[The role of surgery for lung nodules in pediatric oncology]

To evaluate the role of lung nodule surgery in pediatric cancer patients.

The records of all cancer patients (< 18 y) treated at our pediatric institution since 1993 were reviewed. Clinical data, imaging features, surgical attitude, pathology and outcome were analyzed for those patients developing lung nodules on CT scan at any time.

Fifty-seven out of 857 (6.6%) cancer patients had lung nodules at one or more times during their disease course, totalling seventy-five episodes. The primary pathological diagnoses include: Osteosarcoma n = 17, Ewing's sarcoma n = 14, Rhabdomyosarcoma n = 5, Germ cell tumor n = 4, other sarcomas n = 4, Wilms' tumor n = 3, Neuroblastoma n = 3, Lymphoma n = 2. Twenty-nine cases had lung nodules at diagnosis; in 20 they were found during therapy; in 29 concomitant with other sites of relapse off therapy; and in 16 patients as an isolated event during follow-up. Fifty-five biopsy procedures were performed through thoracotomy, thoracoscopy or pleural effusion cytology. Metastasic disease was confirmed in 46, whereas in 9 no malignancy was found. Among the nine, five showed either normal lung tissue or scarring after tumor necrosis, and four had other benign diagnoses including: reactive inflammatory cells, pleural lymphangioma, mycobacteria infection and inflammatory pseudotumor. In 39 instances biopsy was not done either because the diagnosis could be made through specific tests, or because the nodules disappeared in a follow-up CT scan within 2 weeks, or because of disease progressing in spite of treatment. In 4 patients surgical removal of lung metastases has afforded cure.

Lung nodule surgery plays a fundamental role in the management of patients with pediatric malignancies: it allows accurate staging, avoiding overtreatment in more than 15% of the cases, and gives a higher chance of cure in some patients.