Comparison of electromagnetic navigation bronchoscopic localization and computed tomographic imaging-guided methylene blue localization in the resection of pulmonary nodules: a retrospective cohort study

Abstract

Background Accurate localization of small-to-medium pulmonary nodules before video-assisted thoracoscopic surgery (VATS) is essential for success. Traditional imaging methods face challenges in the thoracic cavity. This study compares electromagnetic navigational bronchoscopic (ENB), computed tomography (CT)-guided localization effectiveness and safety with methylene blue marker dye. Materials and Methods This study, approved on May 4, 2024 by the Institutional Review Board of Wuhan Union Hospital (IRB ID UHCT240340) affiliated with Tongji Medical College, included patients with pulmonary nodules scheduled for VATS. Methylene blue was used as a marker dye and injected via CT-guided percutaneous or ENB techniques. The study compared clinical parameters, success rates, and complications between the two localization methods. Results Out of 378 patients who underwent preoperative localization, 254 received electromagnetic navigational bronchoscopy (ENB) and 124 had CT-guided percutaneous marker dye injections. Nodules were significantly larger in the ENB group (p < 0.001). Success rates were similar: ENB at 97.24% and CT-guided at 97.58%. ENB was more effective in the upper lobes than the lower lobes (p = 0.005), with no lobar preference for CT-guided localization (p = 0.073). ENB also had significantly fewer complications than CT-guided procedures (p < 0.001). Conclusions ENB localization success rates are comparable to CT-guided methods, but ENB carries lower risks, particularly for puncture-related complications. CT-guided localization is more effective than ENB for lower lobe nodules.

Keywords

• Pulmonary nodule
• Electromagnetic navigation bronchoscopy
• Computed tomographic imaging-guided localization
• Methylene blue
• Video-assisted thoracoscopic surgery (VATS)