A better option for localization of multiple pulmonary nodules in the ipsilateral lung: electromagnetic navigation bronchoscopy-guided preoperative localization.

Pulmonary nodules are the most common manifestation of lung cancer. The detection rate of multiple nodules has been increasing and it is essential to figure out a precise way for localization of the nodules. The purpose of this study is to evaluate the efficacy, accuracy and safety of electromagnetic navigation bronchoscopy (ENB)-guided dye marking for localizing multiple ipsilateral nodules compared with computed tomography (CT)-guided lung puncture. We performed a retrospective cohort study of patients with multiple nodules in the ipsilateral lung who received preoperative localization [including ENB-guided dye marking (ENBDM) or CT-guided lung puncture] and video-assisted thoracoscopic surgery between September 2018 and April 2023. Data were statistically analyzed and visualized using SPSS v25.0 and Microsoft Excel 2019 software. A total of 203 patients were evaluated, among whom 99 underwent ENBDM to localize nodules preoperatively, and 104 were located by CT-guided lung puncture. In terms of localization time, ENB group compared with CT group consumed less time (8.00±4.66 vs. 22.00±8.82 min, P<0.001). In the ENB group, compared with the CT group, there was no radiation exposure. No related complications occurred in the ENB group, including pleural reaction [0 vs. 8 (7.7%), P=0.01], pneumothorax [0 vs. 36 (34.6%), P<0.001], and hemothorax [0 vs. 15 (14.4%), P<0.001]. However, no significant differences were observed in the success localization rate (97.4% vs. 94.9%, P=0.48) between the two groups. For patients with multiple ipsilateral pulmonary nodules, ENBDM can achieve the similar localization accuracy as CT-guided lung puncture, with shorter localization time and no complications. ENBDM is a safe and effective preoperative localization method for multiple ipsilateral pulmonary nodules.