Preoperative Localization Techniques for Pulmonary Nodules

Accurate preoperative localisation of pulmonary nodules is essential for minimally invasive resection and diagnostic precision. Techniques fall into percutaneous and bronchoscopic approaches, each tailored to nodule size, depth and morphology. Percutaneous methods include hook-wire placement, microcoil deployment, dye injection and radiotracer marking under CT guidance. These afford direct visual or tactile cues during video-assisted thoracoscopic surgery (VATS), but carry risks of pneumothorax and haemorrhage. Bronchoscopic techniques encompass electromagnetic navigation bronchoscopy (ENB) and virtual-assisted lung mapping (VAL-MAP), enabling multispot dye or marker placement via the airway and reducing pleural injury. Hybrid operating rooms combine imaging and intervention in a single setting, streamlining one-step localisation and resection. Emerging device-based strategies, such as actuated continuum probes with integrated ultrasound, promise real-time intraoperative imaging and margin delineation. Across all techniques, advances aim to improve detection of ground-glass opacities and small deep lesions, optimise workflow and minimise patient discomfort while preserving lung parenchyma.

Research from Nature Portfolio

A novel anchor-claw and tri-coloured suture system guided by CT has been assessed in a large retrospective series. Over 590 small pulmonary nodules were successfully localised before VATS, achieving a 97.3 % placement success rate and 100 % device retrieval. The depth of nodules correlated with minor pneumothorax and parenchymal haemorrhage rates, but median procedure duration was under 15 minutes and patient discomfort was minimal. This technique offers a stable, fracture-resistant marker with clear visual cues, facilitating precise thoracoscopic wedge resection without conversion to open surgery in nearly all cases.

Research from all publishers

CT-guided injection of a low-activity technetium-99m radiotracer in a hybrid operating room environment has demonstrated over 90 % thoracoscopic resection success with minimal technical failures. The integration of real-time gamma probe detection permits lower radioisotope doses and lung-sparing resections. Virtual-assisted lung mapping (VAL-MAP) has evolved through electromagnetic navigation bronchoscopy with on-site adjustment, eliminating the need for post-mapping CT. The adoption of indocyanine green fluorescence and a three-dimensional microcoil-based VAL-MAP 2.0 has improved intraoperative mark visibility and resection accuracy for deeply located tumours, while maintaining a low complication profile. A design study of an actuated continuum ultrasound probe optimised via genetic algorithms outlines a deployable device for intraoperative margin delineation. By balancing manoeuvrability and imaging performance, this probe can be inserted through standard thoracoscopic ports to provide single- and multiple-scattering ultrasound data, supporting precise nodule localisation and real-time boundary assessment during wedge resection.

Preoperative Localization Techniques for Pulmonary Nodules publication trend

The graph below shows the total number of articles in preoperative localization techniques for pulmonary nodules across all publications each year (not limited to Nature Index journals).

Technical terms

Video-assisted thoracoscopic surgery (VATS): Minimally invasive lung surgery performed through small chest incisions using a thoracoscope.

Ground-glass opacity (GGO): A hazy radiological appearance indicating partial filling of air spaces, often seen in early or indolent lung lesions.

Radiotracer localisation: Injection of a gamma-emitting substance to mark a nodule for intraoperative detection with a gamma probe.

Electromagnetic navigation bronchoscopy (ENB): A bronchoscopic technique that uses electromagnetic tracking to guide instruments to peripheral lung lesions.

References

1. CT-guided percutaneous marking of small pulmonary nodules with [99mTc]Tc-Macrosalb is very accurate and allows minimally invasive lung-sparing resection: a single-centre quality control. European Journal of Nuclear Medicine and Molecular Imaging (2023).
2. Ten-Year Outcome and Development of Virtual-Assisted Lung Mapping in Thoracic Surgery. Cancers (2023).
3. Design Optimization and Tradeoff Analysis of an Actuated Continuum Probe for Pulmonary Nodule Localization and Resection. Bioengineering (2024).
4. A novel preoperative image-guided localization for small pulmonary nodule resection using a claw-suture device. Scientific Reports (2023).