Feasibility and influencing factors analysis of electromagnetic navigation bronchoscopy guided methylene blue preoperative localization of pulmonary nodules

doi:10.3877/cma.j.issn.1674-6902.2026.02.004

Abstract

Abstract:

Objective

To analyze the effectiveness and safety of electromagnetic navigation bronchoscopy (ENB)-guided methylene blue localization in thoracoscopic surgery for pulmonary nodules, compare it with computed tomography (CT)-guided percutaneous localization, and explore its clinical feasibility and influencing factors.

Methods

A retrospective study was conducted on 248 patients who underwent pulmonary nodule localization and video-assisted thoracoscopic surgery at our hospital from October 2022 to October 2024. Propensity score matching at a 1︰1 ratio resulted in 124 cases in the ENB localization group and 124 cases in the CT localization group. Localization time, localization success rate, and complications were recorded. LASSO regression and logistic regression were used to analyze factors affecting ENB localization time.

Results

The proportion of solid nodules (12.10% vs. 4.03%, P=0.048) and the proportion of bronchus sign (15.32% vs. 7.26%, P=0.045) were higher in the ENB localization group than in the CT localization group. Localization time (15.00 min vs. 16.15 min, P=0.086) and thoracoscopic surgery time (81.50 min vs. 90.00 min, P=0.068) were lower in the ENB localization group compared to the CT localization group (P>0.05). Successful localization of pulmonary nodules was achieved in 122 cases (98.39%) in the ENB localization group, which was higher than the 121 cases (97.58%) in the CT localization group (P=0.651). The rates of hemopneumothorax (0.00% vs. 4.84%, P=0.013) and overall complications (4.84% vs. 17.74%, P=0.001) were lower in the ENB localization group than in the CT localization group. In the ENB localization group, there were 6 cases (4.84%) of complications, with no cases of hemopneumothorax or hemoptysis. Multivariate logistic regression analysis showed that pulmonary nodule location (OR=4.084, P=0.005), pulmonary nodule diameter (OR=2.452, P=0.032), and operator experience (OR=3.227, P=0.005) were risk factors affecting ENB localization time.

Conclusion

ENB-guided methylene blue localization has a success rate comparable to CT-guided localization, with a lower risk of complications. Clinical optimization of ENB localization outcomes should consider pulmonary nodule location, pulmonary nodule diameter, and operator experience.

Key words: Pulmonary nodules, Electromagnetic navigation bronchoscopy, Computed tomography, Localization time

Kai Wang, Qingquan Ren, Qiang Cao, Qiang Liu, Shuai Yang, Jia Wang. Feasibility and influencing factors analysis of electromagnetic navigation bronchoscopy guided methylene blue preoperative localization of pulmonary nodules[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(02): 205-211.

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Figures/Tables 7

References 32

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临床资料	CT定位组(n＝124)	ENB定位组(n＝124)	t/χ²/Z值	P值
吸烟史[n(%)]			0.895	0.639
从不	109(87.90)	111(89.52)
既往	8(6.45)	9(7.26)
现在	7(5.65)	4(3.23)
慢性阻塞性肺疾病[n(%)]	13(10.48)	15(12.10)	0.161	0.688
ASA分级[n(%)]			0.107	0.744
Ⅰ/Ⅱ	100(80.6)	102(82.26)
Ⅲ/Ⅳ	24(19.3)	22(17.74)
平均动脉压[mmHg，(±s)]	101.42±14.69	99.53±12.12	1.105	0.270
肺结节数量[n(%)]			0.107	0.744
1	100(80.5)	102(82.26)
≥2	24(19.35)	22(17.74)
肺结节位置[n(%)]			1.967	0.579
右上叶	58(46.77)	69(55.65)
右下叶	25(20.16)	21(16.94)
左上叶	26(20.97)	22(17.74)
左下叶	15(12.10)	12(9.68)
肺结节直径[mm，M(Q₂₅，Q₇₅)]	10.00(8.00，12.00)	10.00(7.00，14.00)	－0.210	0.834
距胸膜距离[mm，M(Q₂₅，Q₇₅)]	5.00(3.00，14.38)	5.00(2.14，14.95)	－0.756	0.450
肺结节密度[n(%)]			6.059	0.048
纯磨玻璃结节	43(34.68)	34(27.42)
混合型磨玻璃结节	76(61.29)	75(60.48)
实性结节	5(4.03)	15(12.10)
支气管征[n(%)]	9(7.26)	19(15.32)	4.026	0.045
恶性CT征象[n(%)]	62(50.0)	50(40.32)	2.345	0.126

临床资料	CT定位组(n＝124)	ENB定位组(n＝124)	t/χ²/Z值	P值
吸烟史[n(%)]			0.895	0.639
从不	109(87.90)	111(89.52)
既往	8(6.45)	9(7.26)
现在	7(5.65)	4(3.23)
慢性阻塞性肺疾病[n(%)]	13(10.48)	15(12.10)	0.161	0.688
ASA分级[n(%)]			0.107	0.744
Ⅰ/Ⅱ	100(80.6)	102(82.26)
Ⅲ/Ⅳ	24(19.3)	22(17.74)
平均动脉压[mmHg，(±s)]	101.42±14.69	99.53±12.12	1.105	0.270
肺结节数量[n(%)]			0.107	0.744
1	100(80.5)	102(82.26)
≥2	24(19.35)	22(17.74)
肺结节位置[n(%)]			1.967	0.579
右上叶	58(46.77)	69(55.65)
右下叶	25(20.16)	21(16.94)
左上叶	26(20.97)	22(17.74)
左下叶	15(12.10)	12(9.68)
肺结节直径[mm，M(Q₂₅，Q₇₅)]	10.00(8.00，12.00)	10.00(7.00，14.00)	－0.210	0.834
距胸膜距离[mm，M(Q₂₅，Q₇₅)]	5.00(3.00，14.38)	5.00(2.14，14.95)	－0.756	0.450
肺结节密度[n(%)]			6.059	0.048
纯磨玻璃结节	43(34.68)	34(27.42)
混合型磨玻璃结节	76(61.29)	75(60.48)
实性结节	5(4.03)	15(12.10)
支气管征[n(%)]	9(7.26)	19(15.32)	4.026	0.045
恶性CT征象[n(%)]	62(50.0)	50(40.32)	2.345	0.126

手术情况	CT定位组(n＝124)	ENB定位组(n＝124)	χ²/Z值	P值
病理亚型[n(%)]			2.373	0.796
非典型腺瘤样增生	1(0.81)	1(0.81)
原位腺癌	42(33.87)	42(33.87)
微浸润腺癌	45(36.29)	37(29.84)
浸润性腺癌	26(20.97)	29(23.39)
转移性腺癌	1(0.81)	3(2.42)
良性	9(7.26)	12(9.68)
亚甲蓝剂量[ml，M(Q₂₅，Q₇₅)]	0.40(0.30，0.60)	0.40(0.30，0.50)	－1.400	0.162
手术类型[n(%)]			1.203	0.548
Wedge切除	63(50.81)	59(47.58)
肺段切除	61(49.19)	64(51.61)
肺叶切除	0(0.0)	1(0.81)
手术切缘[mm，M(Q₂₅，Q₇₅)]	20.00(12.25，25.00)	20.00(15.00，20.00)	－0.701	0.483
单肺通气时长[mm，M(Q₂₅，Q₇₅)]	56.00(34.25，82.00)	52.50(30.00，72.75)	－1.670	0.095
术者经验[n(%)]			1.362	0.243
≤100例	45(36.29)	54(43.55)
>100例	79(63.37)	70(56.45)
定位时间[mm，M(Q₂₅，Q₇₅)]	16.15(12.88，23.16)	15.00(12.80，18.35)	－1.718	0.086
胸腔镜手术时间[mm，M(Q₂₅，Q₇₅)]	90.00(69.25，120.00)	81.50(61.00，107.00)	－1.822	0.068

手术情况	CT定位组(n＝124)	ENB定位组(n＝124)	χ²/Z值	P值
病理亚型[n(%)]			2.373	0.796
非典型腺瘤样增生	1(0.81)	1(0.81)
原位腺癌	42(33.87)	42(33.87)
微浸润腺癌	45(36.29)	37(29.84)
浸润性腺癌	26(20.97)	29(23.39)
转移性腺癌	1(0.81)	3(2.42)
良性	9(7.26)	12(9.68)
亚甲蓝剂量[ml，M(Q₂₅，Q₇₅)]	0.40(0.30，0.60)	0.40(0.30，0.50)	－1.400	0.162
手术类型[n(%)]			1.203	0.548
Wedge切除	63(50.81)	59(47.58)
肺段切除	61(49.19)	64(51.61)
肺叶切除	0(0.0)	1(0.81)
手术切缘[mm，M(Q₂₅，Q₇₅)]	20.00(12.25，25.00)	20.00(15.00，20.00)	－0.701	0.483
单肺通气时长[mm，M(Q₂₅，Q₇₅)]	56.00(34.25，82.00)	52.50(30.00，72.75)	－1.670	0.095
术者经验[n(%)]			1.362	0.243
≤100例	45(36.29)	54(43.55)
>100例	79(63.37)	70(56.45)
定位时间[mm，M(Q₂₅，Q₇₅)]	16.15(12.88，23.16)	15.00(12.80，18.35)	－1.718	0.086
胸腔镜手术时间[mm，M(Q₂₅，Q₇₅)]	90.00(69.25，120.00)	81.50(61.00，107.00)	－1.822	0.068

肺结节特征	CT定位组(n＝124)				ENB定位组(n＝124)				组间成功率
肺结节特征	定位失败(n＝3)	定位成功(n＝121)	χ²值	P值	定位失败(n＝2)	定位成功(n＝122)	χ²值	P值	χ²值	P值
距胸膜距离			0.374	0.541			0.165	0.684	0.243	0.622
≤10 mm	2(66.67)	81(66.94)			1(50.0)	78(63.93)
>10 mm	1(33.33)	40(33.06)			1(50.0)	44(36.07)
肺结节位置			3.073	0.381			9.970	0.019	1.875	0.599
右上叶	0(0.0)	58(47.93)			0(0.0)	69(56.56)
右下叶	1(33.33)	24(19.83)			2(100.0)	19(15.57)
左上叶	1(33.33)	25(20.66)			0(0.0)	22(18.03)
左下叶	1(33.33)	14(11.57)			0(0.0)	12(9.84)
肺结节直径			0.489	0.485			－	0.217	1.485	0.223
≤10 mm	1(33.33)	65(53.72)			2(100.0)	56(45.90)
>10 mm	2(66.67)	56(46.28)			0(0.0)	66(54.10)
肺结节密度			0.140	0.932			1.328	0.515	5.845	0.054
纯磨玻璃结节	1(33.33)	42(34.71)			0(0.0)	34(27.87)
混合型磨玻璃结节	2(66.67)	74(61.16)			2(100.0)	73(59.84)
实性结节	0(0.0)	5(4.13)			0(0.0)	15(12.30)

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