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Update Course Rewind: Lipiodol for Lung Metastases 2024
With Dr. Gloria Gonzalez · hosted by Dr. M Godoy
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Up to 50% of pediatric oncology patients have lung metastasis during their disease
Surgery can improve survival in patients with lung metastases
Complete resection of all nodules is necessary for optimal outcomes
Minimally invasive surgery is feasible for patients with one or two nodules
The conversion rate due to failure to localize subdural nodules during thoracoscopy is 47%
Conversion rate is much higher without double lung ventilation
CT guidance during thoracoscopy exposes the patient to radiation continuously
Ultrasound is difficult for localizing very small nodules
Calcified lesions in osteosarcoma are difficult to visualize with ultrasound
Hook wire dislodgement rate is reported as 2.4 to 22%
Hook wire dislodgement rate is higher when patients must travel from CT scan to OR under anesthesia
Methylene blue often spreads throughout the chest rather than remaining localized to nodules
ICG cannot be used for nodules deeper than 2 centimeters
Lipiodol marking is performed under CT guidance by interventional radiologists
Lipiodol remains in place for up to 3 months after injection
Surgery can be performed up to one week after Lipiodol marking
Intraoperative C-arm fluoroscopy is used to localize Lipiodol-marked nodules
Complete resection is verified by radioscopy and palpation of the resected specimen
Dr. Gonzalez used Lipiodol in 33 patients with three or four nodules per patient
The technique was used across multiple histologies including osteosarcoma, Ewing sarcoma, Wilms tumor, and infectious disease
Lipiodol marking achieved 100% sensitivity in localizing 50 nodules
Lipiodol is being adapted from adult procedures to pediatric practice