Skip to main content
SpringerLink
Log in

Augmented fluoroscopic bronchoscopy (AFB) versus percutaneous computed tomography-guided dye localization for thoracoscopic resection of small lung nodules: a propensity-matched study

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Dye localization is a useful method for the resection of unidentifiable small pulmonary lesions. This study compares the transbronchial route with augmented fluoroscopic bronchoscopy (AFB) and conventional transthoracic CT-guided methods for preoperative dye localization in thoracoscopic surgery.

Methods

Between April 2015 and March 2019, a total of 231 patients with small pulmonary lesions who received preoperative dye localization via AFB or percutaneous CT-guided technique were enrolled in the study. A propensity-matched analysis, incorporating preoperative variables, was used to compare localization and surgical outcomes between the two groups.

Results

After matching, a total of 90 patients in the AFB group (N = 30) and CT-guided group (N = 60) were selected for analysis. No significant difference was noted in the demographic data between both the groups. Dye localization was successfully performed in 29 patients (96.7%) and 57 patients (95%) with AFB and CT-guided method, respectively. The localization duration (24.1 ± 8.3 vs. 21.4 ± 12.5 min, p = 0.297) and equivalent dose of radiation exposure (3.1 ± 1.5 vs. 2.5 ± 2.0 mSv, p = 0.130) were comparable in both the groups. No major procedure-related complications occurred in either group; however, a higher rate of pneumothorax (0 vs. 16.7%, p = 0.029) and focal intrapulmonary hemorrhage (3.3 vs. 26.7%, p = 0.008) was noted in the CT-guided group.

Conclusion

AFB dye marking is an effective alternative for the preoperative localization of small pulmonary lesions, with a lower risk of procedure-related complications than the conventional CT-guided method.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A (2015) Global cancer statistics, 2012. CA Cancer J Clin 65:87–108

    Article  Google Scholar 

  2. National Lung Screening Trial Research Team, Church TR, Black WC, Aberle DR, Berg CD, Clingan KL, Duan F, Fagerstrom RM, Gareen IF, Gierada DS, Jones GC, Mahon I, Marcus PM, Sicks JD, Jain A, Baum S (2013) Results of initial low-dose computed tomographic screening for lung cancer. N Engl J Med 368:1980–1991

    Article  Google Scholar 

  3. Yang SM, Hsu HH, Chen JS (2017) Recent advances in surgical management of early lung cancer. J Formos Med Assoc 116:917–923

    Article  Google Scholar 

  4. Saito H, Minamiya Y, Matsuzaki I, Tozawa K, Taguchi K, Nakagawa T, Hashimoto M, Hirano Y, Ogawa J (2002) Indication for preoperative localization of small peripheral pulmonary nodules in thoracoscopic surgery. J Thorac Cardiovasc Surg 124:1198–1202

    Article  Google Scholar 

  5. Suzuki K, Nagai K, Yoshida J, Ohmatsu H, Takahashi K, Nishimura M, Nishiwaki Y (1999) Video-assisted thoracoscopic surgery for small indeterminate pulmonary nodules: indications for preoperative marking. Chest 115:563–568

    Article  CAS  Google Scholar 

  6. Lin MW, Chen JS (2016) Image-guided techniques for localizing pulmonary nodules in thoracoscopic surgery. J Thorac Dis 8:S749–755

    Article  PubMed Central  Google Scholar 

  7. Lin MW, Tseng YH, Lee YF, Hsieh MS, Ko WC, Chen JY, Hsu HH, Chang YC, Chen JS (2016) Computed tomography-guided patent blue vital dye localization of pulmonary nodules in uniportal thoracoscopy. J Thorac Cardiovasc Surg 152:535–544

    Article  Google Scholar 

  8. Sato M, Kuwata T, Yamanashi K, Kitamura A, Misawa K, Imashimizu K (2017) Safety and reproducibility of virtual-assisted lung mapping: a multicentre study in Japan. Eur J Cardiothorac Surg 51:861–868

    Google Scholar 

  9. Awais O, Reidy MR, Mehta K, Bianco V, Gooding WE, Schuchert MJ, Luketich JD, Pennathur A (2016) Electromagnetic navigation bronchoscopy-guided dye marking for thoracoscopic resection of pulmonary nodules. Ann Thorac Surg 102:223–229

    Article  Google Scholar 

  10. Hohenforst-Schmidt W, Zarogoulidis P, Vogl T, Turner JF, Browning R, Linsmeier B, Huang H, Li Q, Darwiche K, Freitag L, Simoff M, Kioumis I, Zarogoulidis K, Brachmann J (2014) Cone beam computertomography (CBCT) in interventional chest medicine—high feasibility for endobronchial realtime navigation. J Cancer 5:231–241

    Article  PubMed Central  Google Scholar 

  11. Pritchett MA, Schampaert S, de Groot JAH, Schirmer CC, van der Bom I (2018) Cone-beam CT with augmented fluoroscopy combined with electromagnetic navigation bronchoscopy for biopsy of pulmonary nodules. J Bronchology Interv Pulmonol 25:274–282

    Article  PubMed Central  Google Scholar 

  12. Hogarth DK (2018) Use of augmented fluoroscopic imaging during diagnostic bronchoscopy. Future Oncol 14:2247–2252

    Article  CAS  Google Scholar 

  13. Yang SM, Yu KL, Lin KS, Liu YL, Sun SE, Meng LH, Ko HJ (2019) Cumulative experience of preoperative real-time augmented fluoroscopy-guided endobronchial dye marking for small pulmonary nodules: an analysis of 30 initial patients. J Formos Med Assoc 118:1232–1238

    Article  Google Scholar 

  14. Yang SM, Yu KL, Lin KS, Liu YL, Sun SE, Meng LH, Ko HJ (2019) Real-time augmented fluoroscopy-guided lung marking for thoracoscopic resection of small pulmonary nodules. Surg Endosc 2019:1–18. https://doi.org/10.1007/s00464-019-06972-y

    Article  CAS  Google Scholar 

  15. Murphy MJ, Balter J, Balter S, BenComo JA Jr, Das IJ, Jiang SB (2007) The management of imaging dose during image-guided radiotherapy: report of the AAPM Task Group 75. Med Phys 34:4041–4063

    Article  Google Scholar 

  16. Christner JA, Kofler JM, McCollough CH (2010) Estimating effective dose for ct using dose-length product compared with using organ doses: consequences of adopting international commission on radiological protection publication 103 or dual-energy scanning. Am J Roentgenol 194:881–889

    Article  Google Scholar 

  17. Sutherland J, Belec J, Sheikh A, Chepelev L, Althobaity W, Chow BJW, Mitsouras D, Christensen A, Rybicki FJ, La Russa DJ (2019) Applying modern virtual and augmented reality technologies to medical images and models. J Digit Imaging 32:38–53

    Article  Google Scholar 

  18. Bourier F, Reents T, Ammar-Busch S, Semmler V, Telishevska M, Kottmaier M, Lennerz C, Grebmer C, Kolb C, Deisenhofer I, Hessling G (2016) Transseptal puncture guided by CT-derived 3D-augmented fluoroscopy. J Cardiovasc Electrophysiol 27:369–372

    Article  Google Scholar 

  19. Blanc R, Fahed R, Roux P, Smajda S, Ciccio G, Desilles JP, Redjem H, Mazighi M, Baharvahdat H, Piotin M (2018) Augmented 3D venous navigation for neuroendovascular procedures. J Neurointerv Surg 10:649–652

    Article  Google Scholar 

  20. Hwang EJ, Kim H, Park CM, Yoon SH, Lim HJ, Goo JM (2018) Cone beam computed tomography virtual navigation-guided transthoracic biopsy of small (≤ 1 cm) pulmonary nodules: impact of nodule visibility during real-time fluoroscopy. Br J Radiol 91:20170805

    Article  PubMed Central  Google Scholar 

  21. Yang SM, Ko WC, Lin MW, Hsu HH, Chan CY, Wu IH, Chang YC, Chen JS (2016) Image-guided thoracoscopic surgery with dye localization in a hybrid operating room. J Thorac Dis 8:S681–S689

    Article  PubMed Central  Google Scholar 

  22. Lin CW, Ko HJ, Yang SM, Chen YC, Ko WC, Huang HC, Chen JS, Chang YC (2019) Computed tomography-guided dual localization with microcoil and patent blue vital dye for deep-seated pulmonary nodules in thoracoscopic surgery. J Formos Med Assoc 118:979–985

    Article  Google Scholar 

  23. Sato M (2016) Virtual assisted lung mapping: navigational thoracoscopic lung resection. Cancer Res Front 2:85–104

    Article  Google Scholar 

  24. Sato M, Aoyama A, Yamada T, Menjyu T, Chen F, Sato T, Sonobe M, Omasa M, Date H (2015) Thoracoscopic wedge lung resection using virtual-assisted lung mapping. Asian Cardiovasc Thorac Ann 23:46–54

    Article  Google Scholar 

  25. Bhatt K, Tandon Y, Graham R, Lau CT, Lempel JK, Azok JT, Mazzone PJ, Schneider E, Obuchowski NA, Bolen MA (2018) Electromagnetic navigational bronchoscopy versus CT-guided percutaneous sampling of peripheral indeterminate pulmonary nodules: a cohort study. Radiology 286:1052–1061

    Article  Google Scholar 

  26. Han Y, Kim H, Kong K, Kim SJ, Lee SH, Ryu YJ, Lee JH, Kim Y, Shim SS, Chang JH (2018) Diagnosis of small pulmonary lesions by transbronchial lung biopsy with radial endobronchial ultrasound and virtual bronchoscopic navigation versus CT-guided transthoracic needle biopsy: a systematic review and meta-analysis. PLoS ONE 13:e0191590

    Article  PubMed Central  Google Scholar 

  27. Wang C, Li X, Zhou Z, Zhao H, Li Z, Jiang G, Wang J (2016) Endobronchial ultrasonography with guide sheath versus computed tomography guided transthoracic needle biopsy for peripheral pulmonary lesions: a propensity score matched analysis. J Thorac Dis 8:2758–2764

    Article  CAS  PubMed Central  Google Scholar 

  28. Zhan P, Zhu Q, Miu Y, Liu YF, Wang XX, Zhou ZJ, Jin JJ, Li Q, Sasada S, Izumo T, Tu CY, Cheng WC, Evison M, Lv TF, Song Y (2017) Comparison between endobronchial ultrasound-guided transbronchial biopsy and CT-guided transthoracic lung biopsy for the diagnosis of peripheral lung cancer: a systematic review and meta-analysis. Transl Lung Cancer Res 6:23–34

    Article  PubMed Central  Google Scholar 

  29. Kuo SW, Tseng YF, Dai KY, Chang YC, Chen KC, Lee JM (2019) Electromagnetic navigation bronchoscopy localization versus percutaneous CT-guided localization for lung resection via video-assisted thoracoscopic surgery: a propensity-matched study. J Clin Med 8:379

    Article  PubMed Central  Google Scholar 

  30. Anayama T, Hirohashi K, Miyazaki R, Okada H, Kawamoto N, Yamamoto M, Sato T, Orihashi K (2018) Near-infrared dye marking for thoracoscopic resection of small-sized pulmonary nodules: comparison of percutaneous and bronchoscopic injection techniques. J Cardiothorac Surg 13:5

    Article  PubMed Central  Google Scholar 

  31. Murakami J, Ueda K, Tanaka T, Kobayashi T, Kunihiro Y, Hamano K (2017) The validation of a no-drain policy after thoracoscopic major lung resection. Ann Thorac Surg 104:1005–1011

    Article  Google Scholar 

  32. Yang SM, Wang ML, Hung MH, Hsu HH, Cheng YJ, Chen JS (2017) Tubeless uniportal thoracoscopic wedge resection for peripheral lung nodules. Ann Thorac Surg 103:462–468

    Article  Google Scholar 

Download references

Acknowledgements

We thank the staff of the Biotechnology R&D Center, National Taiwan University Hospital Hsin-Chu Branch for their assistance in the study design and statistical analysis.

Author information

Author notes

  1. Shun-Mao Yang and Yi-Chang Chen have contributed equally to this work and are first co-authors.

Authors and Affiliations

  1. Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

    Shun-Mao Yang & Pei-Ming Huang

  2. Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan

    Shun-Mao Yang & Huan-Jang Ko

  3. Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

    Yi-Chang Chen, Wei-Chun Ko, Hsin-Chieh Huang & Yeun-Chung Chang

  4. Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan

    Kai-Lun Yu

  5. Department of Surgery, National Taiwan University Hospital, Yun-Lin Branch, Yunlin County, Taiwan

    Pei-Ming Huang

Authors
  1. Shun-Mao Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yi-Chang Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wei-Chun Ko
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hsin-Chieh Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kai-Lun Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Huan-Jang Ko
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Pei-Ming Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yeun-Chung Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pei-Ming Huang.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yang, SM., Chen, YC., Ko, WC. et al. Augmented fluoroscopic bronchoscopy (AFB) versus percutaneous computed tomography-guided dye localization for thoracoscopic resection of small lung nodules: a propensity-matched study. Surg Endosc 34, 5393–5401 (2020). https://doi.org/10.1007/s00464-019-07334-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-019-07334-4

Keywords

Search

Navigation