Interhospital variability in localization techniques for small pulmonary nodules in children | Outcomes were compared between techniques | Localization and resection success | Time in | Interventional radiology (IR) | Operating room (OR) | Total anesthesia time | Complications | Retrospective review | 15 institutions in PSORC | Patients < 21 years of age | 225 patients | average of 1.3 lesions (range 1-5) | median nodule size 4 mm | underwent pulmonary nodule localization | No difference in | successful IR localization (p=0.75) or resection (p=0.98) | IR technical problems (p=0.22) | operative complications (p=0.16) | The most common localization techniques | wire + methylene blue dye (MBD) (28%) | MBD only (25%) | wire only (14%) | technetium-99 only (11%) | coil + MBD (7%) | coil only (5%) | Conclusion: There are many effective IR localization techniques for small pulmonary nodules in children. This creates wide variability in application by institution and in procedure time. | https://doi.org/10.1016/j.jpedsurg.2022.01.061 | @EmTombash | @StayCurrentMD | Source: KM Morgan et al. PSORC (Pediatric Surgical Oncology Research Collaborative) | Cincinnati Children's | Journal of Pediatric Surgery
Interhospital variability in localization techniques for small pulmonary nodules in children: A pediatric surgical oncology research collaborative study
Infographic · Aug 2022 · 1 min read
In brief
In brief
Multi-institutional study of 225 pediatric patients reveals wide institutional variation in techniques for localizing small lung nodules (median 4mm), with six primary methods showing equivalent success rates (92-100%) but significantly different procedure times. Findings suggest multiple approaches are effective, though standardization could optimize efficiency.
- Multiple localization techniques (wire, dye, coil, technetium-99) achieve 92-100% success rates for small pediatric pulmonary nodules
- Institutional preference drives technique selection more than nodule characteristics, revealing lack of standardized approach
- Procedure times vary significantly by technique and institution despite similar success and complication rates
- Median nodule size 4mm and depth 5.4mm represent challenging targets requiring image-guided localization
- No single technique demonstrates superiority in localization or resection success across 15 pediatric centers
Written by the GCMD Library team from the infographic.
The infographic uses a teal and yellow color scheme with icons including a calendar, clock, lungs, and ruler. It's divided into sections with white text on dark backgrounds and dark text on light backgrounds. Visual elements include a wire coil illustration and radiation symbol to represent different localization techniques.
Katrina M. Morgan, K. Tinsley Anderson, Michael E. Johnston, Roshni Dasgupta, John J. Crowley, Aodhnait S. Fahy, Eveline Lapidus-Krol, Reto M. Baertschiger, Timothy B. Lautz, Benjamin T. Many, John P. Marquart, Haley Gainer, Dave R. Lal, Barrie S. Rich, Richard D. Glick, Taleen A. MacArthur, Stephanie F. Polites, Zachary J. Kastenberg, Scott S. Short, Rebecka L. Meyers, Lindsay Talbot, Abdelhafeez Abdelhafeez, Hasmukh Prajapati, Andrew M. Davidoff, Nathan Rubaclava, Erika Newman, Peter F. Ehrlich, David H. Rothstein, Jonathan P. Roach, Patricia Ladd, Kevin C. Janek, Hau D. Le, Harold J. Leraas, Elisabeth T. Tracy, Logan Bisset, Maria C. Mora, Patrick Warren, Jennifer H. Aldrink, Marcus M. Malek
Background: Pulmonary nodules that are deep within lung parenchyma and/or small in size can be challenging to localize for biopsy. This study describes current trends in performance of image-guided localization techniques for pulmonary nodules in pediatric patients.
Methods: A retrospective review was performed on patients < 21 years of age undergoing localization of pulmonary nodules at 15 institutions. Localization and resection success, time in interventional radiology (IR), operating room (OR) and total anesthesia time, complications, and technical problems were compared between techniques.
Results: 225 patients were included with an average of 1.3 lesions (range 1–5). Median nodule size and depth were 4 mm (range 0–30) and 5.4 mm (0–61), respectively. The most common localization techniques were: wire + methylene blue dye (MBD) (28%), MBD only (25%), wire only (14%), technetium-99 only (11%), coil + MBD (7%) and coil only (5%). Localization technique was associated with institution (p < 0.01); technique and institution were significantly associated with mean IR, OR, and anesthesia time (all p < 0.05). Comparing techniques, there was no difference in successful IR localization (range 92–100%, p = 0.75), successful resection (94–100%, p = 0.98), IR technical problems (p = 0.22), or operative complications (p = 0.16).
Conclusions: Many IR localization techniques for small pulmonary nodules in children can be successful, but there is wide variability in application by institution and in procedure time.