Electromagnetic navigation bronchoscopy-guided transbronchial dye marking for localization of peripheral lung lesions.

The increase The rise of minimally invasive surgery and the approach of pulmonary nodules without a solid component makes difficult the intraoperative detection. The marking can be guided by CT (radioguided occult lesion localization, ROLL) or more recently, with dye and/or radioisotope with electromagnetic navigation bronchoscopy (ENB). <bold>Objective:</bold> Analyze the characteristics of marked lung lesions and compare results obtained by ENB versus by with those obtained by ROLL. Material and methods: Retrospective observational study of patients with peripheral lung lesions who underwent to presurgical marking. ENB was carried out in the operating room with orotracheal intubation and general anesthesia on the same day of surgical resection. Indocyanine green (1-2ml) and albumin (1ml) were instilled by a fine needle through the channel of the ENB (Arcpoint 21G) (fig 1). ROLL was carried out in the CT room, under local anesthesia and methylene blue (1ml) and radiotracer with Technetium-99m macroaggregated albumin injection. <bold>Results:</bold> Characteristics of patients (n=23), nodules (n=25) and surgery are recordered. All nodules were successfully localized. Two nodules from the same patient are marked at the same time with both methods. Pneumothorax rate were 25% in ROLL, no complications due to ENB. The time to surgery from ROLL was 241min vs 0 in ENB (fig 2). <bold>Conclusions:</bold> Intraoperative marking through ENB is an effective procedure that allows reducing the time and complications from marking to surgery. This method is a safe alternative to traditional CT-guided localization techniques. Multidisciplinary work is important in order to establish protocols on the use of ENB marking.