Application of indocyanine green injection guided by electromagnetic navigation bronchoscopy in localization of pulmonary nodules

BACKGROUND: Accurate localization of pulmonary nodules becomes a crucial step in diagnosis and treatment. However, the efficacy and accuracy of electromagnetic navigation bronchoscopy (ENB)-guided localization with indocyanine green (ICG) injection for video-assisted thoracoscopic surgery (VATS) lung resection remain unclear. METHODS: A retrospective study was performed that patients who had small pulmonary nodules and underwent lung resection after ENB-guided localization were included from Oct 2018 to Mar 2021. The analysis of the efficacy and accuracy of ENB-guided localization was conducted. RESULTS: A total of 181 pulmonary nodules in 173 patients were recorded which were 9.21±4.81 mm in size. The mean time of ENB-guided localization was 7.99±4.9 minutes. The success rate of nodule localization was 98.3% (178/181), while the accuracy was 89% (161/181) without any complication. All patients received thoracoscopic surgery after localization, and all nodules were completely resected. A customized scoring system was used to evaluate localization accuracy, and the patients were divided into four groups according to it. The localization accuracy was positively associated with the bronchus sign (P<0.001) and negatively with the location of the nodule (anterior segment and superior lingual segment of left upper lobe) (P=0.013 and 0.03, respectively). CONCLUSIONS: ENB-guided pulmonary nodule localization by ICG injection is an accurate and effective method with a short operation time and few complications, which could be widely used in clinical practice.