Electromagnetic Navigation-Guided Preoperative Localization of Small Malignant Pulmonary Tumors

Background: Thoracoscopic resection of small pulmonary nodules can be challenging, which highlights the importance of preoperative localization. We report our experience with electromagnetic navigation-guided localization. Methods: The clinical, radiographic, surgical, and pathologic data of patients who underwent electromagnetic navigation-guided preoperative localization for pulmonary tumors smaller than 2 cm were reviewed. Successful localization was defined as successful identification of target lesions during the thoracoscopic procedure without palpation. Result: Included were 30 patients with 35 nodules. There were 31 transthoracic and 5 transbronchial approaches performed. One patient received both approaches for the same tumor, and 3 received both approaches for localization of multiple targets. The median nodule size was 1.0 cm (interquartile range [IQR], 0.8-1.2 cm), and the median distance from the pleural surface was 1.1 cm (IQR, 0.6-2.0 cm). The most commonly used marker for localization was dye (n = 18), followed by microcoils (n =15). In nodules located with microcoils, the median distance between the microcoil and nodule was 1 mm (IQR, 0-3 mm). There were no complications related to the localization procedure. Successful localization was achieved in 27 of 30 patients (90.0%) and in 32 of 35 nodules (91.4%). The pathologic diagnosis was primary pulmonary malignancy in 29 nodules and secondary pulmonary malignancy in 6. Conclusions: Our experience with electromagnetic navigation-guided transbronchial and transthoracic preoperative localization of small, malignant pulmonary tumors shows this technique is feasible and appears to be a viable option for preoperative localization of pulmonary nodules that may be difficult to locate thoracoscopically.