Principles, technical specifications, and clinical application of lung watershed topography map 2.0: A thoracic surgery expert consensus (2024 version)

Wenzhao Zhong; Fan Yang; Jian HU; Fengwei Tan; Xuening Yang; Qiang PU; Wei Jiang; Deping Zhao; Hecheng LI; Xiaolong Yan; Lijie Tan; Junqiang Fan; Guibin Qiao; Qiang Nie; Mingqiang Kang; Weibing WU; Hao Zhang; Zhigang LI; Zihao Chen; Shugeng Gao; Yilong WU

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Principles, technical specifications, and clinical application of lung watershed topography map 2.0: A thoracic surgery expert consensus (2024 version)

VernacularTitle:肺部流域地形图2.0原理、技术规范及临床应用胸外科专家共识（2024版）
Author: Wenzhao ZHONG ^{1
,

2} ; Fan YANG ^{3
,

4} ; Jian HU ⁵ ; Fengwei TAN ⁶ ; Xuening YANG ^{1
,

2} ; Qiang PU ⁷ ; Wei JIANG ⁸ ; Deping ZHAO ⁹ ; Hecheng LI ¹⁰ ; Xiaolong YAN ^{11
,

12} ; Lijie TAN ⁸ ; Junqiang FAN ¹³ ; Guibin QIAO ¹⁴ ; Qiang NIE ^{1
,

2} ; Mingqiang KANG ¹⁵ ; Weibing WU ¹⁶ ; Hao ZHANG ¹⁷ ; Zhigang LI ¹⁸ ; Zihao CHEN ^{1
,

2} ; Shugeng GAO ⁶ ; Yilong WU ^{1
,

2}
Author Information

1. Department of Thoracic Surgery, Guangdong Lung Cancer Institute, Guangdong Provincial People'
2. s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, P. R. China
3. Department of Thoracic Surgery, Peking University People'
4. s Hospital, Beijing, 100044, P. R. China
5. Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, P. R. China
6. Department of Thoracic Surgery, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, 100021, P. R. China
7. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China
8. Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China
9. Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Shanghai, 200433, P. R. China
10. Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China
11. Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'
12. an, 710038, P. R. China
13. Department of Thoracic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, P. R. China
14. Department of Thoracic Surgery, Zhujiang Hospital of Southern Medical University, Guangzhou, 510280, P. R. China
15. Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, P. R. China
16. Department of Thoracic Surgery, Jiangsu Province Hospital, Nanjing, 210029, P. R. China
17. Department of Thoracic Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, P. R. China
18. Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, 200030, P. R. China
Collective Name:Chinese Medical Doctor Association Thoracic Surgeons Branch, China Anti-Cancer Association, The Society of Non-small Cell Lung Cancer, Chinese Research Hospital Association, The Society of Thoracic Surgery, Guangdong Medical Association Lung Tumor Branch
Publication Type:Journal Article
Keywords: Pulmonary nodules; watershed topography map; three-dimensional reconstruction; artificial intelligence; indocyanine green; expert consensus
From: Chinese Journal of Clinical Thoracic and Cardiovascular Surgery 2025;32(02):141-152
CountryChina
Language:Chinese
Abstract: With the widespread adoption of low-dose CT screening and the extensive application of high-resolution CT, the detection rate of sub-centimeter lung nodules has significantly increased. How to scientifically manage these nodules while avoiding overtreatment and diagnostic delays has become an important clinical issue. Among them, lung nodules with a consolidation tumor ratio less than 0.25, dominated by ground-glass shadows, are particularly worthy of attention. The therapeutic challenge for this group is how to achieve precise and complete resection of nodules during surgery while maximizing the preservation of the patient's lung function. The "watershed topography map" is a new technology based on big data and artificial intelligence algorithms. This method uses Dicom data from conventional dose CT scans, combined with microscopic (22-24 levels) capillary network anatomical watershed features, to generate high-precision simulated natural segmentation planes of lung sub-segments through specific textures and forms. This technology forms fluorescent watershed boundaries on the lung surface, which highly fit the actual lung anatomical structure. By analyzing the adjacent relationship between the nodule and the watershed boundary, real-time, visually accurate positioning of the nodule can be achieved. This innovative technology provides a new solution for the intraoperative positioning and resection of lung nodules. This consensus was led by four major domestic societies, jointly with expert teams in related fields, oriented to clinical practical needs, referring to domestic and foreign guidelines and consensus, and finally formed after multiple rounds of consultation, discussion, and voting. The main content covers the theoretical basis of the "watershed topography map" technology, indications, operation procedures, surgical planning details, and postoperative evaluation standards, aiming to provide scientific guidance and exploration directions for clinical peers who are currently or plan to carry out lung nodule resection using the fluorescent microscope watershed analysis method.