Single-stage hybrid localization: a combination of bronchoscopic lung mapping followed by post-mapping computed tomographic reconstruction and additional transthoracic needle localization in a cone beam computed tomography room

Shun-Mao Yang, Wei-Chun Ko, Ling-Hsuan Meng, Li-Wei Chen, Kun-Hsien Lin, Yueh-Lun Liu, Shao-En Sun, Huan-Jang Ko


Background: Bronchoscopic lung mapping is a multispot dye-marking technique, which should be performed under real-time fluoroscopic guidance and post-mapping computed tomographic reconstruction. This study aimed to investigate the feasibility of lung mapping followed by post-mapping computed tomography (CT) and additional needle localization in a cone bean CT (CBCT) room.
Methods: Between February 1, 2018 and August 31, 2018, 11 consecutive patients presenting with 14 lung lesions underwent bronchoscopic lung mapping in a CBCT room followed by thoracoscopic surgery. The efficacy and safety of the procedure were assessed through a retrospective chart review.
Results: The median size of the pulmonary lesions was 8.1 mm [interquartile range (IQR), 7.2–10.8 mm] with a median depth-to-size ratio (D-S) ratio of 2.43 (IQR, 1.56–2.79). Additional needle localizations were performed in 4 patients, of which 3 and 1 patients underwent dual localization with dye and microcoil and localization with dye only, respectively. The median total localization time was 28 min (IQR, 18–69 min), and the median radiation exposure was 345.0 mGy (IQR, 161.8–486.6 mGy). A total of 8 wedge resections, 5 segmentectomies, and 1 lobectomy were performed. The final pathological diagnoses were as follows: primary lung cancer (n=6), lung metastases (n=4), and benign lung lesions (n=4). No adverse events were observed, and the median length of postoperative stay was 4 days (IQR, 3–5 days).
Conclusions: Bronchoscopic lung mapping followed by post-mapping CT and additional needle localization can be performed together in a single examination room equipped with a C-arm CBCT, and the results of localization are contributory to the surgery.