Electromagnetic navigation bronchoscopy-guided preoperative localization of pulmonary nodules in 183 patients: A clinical analysis in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHEN Xiang , ZHANG Yajie , HAN Dingpei ,  LI Hecheng

Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China;

Corresponding author：

LI Hecheng, Email: lihecheng2000@hotmail.com

Keywords：

Electromagnetic navigation bronchoscopy; pulmonary nodules; preoperative localization

DOI：

10.7507/1007-4848.202302016

Video：

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Objective To investigate the clinical efficacy of preoperative location of pulmonary nodules guided by electromagnetic navigation bronchoscopy (ENB). Methods Patients who received preoperative ENB localization and then underwent surgery from March 2021 to November 2022 in the Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine were collected. The clinical efficacy and safety of ENB localization and the related factors that may affect the success of ENB localization were analyzed. Results Initially 200 patients were included, among whom 17 undergoing preoperative localization and biopsy were excluded and a total of 183 patients and 230 nodules were finally included. There were 62 males and 121 females with a mean age of 49.16±12.50 years. The success rate of navigation was 88.7%, and the success rate of ENB localization was 67.4%. The rate of complications related to ENB localization were 2.7%, and the median localization time was 10 (7, 15) min. Multi-variable analysis showed that factors related to successful localization included distance from localization site (OR=0.27, 95%CI 0.13-0.59, P=0.001), staining material (OR=0.40, 95%CI 0.17-0.95, P=0.038), and staining dose (OR=60.39, 95%CI 2.31-1 578.47, P=0.014). Conclusion ENB-guided preoperative localization of pulmonary nodules is safe and effective, and the incidence of complications is low, which can be used to effectively assist the diagnosis and treatment of early lung cancer.

Citation： CHEN Xiang, ZHANG Yajie, HAN Dingpei, LI Hecheng. Electromagnetic navigation bronchoscopy-guided preoperative localization of pulmonary nodules in 183 patients: A clinical analysis in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(11): 1539-1544. doi: 10.7507/1007-4848.202302016 Copy

1.	Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2022. CA Cancer J Clin, 2022, 72(1): 7-33.
2.	Humphrey LL, Deffebach M, Pappas M, et al. Screening for lung cancer with low-dose computed tomography: A systematic review to update the US preventive services task force recommendation. Ann Intern Med, 2013, 159(6): 411-420.
3.	Ciriaco P, Negri G, Puglisi A, et al. Video-assisted thoracoscopic surgery for pulmonary nodules: Rationale for preoperative computed tomography-guided hookwire localization. Eur J Cardiothorac Surg, 2004, 25(3): 429-433.
4.	Chen S, Zhou J, Zhang J, et al. Video-assisted thoracoscopic solitary pulmonary nodule resection after CT-guided hookwire localization: 43 cases report and literature review. Surg Endosc, 2011, 25(6): 1723-1729.
5.	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.
6.	Eberhardt R, Anantham D, Herth F, et al. Electromagnetic navigation diagnostic bronchoscopy in peripheral lung lesions. Chest, 2007, 131(6): 1800-1805.
7.	Marino KA, Sullivan JL, Weksler B. Electromagnetic navigation bronchoscopy for identifying lung nodules for thoracoscopic resection. Ann Thorac Surg, 2016, 102(2): 454-457.
8.	Awais O, Reidy MR, Mehta K, et al. Electromagnetic navigation bronchoscopy-guided dye marking for thoracoscopic resection of pulmonary nodules. Ann Thorac Surg, 2016, 102(1): 223-229.
9.	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.
10.	Bowling MR, Folch EE, Khandhar SJ, et al. Fiducial marker placement with electromagnetic navigation bronchoscopy: A subgroup analysis of the prospective, multicenter NAVIGATE study. Ther Adv Respir Dis, 2019, 13: 1753466619841234.
11.	Song JW, Park IK, Bae SY, et al. Electromagnetic navigation bronchoscopy-guided dye marking for localization of pulmonary nodules. Ann Thorac Surg, 2022, 113(5): 1663-1669.
12.	Baaklini WA, Reinoso MA, Gorin AB, et al. Diagnostic yield of fiberoptic bronchoscopy in evaluating solitary pulmonary nodules. Chest, 2000, 117(4): 1049-1054.
13.	Chen A, Pastis N, Furukawa B, et al. The effect of respiratory motion on pulmonary nodule location during electromagnetic navigation bronchoscopy. Chest, 2015, 147(5): 1275-1281.
14.	Van Schil PE, Rami-Porta R, Asamura H. The 8th TNM edition for lung cancer: A critical analysis. Ann Transl Med, 2018, 6(5): 87.
15.	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.
16.	Solomon SB, White P, Acker DE, et al. Real-time bronchoscope tip localization enables three-dimensional CT image guidance for transbronchial needle aspiration in swine. Chest, 1998, 114(5): 1405-1410.
17.	Jeong JH, Park H, Choi CM, et al. Preoperative electromagnetic navigation bronchoscopy-guided one-stage multiple-dye localization for resection of subsolid nodules: A single-center pilot study. Thorac Cancer, 2022, 13(3): 466-473.
18.	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.
19.	Bolton WD, Howe H, Stephenson JE. The utility of electromagnetic navigational bronchoscopy as a localization tool for robotic resection of small pulmonary nodules. Ann Thorac Surg, 2014, 98(2): 471-475.
20.	Makris D, Scherpereel A, Leroy S, et al. Electromagnetic navigation diagnostic bronchoscopy for small peripheral lung lesions. Eur Respir J, 2007, 29(6): 1187-1192.
21.	Eberhardt R, Anantham D, Ernst A, et al. Multimodality bronchoscopic diagnosis of peripheral lung lesions: A randomized controlled trial. Am J Respir Crit Care Med, 2007, 176(1): 36-41.
22.	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.
23.	Shi J, He J, He J, et al. Electromagnetic navigation-guided preoperative localization: The learning curve analysis. J Thorac Dis, 2021, 13(7): 4339-4348.

1. Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2022. CA Cancer J Clin, 2022, 72(1): 7-33.
2. Humphrey LL, Deffebach M, Pappas M, et al. Screening for lung cancer with low-dose computed tomography: A systematic review to update the US preventive services task force recommendation. Ann Intern Med, 2013, 159(6): 411-420.
3. Ciriaco P, Negri G, Puglisi A, et al. Video-assisted thoracoscopic surgery for pulmonary nodules: Rationale for preoperative computed tomography-guided hookwire localization. Eur J Cardiothorac Surg, 2004, 25(3): 429-433.
4. Chen S, Zhou J, Zhang J, et al. Video-assisted thoracoscopic solitary pulmonary nodule resection after CT-guided hookwire localization: 43 cases report and literature review. Surg Endosc, 2011, 25(6): 1723-1729.
5. 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.
6. Eberhardt R, Anantham D, Herth F, et al. Electromagnetic navigation diagnostic bronchoscopy in peripheral lung lesions. Chest, 2007, 131(6): 1800-1805.
7. Marino KA, Sullivan JL, Weksler B. Electromagnetic navigation bronchoscopy for identifying lung nodules for thoracoscopic resection. Ann Thorac Surg, 2016, 102(2): 454-457.
8. Awais O, Reidy MR, Mehta K, et al. Electromagnetic navigation bronchoscopy-guided dye marking for thoracoscopic resection of pulmonary nodules. Ann Thorac Surg, 2016, 102(1): 223-229.
9. 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.
10. Bowling MR, Folch EE, Khandhar SJ, et al. Fiducial marker placement with electromagnetic navigation bronchoscopy: A subgroup analysis of the prospective, multicenter NAVIGATE study. Ther Adv Respir Dis, 2019, 13: 1753466619841234.
11. Song JW, Park IK, Bae SY, et al. Electromagnetic navigation bronchoscopy-guided dye marking for localization of pulmonary nodules. Ann Thorac Surg, 2022, 113(5): 1663-1669.
12. Baaklini WA, Reinoso MA, Gorin AB, et al. Diagnostic yield of fiberoptic bronchoscopy in evaluating solitary pulmonary nodules. Chest, 2000, 117(4): 1049-1054.
13. Chen A, Pastis N, Furukawa B, et al. The effect of respiratory motion on pulmonary nodule location during electromagnetic navigation bronchoscopy. Chest, 2015, 147(5): 1275-1281.
14. Van Schil PE, Rami-Porta R, Asamura H. The 8th TNM edition for lung cancer: A critical analysis. Ann Transl Med, 2018, 6(5): 87.
15. 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.
16. Solomon SB, White P, Acker DE, et al. Real-time bronchoscope tip localization enables three-dimensional CT image guidance for transbronchial needle aspiration in swine. Chest, 1998, 114(5): 1405-1410.
17. Jeong JH, Park H, Choi CM, et al. Preoperative electromagnetic navigation bronchoscopy-guided one-stage multiple-dye localization for resection of subsolid nodules: A single-center pilot study. Thorac Cancer, 2022, 13(3): 466-473.
18. 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.
19. Bolton WD, Howe H, Stephenson JE. The utility of electromagnetic navigational bronchoscopy as a localization tool for robotic resection of small pulmonary nodules. Ann Thorac Surg, 2014, 98(2): 471-475.
20. Makris D, Scherpereel A, Leroy S, et al. Electromagnetic navigation diagnostic bronchoscopy for small peripheral lung lesions. Eur Respir J, 2007, 29(6): 1187-1192.
21. Eberhardt R, Anantham D, Ernst A, et al. Multimodality bronchoscopic diagnosis of peripheral lung lesions: A randomized controlled trial. Am J Respir Crit Care Med, 2007, 176(1): 36-41.
22. 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.
23. Shi J, He J, He J, et al. Electromagnetic navigation-guided preoperative localization: The learning curve analysis. J Thorac Dis, 2021, 13(7): 4339-4348.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Electromagnetic navigation bronchoscopy-guided preoperative localization of pulmonary nodules in 183 patients: A clinical analysis in a single center

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