Single-Encounter Augmented Reality-Guided Localization for Resection of Suspected Early-Stage Lung Cancer: A Randomized Clinical Trial.

Summary

Across 270 mITT patients, single-encounter AR-guided localization achieved noninferior surgical success versus standard CT-guided localization while markedly reducing radiation exposure, preprocedural pain, puncture time, and localization-to-incision delays. This streamlined OR-based workflow under general anesthesia may decongest CT suites and improve patient experience without compromising surgical margins.

Key Findings

• Noninferiority achieved for successful sublobar resection: 98.5% (AR) vs 99.3% (CT); risk difference −0.8 percentage points (95% CI, −2.7 to 3.9).
• Radiation exposure was substantially lower with AR (median 456.5 vs 1260.1 mGy·cm; P<.001).
• Preprocedural pain was lower with AR (NRS 0 vs 5; P<.001), with shorter puncture time (0.63 vs 6.50 minutes) and localization-to-incision interval (2.0 vs 33.5 minutes).
• Localization accuracy (error) did not differ significantly; pneumothorax occurred in 29.4% of CT-guided cases.

Clinical Implications

Thoracic teams can consider AR-guided single-encounter localization to reduce radiation and streamline care, particularly for small nodules suitable for sublobar resection, while ensuring adequate margins.

Limitations

• Differences in anesthesia setting (general anesthesia in AR vs local for CT) may confound pain-related endpoints
• Study conducted in Chinese centers; generalizability to other health systems requires validation

Future Directions

External validation in diverse systems, cost-effectiveness analyses, and evaluation in more complex nodules (e.g., ground-glass, deep lesions) with standardized margin protocols.