Eastern Cardiothoracic Surgical Society

Identifying Small Pulmonary Nodules for Minimally Invasive Resection: The Role of Electromagnetic Navigational Bronchoscopy
Katy A. Marino, Jennifer Sullivan, Benny Weksler. UTHSC, Memphis, TN USA.


Objective: Pulmonary Nodules smaller than 1 cm can be difficult to identify during minimally invasive resection (VATS), often requiring conversion to thoracotomy. We hypothesized that localizing nodules with electromagnetic navigational bronchoscopy (ENB) and marking them with methylene blue (MB) would allow VATS and reduce conversion to thoracotomy.

Methods: We identified all patients who underwent ENB followed by VATS from 2011 to 2014. Lung nodules smaller than 10 mm and nodules smaller than 20 mm and located more than 10 mm from the pleural surface were localized and marked with MB. Immediately after marking, all patients underwent resection.

Results: 70 patients underwent ENB marking followed by VATS. There were 41 males; median age was 57 years (range 23-82, interquartile range [IQR] 15). The majority of patients (68/70) had one nodule localized; 2/70 had two nodules localized. Median nodule size was 8 mm (4-17, IQR 5). Median distance from the pleural surface was 6 mm (1-19, IQR 6). There were no conversions to thoracotomy. Nodule marking was successful in 70 of 72 attempts (97.2%) with 2 nodules identified by palpation. The majority of patients (31/70, 44.3%) had metastases from other sites (Table SA17-1). There were no complications related to ENB marking or wedge resections.

Conclusions: Localizing and marking small nodules using ENB is safe and effective for identification prior to VATS resection.

Table 1 –Classification of Nodules Resected Using ENB,MB Marking, and VATS Wedge Resection
Diagnosis N/total (%)
Lung Metastases 31/70 (44.3%)
Colon cancer 12/31 (38.7%)
Breast cancer 8/31 (25.8%)
Sarcoma 7/31 (22.6%)
Lymphoma 2/31 (6.5%)
Other 2/31 (6.5%)
   
Lung cancer 27/70 (38.6%)
   
Adenocarcinoma 15/27 (55.6%)
Squamous Cell Carcinoma 7/27 (25.9%)
Carcinoid Lung Tumor 2/ 27 (7.4%)
Other 3 /27 (11.1%)
   
Benign Lesion 12/70 (17.1%)