What the literature has found and what our experience has been is that percutaneous biopsy is equivalent to open biopsy for a couple of things. One is you can make the diagnosis. It is equivalent with respect to being able to understand high risk versus low risk, and then The MICA amplification can be determined as well. Where percutaneous biopsy falls short is with determining LOH.
the families that have been scrutinized or um at least uh. Um, queried the most about whether this was non-accidenal versus accidental trauma, um, leading to a subdural head bleed was, um, people of more ethnic minorities
What we found is that sometimes after, you know, 5 or 6 cycles, these tumors become more hard and have just a different texture and can perhaps make the operation a little more challenging.
Surveillance protocol for observed neonatal masses: ultrasound and catecholamines at birth, 3 weeks, 6 weeks, 12 weeks, then spacing out through first year, then every 6 months, then yearly
quoteI think one of the other things when you speak to the family, it's really important to reassure them that even if the mass increases in size and you take it out, it is likely to be a very, very low risk tumor.↗
▶Ep 1 · 11:07
epidemiologicalNocktern study showed approximately 98% event-free survival and 100% overall survival in observed prenatal neuroblastoma↗
▶Ep 1 · 11:37
guidelineAfter one year, surveillance becomes every six months, then yearly↗
▶Ep 1 · 11:37
guidelineFirst-year surveillance protocol: ultrasound and catecholamines at birth, 3 weeks, 6 weeks, 12 weeks, then spaced out to one year↗
▶Ep 1 · 13:38
quoteI will say the last one of these that I had at the 12-month scan it got bigger. And we took it out and it was a ended up being a sequestration.↗
▶Ep 1 · 16:07
guidelineLaparoscopic approach is reasonable for masses less than 6 centimeters↗
▶Ep 1 · 17:00
clinicalBiology of neuroblastoma is more important than lymph node status for treatment decisions↗
▶Ep 1 · 17:30
clinicalStage MS (formerly 4S) with skin lesions and liver mets still tends to have good biology↗
▶Ep 1 · 17:30
quoteThe biology of these tumors tend to still be good. These aren't bad neuroblastomas.↗
▶Ep 1 · 17:58
guidelineOnce respiratory compromise begins, treatment options include chemotherapy, radiation, or emergent decompressive laparotomy↗
▶Ep 1 · 17:58
quoteIf they're not in any distress, they're treated with my favorite protocol, which is aggressive observation.↗
▶Ep 1 · 17:58
guidelineStage MS without distress can be treated with aggressive observation↗
▶Ep 1 · 19:52
clinicalLiver biopsy in newborns is difficult because bleeding is hard to control↗
▶Ep 1 · 21:05
clinicalVIP secretion can cause severe diarrhea in neuroblastoma↗
▶Ep 1 · 21:05
guidelineInitial workup for abdominal mass includes ultrasound to determine solid vs cystic, then CT with PO and IV contrast if solid↗
▶Ep 1 · 26:03
guidelinePET scan is not part of routine initial diagnostic workup but may be used for MIBG-negative soft tissue areas to distinguish recurrence from scar↗
Neuroblastoma
▶Ep 2 · 2:32
quoteI mostly am quite reassuring at this stage. It's still a bit early.↗
▶Ep 2 · 2:47
quoteI think it's important to reassure and help the mom understand that the priority during the pregnancy is the mom. And once the baby is born, then we'll learn more.↗
▶Ep 2 · 9:58
guidelineSurveillance protocol for observed neonatal masses: ultrasound and catecholamines at birth, 3 weeks, 6 weeks, 12 weeks, then spacing out through first year, then every 6 months, then yearly↗
▶Ep 2 · 13:20
guidelineCriteria for surgery in observed neonatal neuroblastoma: >50% volume increase or >50% increase in VMA or HVA↗
▶Ep 2 · 14:50
clinicalStage MS (formerly 4S) neuroblastoma with liver and skin metastases in neonates has good biology and can be observed unless respiratory compromise develops from hepatomegaly↗
▶Ep 2 · 15:42
clinicalTreatment options for MS neuroblastoma with respiratory compromise include chemotherapy, radiation, or emergent decompressive laparotomy↗
▶Ep 2 · 26:56
epidemiologicalApproximately 50% of children's hospitals now use percutaneous biopsy for suspected neuroblastoma↗
▶Ep 2 · 28:04
clinicalPercutaneous biopsy is equivalent to open biopsy for diagnosis and NMEC determination but may fail for 11q loss of heterozygosity assessment↗
▶Ep 2 · 28:55
clinicalOptimized percutaneous biopsy technique requires 10-12 cores, higher gauge needle, and pathologist present for frozen section to confirm viable tumor↗
▶Ep 2 · 29:45
clinicalOpen biopsy patients have higher risk of blood transfusion, higher narcotic use, and more frequent hospital admission compared to percutaneous biopsy↗
▶Ep 2 · 33:49
clinicalLoss of heterozygosity at 11q is the most common segmental chromosomal alteration in neuroblastoma and can elevate risk category↗
▶Ep 2 · 37:20
clinicalHigh-risk neuroblastoma patients require double-lumen external catheter (not port) for bone marrow transplant↗
▶Ep 2 · 42:40
clinicalAfter 5-6 cycles of chemotherapy, neuroblastomas become more fibrotic and harder to resect↗
▶Ep 2 · 52:19
quoteOne thing we try to teach the residents is that with neuroblastoma surgery, there's no reason to cause disability.↗
Neuroblastoma
▶Ep 3 · 2:38
clinicalFor prenatal suprarenal mass at 26 weeks gestation, no additional studies are obtained before delivery; after birth, ultrasound and urine catecholamines are the initial workup.↗
▶Ep 3 · 3:11
quoteI think it's important to reassure and help the mom understand that the priority during the pregnancy is the mom.↗
▶Ep 3 · 7:08
clinicalIn neonates and the perinatal phase, the most common sites of neuroblastoma metastasis are liver, bone, skin, and lymph nodes.↗
▶Ep 3 · 9:54
guidelineSurveillance protocol for observed neonatal neuroblastoma includes intensive first-year monitoring: ultrasound and urine catecholamines at birth, 3 weeks, 6 weeks, 12 weeks, then every 6 months after 1 year if stable.↗
▶Ep 3 · 11:43
quoteI will say the last one of these that I had at the 12-month scans, it got bigger and we took it out and it was ended up being a sequestration.↗
▶Ep 3 · 12:17
quoteI think it's just important to make sure that we are very reassuring to the family that based on all the information we have, this is what this probably is, but that we have to have some level of uncertainty because we don't biopsy these kids.↗
▶Ep 3 · 12:35
guidelineCriteria for surgical intervention in observed neonatal neuroblastoma include tumor size reaching 5 cm, greater than 50% volume increase, or 50% increase in urine catecholamines (VMA or HVA).↗
▶Ep 3 · 13:57
clinicalLaparoscopic resection is appropriate for neonatal neuroblastoma less than 6 cm; one case of presumed neuroblastoma removed laparoscopically at 3.5 cm proved to be pulmonary sequestration.↗
▶Ep 3 · 14:50
clinicalStage MS neuroblastoma (formerly 4S) with skin lesions and liver metastases in neonates generally has good biology and can be managed with observation unless hepatic mass effect causes respiratory compromise.↗
▶Ep 3 · 18:33
guidelineInitial workup for a 3-year-old with large abdominal mass includes ultrasound to assess solid vs cystic nature, CT with PO and IV contrast, CBC, comprehensive metabolic panel, amylase, lipase, LDH, and urine catecholamines.↗
▶Ep 3 · 18:44
clinicalVIP-secreting neuroblastoma can cause severe diarrhea, though this is a rare presentation.↗
▶Ep 3 · 18:44
quoteI saw a child today that had diarrhea. I thought that was interesting cause we, we, I've always read that you can get, you know, VIP secretion and and severe diarrhea from neuroblastoma, but I had not seen that.↗
▶Ep 3 · 26:56
epidemiologicalApproximately 50% of children's hospitals now use percutaneous biopsy for neuroblastoma; approximately 80% of patients at Michigan receive percutaneous biopsy upfront.↗
▶Ep 3 · 27:44
quoteWhat the literature has found and what our experience has been is that percutaneous biopsy is equivalent to open biopsy for a couple of things. One is you can make the diagnosis. It is equivalent with respect to being able to understand high risk versus low risk, and then The MICA amplification can be determined as well. Where percutaneous biopsy falls short is with determining LOH.↗
▶Ep 3 · 27:44
clinicalPercutaneous biopsy is equivalent to open biopsy for making the diagnosis, determining high vs low risk, and assessing MYCN amplification, but historically fails to provide adequate tissue for 11Q loss of heterozygosity determination.↗
▶Ep 3 · 28:29
clinicalOptimization strategies for percutaneous neuroblastoma biopsy include pathologist presence for frozen section to confirm viable tumor (not necrotic tissue), obtaining 10-12 cores, using higher gauge needles, and retroperitoneal approach.↗
▶Ep 3 · 29:35
clinicalPatients undergoing open biopsy have higher risk of blood transfusion, higher postoperative narcotic use, and more frequent hospital admission compared to percutaneous biopsy.↗
▶Ep 3 · 33:51
clinical11Q loss of heterozygosity is the most common segmental chromosomal alteration in neuroblastoma and is the only other factor that elevates MYCN non-amplified patients to high risk or from low to intermediate risk.↗
▶Ep 3 · 42:24
quoteI don't think we see much tumor shrinkage after 4 cycles.↗
▶Ep 3 · 42:50
clinicalAfter 5-6 cycles of chemotherapy, neuroblastoma tumors become more fibrotic and hard, making surgical resection more technically difficult.↗
▶Ep 3 · 42:50
quoteWhat we found is that sometimes after, you know, 5 or 6 cycles, these tumors become more hard and have just a different texture and can perhaps make the operation a little more challenging.↗
▶Ep 3 · 52:21
opinionNeuroblastoma surgery should not cause disability; nephrectomy should be avoided when possible because it requires chemotherapy dose reduction, and operations near brachial plexus or other critical structures require careful consideration of risk vs benefit.↗
▶Ep 3 · 52:21
quoteOne thing we're trying to teach the residents is that with neuroblastoma surgery, there's no reason to cause disability.↗
Erika's statements about Adrenal Tumors14 statements
quoteI mostly am quite reassuring at this stage. It's still a bit early.↗
▶Ep 2 · 2:47
quoteI think it's important to reassure and help the mom understand that the priority during the pregnancy is the mom. And once the baby is born, then we'll learn more.↗
▶Ep 2 · 9:58
guidelineSurveillance protocol for observed neonatal masses: ultrasound and catecholamines at birth, 3 weeks, 6 weeks, 12 weeks, then spacing out through first year, then every 6 months, then yearly↗
▶Ep 2 · 13:20
guidelineCriteria for surgery in observed neonatal neuroblastoma: >50% volume increase or >50% increase in VMA or HVA↗
▶Ep 2 · 14:50
clinicalStage MS (formerly 4S) neuroblastoma with liver and skin metastases in neonates has good biology and can be observed unless respiratory compromise develops from hepatomegaly↗
▶Ep 2 · 15:42
clinicalTreatment options for MS neuroblastoma with respiratory compromise include chemotherapy, radiation, or emergent decompressive laparotomy↗
▶Ep 2 · 26:56
epidemiologicalApproximately 50% of children's hospitals now use percutaneous biopsy for suspected neuroblastoma↗
▶Ep 2 · 28:04
clinicalPercutaneous biopsy is equivalent to open biopsy for diagnosis and NMEC determination but may fail for 11q loss of heterozygosity assessment↗
▶Ep 2 · 28:55
clinicalOptimized percutaneous biopsy technique requires 10-12 cores, higher gauge needle, and pathologist present for frozen section to confirm viable tumor↗
▶Ep 2 · 29:45
clinicalOpen biopsy patients have higher risk of blood transfusion, higher narcotic use, and more frequent hospital admission compared to percutaneous biopsy↗
▶Ep 2 · 33:49
clinicalLoss of heterozygosity at 11q is the most common segmental chromosomal alteration in neuroblastoma and can elevate risk category↗
▶Ep 2 · 37:20
clinicalHigh-risk neuroblastoma patients require double-lumen external catheter (not port) for bone marrow transplant↗
▶Ep 2 · 42:40
clinicalAfter 5-6 cycles of chemotherapy, neuroblastomas become more fibrotic and harder to resect↗
▶Ep 2 · 52:19
quoteOne thing we try to teach the residents is that with neuroblastoma surgery, there's no reason to cause disability.↗
Erika's statements about Colorectal / ARM & Hirschsprung21 statements
quoteI mostly am quite reassuring at this stage. It's still a bit early.↗
▶Ep 74 · 2:47
quoteI think it's important to reassure and help the mom understand that the priority during the pregnancy is the mom. And once the baby is born, then we'll learn more.↗
▶Ep 74 · 9:58
guidelineSurveillance protocol for observed neonatal masses: ultrasound and catecholamines at birth, 3 weeks, 6 weeks, 12 weeks, then spacing out through first year, then every 6 months, then yearly↗
▶Ep 74 · 13:20
guidelineCriteria for surgery in observed neonatal neuroblastoma: >50% volume increase or >50% increase in VMA or HVA↗
▶Ep 74 · 14:50
clinicalStage MS (formerly 4S) neuroblastoma with liver and skin metastases in neonates has good biology and can be observed unless respiratory compromise develops from hepatomegaly↗
▶Ep 74 · 15:42
clinicalTreatment options for MS neuroblastoma with respiratory compromise include chemotherapy, radiation, or emergent decompressive laparotomy↗
▶Ep 74 · 26:56
epidemiologicalApproximately 50% of children's hospitals now use percutaneous biopsy for suspected neuroblastoma↗
▶Ep 74 · 28:04
clinicalPercutaneous biopsy is equivalent to open biopsy for diagnosis and NMEC determination but may fail for 11q loss of heterozygosity assessment↗
▶Ep 74 · 28:55
clinicalOptimized percutaneous biopsy technique requires 10-12 cores, higher gauge needle, and pathologist present for frozen section to confirm viable tumor↗
▶Ep 74 · 29:45
clinicalOpen biopsy patients have higher risk of blood transfusion, higher narcotic use, and more frequent hospital admission compared to percutaneous biopsy↗
▶Ep 74 · 33:49
clinicalLoss of heterozygosity at 11q is the most common segmental chromosomal alteration in neuroblastoma and can elevate risk category↗
▶Ep 74 · 37:20
clinicalHigh-risk neuroblastoma patients require double-lumen external catheter (not port) for bone marrow transplant↗
▶Ep 74 · 42:40
clinicalAfter 5-6 cycles of chemotherapy, neuroblastomas become more fibrotic and harder to resect↗
▶Ep 74 · 52:19
quoteOne thing we try to teach the residents is that with neuroblastoma surgery, there's no reason to cause disability.↗
Colorectal Quiz Episode 37: The Yancey-Soave story of the original surgical descriptions for Hirschsprung disease
▶Ep 136 · 1:35
quoteI never learned about Dr. Yancey when I was training in general surgery and when I was doing my fellowship in pediatric surgery.↗
▶Ep 136 · 7:05
quoteI think that this is an example of sort of some of the historical structural inequities that we know exist, where in 1951 and 1952, you know, Black academics could not publish their work in mainstream journals.↗
▶Ep 136 · 7:05
epidemiologicalIn 1951-1952, Black academics could not publish their work in mainstream surgical journals.↗
▶Ep 136 · 12:26
clinicalThe Hirschsprung interest group members write papers, review manuscripts for journals, write board questions, and influence CPT coding.↗
▶Ep 136 · 12:26
quoteI basically just bombarded the meeting because I don't even think you guys had invited me. I think I just came in and asked for five minutes or 10 minutes on the agenda.↗
▶Ep 136 · 14:30
clinicalWhen reviewing articles for journals, Dr. Newman now sends back revisions to ensure correct references to Dr. Yancey's work are included.↗
▶Ep 136 · 14:51
quoteWhen I review a article for a journal, I send back revisions, including, you know, making sure to use the correct references.↗
Erika's statements about Fecal Incontinence7 statements
Colorectal Quiz Episode 37: The Yancey-Soave story of the original surgical descriptions for Hirschsprung disease
▶Ep 8 · 1:35
quoteI never learned about Dr. Yancey when I was training in general surgery and when I was doing my fellowship in pediatric surgery.↗
▶Ep 8 · 7:05
quoteI think that this is an example of sort of some of the historical structural inequities that we know exist, where in 1951 and 1952, you know, Black academics could not publish their work in mainstream journals.↗
▶Ep 8 · 7:05
epidemiologicalIn 1951-1952, Black academics could not publish their work in mainstream surgical journals.↗
▶Ep 8 · 12:26
quoteI basically just bombarded the meeting because I don't even think you guys had invited me. I think I just came in and asked for five minutes or 10 minutes on the agenda.↗
▶Ep 8 · 12:26
clinicalThe Hirschsprung interest group members write papers, review manuscripts for journals, write board questions, and influence CPT coding.↗
▶Ep 8 · 14:30
clinicalWhen reviewing articles for journals, Dr. Newman now sends back revisions to ensure correct references to Dr. Yancey's work are included.↗
▶Ep 8 · 14:51
quoteWhen I review a article for a journal, I send back revisions, including, you know, making sure to use the correct references.↗
Erika's statements about Hirschsprung disease7 statements
Colorectal Quiz Episode 37: The Yancey-Soave story of the original surgical descriptions for Hirschsprung disease
▶Ep 56 · 1:35
quoteI never learned about Dr. Yancey when I was training in general surgery and when I was doing my fellowship in pediatric surgery.↗
▶Ep 56 · 7:05
epidemiologicalIn 1951-1952, Black academics could not publish their work in mainstream surgical journals.↗
▶Ep 56 · 7:05
quoteI think that this is an example of sort of some of the historical structural inequities that we know exist, where in 1951 and 1952, you know, Black academics could not publish their work in mainstream journals.↗
▶Ep 56 · 12:26
quoteI basically just bombarded the meeting because I don't even think you guys had invited me. I think I just came in and asked for five minutes or 10 minutes on the agenda.↗
▶Ep 56 · 12:26
clinicalThe Hirschsprung interest group members write papers, review manuscripts for journals, write board questions, and influence CPT coding.↗
▶Ep 56 · 14:30
clinicalWhen reviewing articles for journals, Dr. Newman now sends back revisions to ensure correct references to Dr. Yancey's work are included.↗
▶Ep 56 · 14:51
quoteWhen I review a article for a journal, I send back revisions, including, you know, making sure to use the correct references.↗
quotehow many times has there been a black family that has been Put through child protective services has been called, they need to go to the house, they then, they need to make sure that there's a bunk bed in the house that the kid fell out, um, we keep the child there, you know, after we've deemed them medically fit for discharge, waiting on disposition from the social worker↗
▶Ep 2 · 11:25
quotehow many times has that happened to a black family whereas, you know, an, an, a majority family or a white family has come with the same story and It's very noticeable that those families are not put through the same scrutiny↗
▶Ep 2 · 11:50
quotethe families that have been scrutinized or um at least uh. Um, queried the most about whether this was non-accidenal versus accidental trauma, um, leading to a subdural head bleed was, um, people of more ethnic minorities↗
▶Ep 2 · 12:40
clinicalBias affects medical decision-making including who gets referred for procedures and who gets surgery↗
▶Ep 2 · 13:05
quoteI think it's our responsibility to do that, particularly with data arising now that healthy children are dying, um, based on the color of their skin↗
Erika's statements about Neuroblastoma30 statements
quoteI think one of the other things when you speak to the family, it's really important to reassure them that even if the mass increases in size and you take it out, it is likely to be a very, very low risk tumor.↗
▶Ep 1 · 11:07
epidemiologicalNocktern study showed approximately 98% event-free survival and 100% overall survival in observed prenatal neuroblastoma↗
▶Ep 1 · 11:37
guidelineFirst-year surveillance protocol: ultrasound and catecholamines at birth, 3 weeks, 6 weeks, 12 weeks, then spaced out to one year↗
▶Ep 1 · 11:37
guidelineAfter one year, surveillance becomes every six months, then yearly↗
▶Ep 1 · 13:38
quoteI will say the last one of these that I had at the 12-month scan it got bigger. And we took it out and it was a ended up being a sequestration.↗
▶Ep 1 · 16:07
guidelineLaparoscopic approach is reasonable for masses less than 6 centimeters↗
▶Ep 1 · 17:00
clinicalBiology of neuroblastoma is more important than lymph node status for treatment decisions↗
▶Ep 1 · 17:30
clinicalStage MS (formerly 4S) with skin lesions and liver mets still tends to have good biology↗
▶Ep 1 · 17:30
quoteThe biology of these tumors tend to still be good. These aren't bad neuroblastomas.↗
▶Ep 1 · 17:58
guidelineStage MS without distress can be treated with aggressive observation↗
▶Ep 1 · 17:58
quoteIf they're not in any distress, they're treated with my favorite protocol, which is aggressive observation.↗
▶Ep 1 · 17:58
guidelineOnce respiratory compromise begins, treatment options include chemotherapy, radiation, or emergent decompressive laparotomy↗
▶Ep 1 · 19:52
clinicalLiver biopsy in newborns is difficult because bleeding is hard to control↗
▶Ep 1 · 21:05
clinicalVIP secretion can cause severe diarrhea in neuroblastoma↗
▶Ep 1 · 21:05
guidelineInitial workup for abdominal mass includes ultrasound to determine solid vs cystic, then CT with PO and IV contrast if solid↗
▶Ep 1 · 26:03
guidelinePET scan is not part of routine initial diagnostic workup but may be used for MIBG-negative soft tissue areas to distinguish recurrence from scar↗
Neuroblastoma
▶Ep 3 · 2:32
quoteI mostly am quite reassuring at this stage. It's still a bit early.↗
▶Ep 3 · 2:47
quoteI think it's important to reassure and help the mom understand that the priority during the pregnancy is the mom. And once the baby is born, then we'll learn more.↗
▶Ep 3 · 9:58
guidelineSurveillance protocol for observed neonatal masses: ultrasound and catecholamines at birth, 3 weeks, 6 weeks, 12 weeks, then spacing out through first year, then every 6 months, then yearly↗
▶Ep 3 · 13:20
guidelineCriteria for surgery in observed neonatal neuroblastoma: >50% volume increase or >50% increase in VMA or HVA↗
▶Ep 3 · 14:50
clinicalStage MS (formerly 4S) neuroblastoma with liver and skin metastases in neonates has good biology and can be observed unless respiratory compromise develops from hepatomegaly↗
▶Ep 3 · 15:42
clinicalTreatment options for MS neuroblastoma with respiratory compromise include chemotherapy, radiation, or emergent decompressive laparotomy↗
▶Ep 3 · 26:56
epidemiologicalApproximately 50% of children's hospitals now use percutaneous biopsy for suspected neuroblastoma↗
▶Ep 3 · 28:04
clinicalPercutaneous biopsy is equivalent to open biopsy for diagnosis and NMEC determination but may fail for 11q loss of heterozygosity assessment↗
▶Ep 3 · 28:55
clinicalOptimized percutaneous biopsy technique requires 10-12 cores, higher gauge needle, and pathologist present for frozen section to confirm viable tumor↗
▶Ep 3 · 29:45
clinicalOpen biopsy patients have higher risk of blood transfusion, higher narcotic use, and more frequent hospital admission compared to percutaneous biopsy↗
▶Ep 3 · 33:49
clinicalLoss of heterozygosity at 11q is the most common segmental chromosomal alteration in neuroblastoma and can elevate risk category↗
▶Ep 3 · 37:20
clinicalHigh-risk neuroblastoma patients require double-lumen external catheter (not port) for bone marrow transplant↗
▶Ep 3 · 42:40
clinicalAfter 5-6 cycles of chemotherapy, neuroblastomas become more fibrotic and harder to resect↗
▶Ep 3 · 52:19
quoteOne thing we try to teach the residents is that with neuroblastoma surgery, there's no reason to cause disability.↗
Erika's statements about Neuroblastoma30 statements
quoteI think one of the other things when you speak to the family, it's really important to reassure them that even if the mass increases in size and you take it out, it is likely to be a very, very low risk tumor.↗
▶Ep 3 · 11:07
epidemiologicalNocktern study showed approximately 98% event-free survival and 100% overall survival in observed prenatal neuroblastoma↗
▶Ep 3 · 11:37
guidelineAfter one year, surveillance becomes every six months, then yearly↗
▶Ep 3 · 11:37
guidelineFirst-year surveillance protocol: ultrasound and catecholamines at birth, 3 weeks, 6 weeks, 12 weeks, then spaced out to one year↗
▶Ep 3 · 13:38
quoteI will say the last one of these that I had at the 12-month scan it got bigger. And we took it out and it was a ended up being a sequestration.↗
▶Ep 3 · 16:07
guidelineLaparoscopic approach is reasonable for masses less than 6 centimeters↗
▶Ep 3 · 17:00
clinicalBiology of neuroblastoma is more important than lymph node status for treatment decisions↗
▶Ep 3 · 17:30
clinicalStage MS (formerly 4S) with skin lesions and liver mets still tends to have good biology↗
▶Ep 3 · 17:30
quoteThe biology of these tumors tend to still be good. These aren't bad neuroblastomas.↗
▶Ep 3 · 17:58
guidelineOnce respiratory compromise begins, treatment options include chemotherapy, radiation, or emergent decompressive laparotomy↗
▶Ep 3 · 17:58
quoteIf they're not in any distress, they're treated with my favorite protocol, which is aggressive observation.↗
▶Ep 3 · 17:58
guidelineStage MS without distress can be treated with aggressive observation↗
▶Ep 3 · 19:52
clinicalLiver biopsy in newborns is difficult because bleeding is hard to control↗
▶Ep 3 · 21:05
guidelineInitial workup for abdominal mass includes ultrasound to determine solid vs cystic, then CT with PO and IV contrast if solid↗
▶Ep 3 · 21:05
clinicalVIP secretion can cause severe diarrhea in neuroblastoma↗
▶Ep 3 · 26:03
guidelinePET scan is not part of routine initial diagnostic workup but may be used for MIBG-negative soft tissue areas to distinguish recurrence from scar↗
Neuroblastoma
▶Ep 6 · 2:32
quoteI mostly am quite reassuring at this stage. It's still a bit early.↗
▶Ep 6 · 2:47
quoteI think it's important to reassure and help the mom understand that the priority during the pregnancy is the mom. And once the baby is born, then we'll learn more.↗
▶Ep 6 · 9:58
guidelineSurveillance protocol for observed neonatal masses: ultrasound and catecholamines at birth, 3 weeks, 6 weeks, 12 weeks, then spacing out through first year, then every 6 months, then yearly↗
▶Ep 6 · 13:20
guidelineCriteria for surgery in observed neonatal neuroblastoma: >50% volume increase or >50% increase in VMA or HVA↗
▶Ep 6 · 14:50
clinicalStage MS (formerly 4S) neuroblastoma with liver and skin metastases in neonates has good biology and can be observed unless respiratory compromise develops from hepatomegaly↗
▶Ep 6 · 15:42
clinicalTreatment options for MS neuroblastoma with respiratory compromise include chemotherapy, radiation, or emergent decompressive laparotomy↗
▶Ep 6 · 26:56
epidemiologicalApproximately 50% of children's hospitals now use percutaneous biopsy for suspected neuroblastoma↗
▶Ep 6 · 28:04
clinicalPercutaneous biopsy is equivalent to open biopsy for diagnosis and NMEC determination but may fail for 11q loss of heterozygosity assessment↗
▶Ep 6 · 28:55
clinicalOptimized percutaneous biopsy technique requires 10-12 cores, higher gauge needle, and pathologist present for frozen section to confirm viable tumor↗
▶Ep 6 · 29:45
clinicalOpen biopsy patients have higher risk of blood transfusion, higher narcotic use, and more frequent hospital admission compared to percutaneous biopsy↗
▶Ep 6 · 33:49
clinicalLoss of heterozygosity at 11q is the most common segmental chromosomal alteration in neuroblastoma and can elevate risk category↗
▶Ep 6 · 37:20
clinicalHigh-risk neuroblastoma patients require double-lumen external catheter (not port) for bone marrow transplant↗
▶Ep 6 · 42:40
clinicalAfter 5-6 cycles of chemotherapy, neuroblastomas become more fibrotic and harder to resect↗
▶Ep 6 · 52:19
quoteOne thing we try to teach the residents is that with neuroblastoma surgery, there's no reason to cause disability.↗
Erika's statements about Pediatric Oncology30 statements
quoteI think one of the other things when you speak to the family, it's really important to reassure them that even if the mass increases in size and you take it out, it is likely to be a very, very low risk tumor.↗
▶Ep 184 · 11:07
epidemiologicalNocktern study showed approximately 98% event-free survival and 100% overall survival in observed prenatal neuroblastoma↗
▶Ep 184 · 11:37
guidelineFirst-year surveillance protocol: ultrasound and catecholamines at birth, 3 weeks, 6 weeks, 12 weeks, then spaced out to one year↗
▶Ep 184 · 11:37
guidelineAfter one year, surveillance becomes every six months, then yearly↗
▶Ep 184 · 13:38
quoteI will say the last one of these that I had at the 12-month scan it got bigger. And we took it out and it was a ended up being a sequestration.↗
▶Ep 184 · 16:07
guidelineLaparoscopic approach is reasonable for masses less than 6 centimeters↗
▶Ep 184 · 17:00
clinicalBiology of neuroblastoma is more important than lymph node status for treatment decisions↗
▶Ep 184 · 17:30
quoteThe biology of these tumors tend to still be good. These aren't bad neuroblastomas.↗
▶Ep 184 · 17:30
clinicalStage MS (formerly 4S) with skin lesions and liver mets still tends to have good biology↗
▶Ep 184 · 17:58
quoteIf they're not in any distress, they're treated with my favorite protocol, which is aggressive observation.↗
▶Ep 184 · 17:58
guidelineStage MS without distress can be treated with aggressive observation↗
▶Ep 184 · 17:58
guidelineOnce respiratory compromise begins, treatment options include chemotherapy, radiation, or emergent decompressive laparotomy↗
▶Ep 184 · 19:52
clinicalLiver biopsy in newborns is difficult because bleeding is hard to control↗
▶Ep 184 · 21:05
clinicalVIP secretion can cause severe diarrhea in neuroblastoma↗
▶Ep 184 · 21:05
guidelineInitial workup for abdominal mass includes ultrasound to determine solid vs cystic, then CT with PO and IV contrast if solid↗
▶Ep 184 · 26:03
guidelinePET scan is not part of routine initial diagnostic workup but may be used for MIBG-negative soft tissue areas to distinguish recurrence from scar↗
Neuroblastoma
▶Ep 252 · 2:32
quoteI mostly am quite reassuring at this stage. It's still a bit early.↗
▶Ep 252 · 2:47
quoteI think it's important to reassure and help the mom understand that the priority during the pregnancy is the mom. And once the baby is born, then we'll learn more.↗
▶Ep 252 · 9:58
guidelineSurveillance protocol for observed neonatal masses: ultrasound and catecholamines at birth, 3 weeks, 6 weeks, 12 weeks, then spacing out through first year, then every 6 months, then yearly↗
▶Ep 252 · 13:20
guidelineCriteria for surgery in observed neonatal neuroblastoma: >50% volume increase or >50% increase in VMA or HVA↗
▶Ep 252 · 14:50
clinicalStage MS (formerly 4S) neuroblastoma with liver and skin metastases in neonates has good biology and can be observed unless respiratory compromise develops from hepatomegaly↗
▶Ep 252 · 15:42
clinicalTreatment options for MS neuroblastoma with respiratory compromise include chemotherapy, radiation, or emergent decompressive laparotomy↗
▶Ep 252 · 26:56
epidemiologicalApproximately 50% of children's hospitals now use percutaneous biopsy for suspected neuroblastoma↗
▶Ep 252 · 28:04
clinicalPercutaneous biopsy is equivalent to open biopsy for diagnosis and NMEC determination but may fail for 11q loss of heterozygosity assessment↗
▶Ep 252 · 28:55
clinicalOptimized percutaneous biopsy technique requires 10-12 cores, higher gauge needle, and pathologist present for frozen section to confirm viable tumor↗
▶Ep 252 · 29:45
clinicalOpen biopsy patients have higher risk of blood transfusion, higher narcotic use, and more frequent hospital admission compared to percutaneous biopsy↗
▶Ep 252 · 33:49
clinicalLoss of heterozygosity at 11q is the most common segmental chromosomal alteration in neuroblastoma and can elevate risk category↗
▶Ep 252 · 37:20
clinicalHigh-risk neuroblastoma patients require double-lumen external catheter (not port) for bone marrow transplant↗
▶Ep 252 · 42:40
clinicalAfter 5-6 cycles of chemotherapy, neuroblastomas become more fibrotic and harder to resect↗
▶Ep 252 · 52:19
quoteOne thing we try to teach the residents is that with neuroblastoma surgery, there's no reason to cause disability.↗
Erika's statements about Soft Tissue Sarcoma (lymph nodes)14 statements
quoteI mostly am quite reassuring at this stage. It's still a bit early.↗
▶Ep 5 · 2:47
quoteI think it's important to reassure and help the mom understand that the priority during the pregnancy is the mom. And once the baby is born, then we'll learn more.↗
▶Ep 5 · 9:58
guidelineSurveillance protocol for observed neonatal masses: ultrasound and catecholamines at birth, 3 weeks, 6 weeks, 12 weeks, then spacing out through first year, then every 6 months, then yearly↗
▶Ep 5 · 13:20
guidelineCriteria for surgery in observed neonatal neuroblastoma: >50% volume increase or >50% increase in VMA or HVA↗
▶Ep 5 · 14:50
clinicalStage MS (formerly 4S) neuroblastoma with liver and skin metastases in neonates has good biology and can be observed unless respiratory compromise develops from hepatomegaly↗
▶Ep 5 · 15:42
clinicalTreatment options for MS neuroblastoma with respiratory compromise include chemotherapy, radiation, or emergent decompressive laparotomy↗
▶Ep 5 · 26:56
epidemiologicalApproximately 50% of children's hospitals now use percutaneous biopsy for suspected neuroblastoma↗
▶Ep 5 · 28:04
clinicalPercutaneous biopsy is equivalent to open biopsy for diagnosis and NMEC determination but may fail for 11q loss of heterozygosity assessment↗
▶Ep 5 · 28:55
clinicalOptimized percutaneous biopsy technique requires 10-12 cores, higher gauge needle, and pathologist present for frozen section to confirm viable tumor↗
▶Ep 5 · 29:45
clinicalOpen biopsy patients have higher risk of blood transfusion, higher narcotic use, and more frequent hospital admission compared to percutaneous biopsy↗
▶Ep 5 · 33:49
clinicalLoss of heterozygosity at 11q is the most common segmental chromosomal alteration in neuroblastoma and can elevate risk category↗
▶Ep 5 · 37:20
clinicalHigh-risk neuroblastoma patients require double-lumen external catheter (not port) for bone marrow transplant↗
▶Ep 5 · 42:40
clinicalAfter 5-6 cycles of chemotherapy, neuroblastomas become more fibrotic and harder to resect↗
▶Ep 5 · 52:19
quoteOne thing we try to teach the residents is that with neuroblastoma surgery, there's no reason to cause disability.↗
quoteI mostly am quite reassuring at this stage. It's still a bit early.↗
▶Ep 9 · 2:47
quoteI think it's important to reassure and help the mom understand that the priority during the pregnancy is the mom. And once the baby is born, then we'll learn more.↗
▶Ep 9 · 9:58
guidelineSurveillance protocol for observed neonatal masses: ultrasound and catecholamines at birth, 3 weeks, 6 weeks, 12 weeks, then spacing out through first year, then every 6 months, then yearly↗
▶Ep 9 · 13:20
guidelineCriteria for surgery in observed neonatal neuroblastoma: >50% volume increase or >50% increase in VMA or HVA↗
▶Ep 9 · 14:50
clinicalStage MS (formerly 4S) neuroblastoma with liver and skin metastases in neonates has good biology and can be observed unless respiratory compromise develops from hepatomegaly↗
▶Ep 9 · 15:42
clinicalTreatment options for MS neuroblastoma with respiratory compromise include chemotherapy, radiation, or emergent decompressive laparotomy↗
▶Ep 9 · 26:56
epidemiologicalApproximately 50% of children's hospitals now use percutaneous biopsy for suspected neuroblastoma↗
▶Ep 9 · 28:04
clinicalPercutaneous biopsy is equivalent to open biopsy for diagnosis and NMEC determination but may fail for 11q loss of heterozygosity assessment↗
▶Ep 9 · 28:55
clinicalOptimized percutaneous biopsy technique requires 10-12 cores, higher gauge needle, and pathologist present for frozen section to confirm viable tumor↗
▶Ep 9 · 29:45
clinicalOpen biopsy patients have higher risk of blood transfusion, higher narcotic use, and more frequent hospital admission compared to percutaneous biopsy↗
▶Ep 9 · 33:49
clinicalLoss of heterozygosity at 11q is the most common segmental chromosomal alteration in neuroblastoma and can elevate risk category↗
▶Ep 9 · 37:20
clinicalHigh-risk neuroblastoma patients require double-lumen external catheter (not port) for bone marrow transplant↗
▶Ep 9 · 42:40
clinicalAfter 5-6 cycles of chemotherapy, neuroblastomas become more fibrotic and harder to resect↗
▶Ep 9 · 52:19
quoteOne thing we try to teach the residents is that with neuroblastoma surgery, there's no reason to cause disability.↗
Summaries Erika gave as host
· 5 summaries
Recaps of other experts' statements, not Erika's own clinical position.
Summaries Erika gave as host · Hypertension5 summaries
host summaryErika Newman summarizing the discussion: Data from the Implicit Association Test (IAT) collecting data from millions of participants shows all healthcare providers have bias that favors whites↗
▶Ep 2 · 12:25
host summaryErika Newman summarizing the discussion: the data shows that all healthcare providers have bias that, um, favors whites↗
▶Ep 2 · 12:55
host summaryErika Newman summarizing the discussion: Children and adolescents experience bias not only in healthcare but in education and the criminal justice system↗
▶Ep 2 · 13:05
host summaryErika Newman summarizing the discussion: Biases are not hard-wired, can be changed, and can be replaced with new associations↗
▶Ep 2 · 46:51
host summaryErika Newman summarizing the discussion: In Sweden, which has universal healthcare, similar disparities are seen based on neighborhood locations affecting health outcomes↗
