Ethiodized Oil Localization for Thoracoscopic Lung Nodule Resection in Children

To evaluate the effectiveness and safety of computed tomography (CT)-guided ethiodized oil marking for thoracoscopic excisional biopsies of pulmonary nodules in children with cancer.

This was a retrospective, single-center study conducted between January 2014 and June 2024 of pediatric patients with cancer who underwent thoracoscopic resection of pulmonary nodules localized using a preoperative ethiodized oil marking technique. A total of 30 patients underwent 36 thoracoscopic procedures using ethiodized oil-guided localization. The mean age was 11.5 years (SD ± 4.2).

There were a total of 52 pulmonary nodules localized and resected, with a mean size of 3.7 mm (SD ± 1.9) and a mean distance from the pleural surface of 5.6 mm (SD ± 4.1). The mean time between marking and surgery was 23.3 hours (SD ± 12.3). At the surgical resection, 53 (98.1%) of 54 nodules were successfully localized using ethiodized oil and removed. The remaining, unlocalized nodule was resected using anatomical landmarks. One patient experienced localized vascular ethiodized oil infiltration without further extension or clinical consequences. Small rim pneumothorax developed in 9 patients (mild adverse event [AE]), with only 1 requiring chest tube placement (moderate AE). No hemothorax or postprocedural hematoma occurred.

CT-guided ethiodized oil marking proved to be a safe and effective method for localizing small pulmonary nodules before thoracoscopic resection in pediatric patients, achieving high success rates with minimal complications.