title: Electromagnetic Navigation Bronchoscopy for Identifying Lung Nodules for Thoracoscopic Resection.
abstract: BACKGROUND
  Pulmonary nodules smaller than 1 cm can be difficult to identify during minimally invasive resection, necessitating conversion to thoracotomy. We hypothesized that localizing nodules with electromagnetic navigation bronchoscopy and marking them with methylene blue would allow minimally invasive resection and reduce conversion to thoracotomy.
  
  
  METHODS
  We retrospectively identified all patients who underwent electromagnetic navigation bronchoscopy followed by minimally invasive resection of a pulmonary nodule from 2011 to 2014. Lung nodules smaller than 10 mm and nodules smaller than 20 mm that were also located more than 10 mm from the pleural surface were localized and marked with methylene blue. Immediately after marking, all patients underwent resection.
  
  
  RESULTS
  Seventy patients underwent electromagnetic navigation bronchoscopy marking followed by minimally invasive resection. The majority of patients (68/70, 97%) had one nodule localized; 2 patients (2/70, 3%) had two nodules localized. The median nodule size was 8 mm (range, 4-17 mm; interquartile range, 5 mm). The median distance from the pleural surface was 6 mm (range, 1-19 mm; interquartile range, 6 mm). There were no conversions to thoracotomy. Nodule marking was successful in 70 of 72 attempts (97.2%); two nodules were identified by palpation. The nodules were most commonly metastases from other sites (31/70, 44.3%). There were no adverse events related to electromagnetic navigation bronchoscopy-guided marking or wedge resection, and minimal adverse events after resections that were more extensive.
  
  
  CONCLUSIONS
  Localizing and marking small pulmonary nodules using electromagnetic navigation bronchoscopy is safe and effective for nodule identification before minimally invasive resection.
authors.affiliation: Division of Thoracic Surgery, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Katy A
authors.initials: KA
authors.lastname: Marino
authors.affiliation: Division of Thoracic Surgery, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Sullivan
authors.affiliation: Division of Thoracic Surgery, University of Tennessee Health Science Center, Memphis, Tennessee. Electronic address: bweksler@uthsc.edu.
authors.forename: Benny
authors.initials: B
authors.lastname: Weksler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy / Q000379:methods*; D055590:Electromagnetic Phenomena; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed; D055815:Young Adult