Comparison Between The Application Of CT-guided Hook-wire Puncture Localization And ENB-guided Localization In Thoracoscopic Pulmonary Nodule Resection

Objective Lung cancer is the leading cause of death of cancer around the world.With the widely use of low dose CT and increasing healthy demands of people,more small pulmonary nodules that are being referred to thoracic surgeons although there are several conventional methods to obtain tissues of small nodules.Video-assisted thoracoscopic surgery has become an important method for minimally invasive treatment of thoracic surgery.However,nodules can be challenging to resect with minimally procedures when they cannot be palpated.Computed tomography-guided placement of Hook-wire is widely used to assist surgeons to perform surgical resection.And electromagnetic navigational bronchoscopy guided localization has been developed in recent years as a localization technique for minimally invasive resection.The aims of this study were to evaluate the feasibility and effectiveness of both methods and to determine whether electromagnetic navigational bronchoscopy guided localization is a safer and more effective method than computed tomography–guided localization.Method We retrospectively analyzed patients who underwent computed tomography-guided placement of Hook-wire or electromagnetic navigational bronchoscopy guided localization prior to video assisted thoracic surgery between February 2017 and December 2018 in thoracic surgery.Results 126 patients with 129 nodules were divided into two groups according to the two localization methods.61 patients with 64 nodules accepted computed tomography-guided Hook-wire placement,65 patients received electromagnetic navigational bronchoscopy guided localization(43 for methylene blue injection and 22 for vetorial localization).There were no significant differences in age,gender,nodule size,nodule location,and pathologic findings between the two groups.Nodule marking was successful in 62 of 64 attempts(96.9%)in computed tomography group,among whom two nodules were found displacement of Hook-wire and were identified by bleeding point on the surface of the lung,and one patient required closed drainage as a result of pneumothorax.All nodules in the electromagnetic navigational bronchoscopy group were successfully located 100%(65/65),and 2 cases showed an enlarged area of methylene blue staining on visceral pleura,and there was no LG shift in the vetorial localization method.Postoperative complications occurred in 4%(5/126)of all patients.No conversion to thoracotomy was found in any cases.There was a statistically significant difference between the two groups in localization time(17.2 ± 4.2 min vs 20.4 ± 3.3 min,p < 0.001)and post-localization waiting time(21.2±5.6min vs 95.6±36.5min,p<0.001).And there was no statistically significant difference in the time of wedge resection(p=0.237),postoperative drainage time(p=0.707),rate of complication(p=0.661)and postoperative hospital stay(p=9.950).Conclusion We found electromagnetic navigational bronchoscopy to be as safe and effective as computed tomography-guided Hook-wire placement and to provide a significantly decreased localization time and waiting time between localization and surgical resection.