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

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. MeyersLindsay 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*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1013-1017
Number of pages5
JournalJournal of pediatric surgery
Issue number6
StatePublished - Jun 2022


  • CT-guided localization
  • Lung metastasis
  • Lung nodule

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health


Dive into the research topics of 'Interhospital variability in localization techniques for small pulmonary nodules in children: A pediatric surgical oncology research collaborative study'. Together they form a unique fingerprint.

Cite this