566-1573.
20. Furukawa BS, Pastis NJ, Tanner NT, et al. Comparing pulmonary nodule location during electromagnetic bronchoscopy with predicted location on the basis of two virtual airway maps at different phases of respiration. Chest, 2018, 153(1): 181-186.
21. Hsu PK, Wu YC. The feasibility of electromagnetic navigation-guided percutaneous microcoil localization for thoracoscopic resection of small pulmonary nodules. J Thorac Cardiovasc Surg, 2019, 157(4): e211-e214.
22. Rouchy RC, Moreau-Gaudry A, Chipon E, et al. Evaluation of the clinical benefit of an electromagnetic navigation system for CT-guided interventional radiology procedures in the thoraco-abdominal region compared with conventional CT guidance (CTNAV Ⅱ): Study protocol for a randomised controlled trial. Trials, 2017, 18(1): 306.
23. Marino KA, Sullivan JL, Weksler B. Electromagnetic navigation bronchoscopy for identifying lung nodules for thoracoscopic resection. Ann Thorac Surg, 2016, 102(2): 454-457.
24. Qi H, Wan C, Zhang L, et al. Early effective treatment of small pulmonary nodules with video-assisted thoracoscopic surgery combined with CT-guided dual-barbed hookwire localization. Oncotarget, 2017, 8(24): 38793-38801.
25. Ito K, Shimada J, Shimomura M, et al. Safety and reliability of computed tomography-guided lipiodol marking for undetectable pulmonary lesions. Interact Cardiovasc Thorac Surg, 2020, 30(4): 546-551.
26. Hasegawa T, Kuroda H, Sato Y, et al. The utility of indigo carmine and lipiodol mixture for preoperative pulmonary nodule localization before video-assisted thoracic surgery. J Vasc Interv Radiol, 2019, 30(3): 446-452.
27. Piao Z, Han SJ, Cho HJ, et al. Feasibility of electromagnetic navigation bronchoscopy-guided lung resection for pulmonary ground-glass opacity nodules. J Thorac Dis, 2020, 12(5): 2467-2473.
28. Bowling MR, Folch EE, Khandhar SJ, et al. Pleural dye marking of lung nodules by electromagnetic navigation bronchoscopy. Clin Respir J, 2019, 13(11): 700-707.
29. Lee HJ, Lerner AD, Coleman B, et al. Learning electromagnetic navigational bronchoscopy and percutaneous transthoracic needle biopsy (LEAP): A pilot study. J Bronchology Interv Pulmonol, 2019, 26(1): 55-61.
30. Shiekh Y, Haseeb WA, Feroz I, et al. Evaluation of various patient-, lesion-, and procedure-related factors on the occurrence of pneumothorax as a complication of CT-guided percutaneous transthoracic needle biopsy. Pol J Radiol, 2019, 84: e73-e79.
31. 刘君, 唐平, 赵艳军, 等. 超声对经皮肺穿刺活检后气胸的检测效能及其对降低患者辐射中的价值. 中国医学计算机成像杂志, 2019, 25(4): 396-399.
32. Folch EE, Labarca G, Ospina-Delgado D, et al. Sensitivity and safety of electromagnetic navigation bronchoscopy for lung cancer diagnosis: Systematic review and meta-analysis. Chest, 2020, 158(4): 1753-1769.
33. McGuire AL, Myers R, Grant K, et al. The diagnostic accuracy and sensitivity for malignancy of radial-endobronchial ultrasound and electromagnetic navigation bronchoscopy for sampling of peripheral pulmonary lesions: Systematic review and meta-analysis. J Bronchology Interv Pulmonol, 2020, 27(2): 106-121.
34. Madariaga MLL, Lanuti M. Sampling of suspicious solitary pulmonary nodules: Electromagnetic navigational bronchoscopy and video-assisted thoracoscopic surgery. Semin Roentgenol, 2017, 52(3): 178-184.
35. Dale CR, Madtes DK, Fan VS, et al. Navigational bronchoscopy with biopsy versus computed tomography-guided biopsy for the diagnosis of a solitary pulmonary nodule: A cost-consequences analysis. J Bronchology Interv Pulmonol, 2012, 19(4): 294-303.
36. Atkins NK, Marjara J, Kaifi JT, et al. Role of computed tomography-guided biopsies in the era of electromagnetic navigational bronchoscopy: A retrospective study of factors predicting diagnostic yield in electromagnetic navigational bronchoscopy and computed tomography biopsies. J Clin Imaging Sci, 2020, 10: 33.
37. Sato T, Yutaka Y, Ueda Y, et al. Diagnostic yield of electromagnetic navigational bronchoscopy: Results of initial 35 cases in a Japanese institute. J Thorac Dis, 2018, 10(Suppl 14): S1615-S1619.
38. Folch EE, Bowling MR, Gildea TR, et al. Design of a prospective, multicenter, global, cohort study of electromagnetic navigation bronchoscopy. BMC Pulm Med, 2016, 16(1): 60.
39. Folch EE, Pritchett MA, Nead MA, et al. Electromagnetic navigation bronchoscopy for peripheral pulmonary lesions: One-year results of the prospective, multicenter NAVIGATE study. J Thorac Oncol, 2019, 14(3): 445-458.
40. Bhatt KM, Tandon YK, Graham R, et al. Electromagnetic navigational bronchoscopy versus Ct-guided percutaneous sampling of peripheral indeterminate pulmonary nodules: A cohort study. Radiology, 2018, 286(3): 1052-1061.
41. Jiang N, Zhang L, Hao Y, et al. Combination of electromagnetic navigation bronchoscopy-guided microwave ablation and thoracoscopic resection: An alternative for treatment of multiple pulmonary nodules. Thorac Cancer, 2020, 11(6): 1728-1733.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical effectiveness and safety of electromagnetic navigation-guided localization and CT-guided percutaneous localization for pulmonary nodules: A systematic review and meta-analysis

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