Comparative Analysis of ENB with ICG vs Hook-Wire for Pulmonary Nodule Localization

Overview

This study compared electromagnetic navigation bronchoscopy (ENB) combined with indocyanine green (ICG) staining to hook-wire percutaneous localization for pulmonary nodules adjacent to lung fissures. ENB with ICG showed a lower rate of extended resection and fewer complications, despite requiring longer localization time.

Background

Accurate preoperative localization of small pulmonary nodules near lung fissures is critical for successful thoracoscopic surgery and minimizing postoperative complications. Traditional CT-guided hook-wire localization, while simple and widely used, can be inaccurate for nodules near fissures due to lung movement and relative positioning. ENB combined with ICG staining offers a bronchoscopic approach that allows precise localization deep within the bronchial tree, potentially improving surgical outcomes.

Data Highlights

Key Findings

• ENB with ICG staining required significantly longer localization time than hook-wire localization (25.30 vs. 19.68 minutes).
• The need for extended resection was significantly lower in the ENB group (3.0%) compared to the hook-wire group (22.6%).
• The incidence of pneumothorax was significantly reduced in the ENB group (6.10%) versus the hook-wire group (25.80%).
• ENB allows accurate positioning close to pulmonary nodules near fissures, overcoming limitations of hook-wire localization related to lung movement and relative positioning.
• Hook-wire localization may lead to inaccurate margins and increased risk of tumor implantation due to forced expansion of resection range or cutting through the tumor.

Clinical Implications

ENB combined with ICG staining should be considered for preoperative localization of pulmonary nodules near fissures to reduce complications such as pneumothorax and minimize the need for extended resections. Although ENB requires more time for localization, its higher accuracy and safety profile may improve surgical outcomes and preserve lung tissue.

Conclusion

ENB with ICG staining offers a safer and more precise alternative to hook-wire localization for pulmonary nodules adjacent to fissures, significantly reducing extended resections and pneumothorax incidence. This technique enhances preoperative planning and may improve thoracoscopic surgery success.

References

1. LungCare/China/2023-2025 -- Electromagnetic Navigation Bronchoscopy System
2. Soochow University Hospitals/2023-2025 -- Retrospective Cohort Study on Pulmonary Nodule Localization