Needle localization of small pediatric tumors for surgical biopsy

Background. Small pediatric tumors may be difficult to biopsy or resect. Objective. To examine the benefits of needle localization of a variety of small pediatric tumors before surgical biopsy or excision. Materials and methods. Seven patients aged 1-19 years underwent 12 procedures for needle localization of suspected tumor. Two patients had undergone previous biopsies without needle localization with negative results. Computed tomography (four patients) or ultrasonography (three patients) guided needle placement. Each patient had suspected tumor(s) in 1-3 anatomical sites, including thigh (7), lung (2), parasacral region (2), and iliac bone (1). Results: All 12 lesions (9 less than 1 cm³ in volume) were successfully localized for excision or biopsy. Three small (< 1 cm³) soft-tissue lesions (two ganglioneuroblastomas and one ganglioneuroma) were excised from one patient, a 0.65-cm³ residual soft-tissue sarcoma from another; and recurrent bilateral teratomas from a third. Two peripheral primitive neuroectodermal tumors were excised with positive margins from a fourth patient. Two lesions contained only fibrosis, as determined by histopathology. Two other patients underwent thoracoscopic removal of lung metastases that were less than 0.1 cm³. Conclusion. Needle localization allows effective and less invasive excision or biopsy of a variety of small pediatric soft-tissue lesions.