Preoperative localization of pulmonary nodules: virtual bronchoscopic navigation vs a 4‑hook localization needle

Abstract

Introduction: Both virtual bronchoscopic navigation (VBN) and puncture with a 4‑hook localization needle are viable methods for localizing pulmonary nodules. However, there is a paucity of research that compares these 2 approaches.

Aim: This study aimed to assess and compare the efficacy of and complications associated with these 2 approaches to pulmonary nodule localization.

Materials and methods: We analyzed 223 patients who underwent VBN (n = 98) or needle localization (n = 125) of pulmonary nodules between April 2020 and December 2022. Each study group was divided into 2 subgroups, namely the solitary‑nodule group and the 2‑nodule group. We collected and analyzed data on localization time, accuracy, success rate, and complications in each group.

Results: In the solitary‑nodule subgroup, the mean (SD) distance between the localization point and the pulmonary nodule was 6.2 (6.1) mm for the needle‑localization group and 8.6 (4.8) mm for the VBN‑localization group (P = 0.01). In the 2‑nodule subgroup, the mean (SD) distance did not significantly differ and amounted to 8.7 (4.6) mm for the needle‑localization group and 8.4 (4.4) mm for the VBN‑localization group. However, the mean (SD) time required for localization was shorter in the VBN‑localization group (17.2 [2.6] min) than in the needle‑localization group (26.6 [3.9] min; P <0.001), which indicated that VBN was more efficient in 2‑nodule localization. The solitary nodule- and 2‑nodule-localization procedures differed significantly in terms of complications, such as pneumothorax and bleeding, with fewer complications reported in the VBN‑localization group.

Conclusions: In comparison with needle localization, VBN localization was associated with fewer complications. In the case of 2 pulmonary nodules, VBN localization outperformed the needle approach, with shorter localization time, fewer complications, and no radiation exposure.

Keywords: 4‑hook localization needle; localization; pulmonary nodules; virtual bronchoscopic navigation.

FIGURE 1

Pulmonary nodule localization using a 4‑hook localization needle; A – coronal localization by computed tomography and sagittal marking with steel needles; B – insertion of the localization needle into the lung tissue and positioning it near the pulmonary nodule selected for resection; C – release of the localization needle (arrow) and recording its relative position to the pulmonary nodule; D – resection of the needle and the surrounding lung tissue based on the markings of the localization needle and identification of the pulmonary nodule; E – removal of

FIGURE 2

Pulmonary nodule localization using virtual bronchoscopic navigation (VBN); A – computed tomography image showing a small pulmonary nodule (arrow) located in the right lower lobe; B – preoperative design of the VBN localization path with the LungPro software; C – injection of a indocyanine green marker into the corresponding site based on the virtual navigation pathway; D – verification of localization accuracy after thoracoscopic surgery