Abstract
BACKGROUND: Lung cancer frequently presents with bilateral multiple pulmonary nodules (BMPNs), whose accurate intraoperative localization during surgery is challenging, making reliable preoperative localization essential. This retrospective study evaluates the safety and efficacy of electromagnetic navigation bronchoscopy-guided dye marking (ENBDM) compared with conventional computed tomography-guided percutaneous dye marking (CTPDM) for localizing BMPNs. METHODS: A retrospective cohort study was conducted on patients with BMPNs who underwent preoperative localization (either ENBDM or CTPDM) followed by video-assisted thoracoscopic surgery (VATS) between January 2020 and September 2024. Patients' characteristics, nodule features, localization procedural details, procedure-related complications, pain scores, and surgical outcomes were compared between the two groups. RESULTS: A total of 150 patients were evaluated, including 79 patients who underwent ENBDM for preoperative pulmonary nodule localization and 71 patients who underwent CTPDM. Compared to the computed tomography (CT) group, the ENB group localized smaller nodules {6 [interquartile range (IQR), 5-8] vs. 7 (IQR, 6-9) mm, P<0.001} while requiring less localization time [8 (IQR, 7-10.5) vs. 25 (IQR, 20.5-32) min, P<0.001]. The distance between the positioning points marked by ENB and CT and the pulmonary nodules showed no significant difference [12 (IQR, 10-15) vs. 11 (IQR, 6-18) mm, P=0.15]. The ENB group was not exposed to radiation (0 vs. 6.6±1.9, P<0.001). No procedure-related complications, such as pneumothorax, hemothorax, pulmonary hematoma, or other adverse events, were observed in the ENB group. Moreover, the post-procedure pain scores in the CT group were significantly higher than those in the ENB group (3.1±1.5 vs. 0, P<0.001). CONCLUSIONS: For patients with BMPNs, ENB-guided localization achieved comparable accuracy to CT-guided localization, while offering significantly shorter localization times and a complete absence of complications. ENBDM represents a safe, efficient, and reliable method for preoperative localization of BMPNs.