Interhospital variability in localization techniques for small pulmonary nodules in children: A pediatric surgical oncology research collaborative study

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. Level of evidence: Retrospective review, Level 3.(c) 2022 Elsevier Inc. All rights reserved.

Automated summary

This study describes current trends in performance of image-guided localization techniques for pulmonary nodules in pediatric patients. The results indicate that various image-guided localization techniques can be successful for small pulmonary nodules in children, but there is significant variability in their application and procedure time among different institutions.