Small pulmonary nodule localization techniques in the era of lung cancer screening: a narrative review

The widespread adoption of high-resolution computed tomography (CT) screening has led to increased detection of small pulmonary nodules, necessitating accurate localization techniques for surgical resection. This review examines the evolution, efficacy, and safety of various localization methods for small pulmonary nodules. Studies focusing on localization techniques for pulmonary nodules <= 30 mm in diameter were included, with emphasis on technical success rates and complication profiles. Preoperative CT-guided techniques, including hook-wire (success rate 94-98%) and anchored needle localization (success rate >99%, dislodgement rate 0%) demonstrate high technical success rates, though with varying complication profiles. Microcoil localization (97-98% success) shows comparable efficacy with lower complication rates. Dye-based methods offer simplicity but can be limited by rapid diffusion. Newer techniques like medical adhesive localization (success rate up to 100%) and electromagnetic navigation bronchoscopy (97.2% success) show promise in reducing complications and improving accuracy. Intraoperative methods such as ultrasound and hybrid operating room approaches provide real-time guidance but may be limited by nodule characteristics and available expertise. This review presents a radar chart analysis comparing techniques across key parameters and introduces an innovative decision-making algorithm that considers nodule characteristics, patient factors, and institutional resources, providing practical guidance and serving as a reference for clinicians. While no single method is universally superior, the trend towards minimally invasive, precise, and flexible approaches is evident. Future research should focus on large-scale comparative studies and the integration of artificial intelligence for optimized technique selection and improved patient outcomes.