# Soft Tissue Sarcoma (lymph nodes) — GCMD Library living collection

Also covered as: neuroblastoma · Wilms tumor · metastatic disease · bilateral Wilms tumor · cutaneous melanoma · nodal involvement · pulmonary metastases

Experts: Dr. Todd Ponsky, Dr. Daniel von Allmen, Dr. Rae Hanke, Dr. Peter Ehrlich

Updated: n/a · 14 episodes · 405 cited statements

## Episodes
### Fundamentals
- [Topics in 10: Neuroblastoma](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659) — podcast · 10:25 · [machine version](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659.md)
- [Topics in 10: Wilms Tumor](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583) — podcast · 12:29 · [machine version](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583.md)

### Surgical Management
- [Update Course Rewind: Highlighting Collaboration from Surgery & Interventional Radiology in the OR 2024](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109) — video · 10:20 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109.md)

### Evidence & Research
- [Wilms Tumor Protocol Violations: Practice Gap discussion at Update Course 2018](https://qa.library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345) — video · 9:55 · [machine version](https://qa.library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345.md)
- [BOB in Ped Surg 2023 - IPSO Winner - Steven Scoville, MD](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323) — video · [machine version](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323.md)
- [BOB Ped Surg 2023 - Steven Scoville, IPSO  - Presentation](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343) — video · 5:05 · [machine version](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343.md)
- [Indocyanine green assists with sentinel lymph node mapping in pediatric and adolescent patients](https://qa.library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056) — video · 1:13 · [machine version](https://qa.library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056.md)

### Case-Based Learning
- [Lumps & Bumps: Soft Tissue Masses and Lesions](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628) — video · 67:50 · [machine version](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628.md)
- [Neuroblastoma](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620) — podcast · 56:19 · [machine version](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620.md)
- [Update Course Rewind: Chest Wall Reconstruction 2024](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839) — video · 5:32 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839.md)

### In-Depth Reviews
- [Ovarian Tumors Video Podcast](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979) — podcast · 34:06 · [machine version](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979.md)
- [Colon Cancer with Conor Delaney](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443) — podcast · 26:50 · [machine version](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443.md)
- [Thyroid Disorders](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302) — podcast · 45:51 · [machine version](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302.md)
- [Wilms Tumor: Audio Chapter](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487) — podcast · 64:03 · [machine version](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=0) Introduction and Background (Ep 8)
- [2:29](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=149) Initial Evaluation of Thyroid Nodules (Ep 8)
- [6:56](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=416) Laboratory and Imaging Workup (Ep 8)
- [9:26](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=566) Ultrasound Characteristics and Biopsy Criteria (Ep 8)
- [11:40](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=700) FNA Technique and Papillary Cancer Diagnosis (Ep 8)
- [14:17](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=857) Surgical Management of Papillary Thyroid Cancer (Ep 8)
- [17:40](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1060) Postoperative Management and Risk Stratification (Ep 8)
- [21:48](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1308) Follicular Lesions and Indeterminate Cytology (Ep 8)
- [24:39](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1479) Frozen Section and Follicular Cancer Management (Ep 8)
- [27:53](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1673) Benign Nodules and Inadequate Specimens (Ep 8)
- [30:08](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1808) Medullary Thyroid Cancer: Initial Workup (Ep 8)
- [35:20](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2120) MEN Syndromes and Prophylactic Thyroidectomy (Ep 8)
- [39:27](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2367) Medullary Cancer: Postoperative Management (Ep 8)
- [41:59](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2519) Graves' Disease and Diffuse Papillary Cancer (Ep 8)
- [44:23](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2663) Closing Remarks (Ep 8)
- [0:01](https://qa.library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=1) Case presentation and audience polling on management of metastatic Wilms tumor (Ep 1)
- [1:52](https://qa.library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=112) Lymph node sampling requirement and local versus systemic staging (Ep 1)
- [5:20](https://qa.library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=320) Management of pulmonary nodules and radiation therapy criteria (Ep 1)
- [8:01](https://qa.library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=481) Summary of take-home points and quality improvement outcomes (Ep 1)
- [0:00](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=0) Introduction and Pyogenic Granuloma Management (Ep 2)
- [5:40](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=340) Spitz Nevus: Diagnosis and Re-excision Controversy (Ep 2)
- [14:37](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=877) Pediatric Melanoma: Margins and Sentinel Node Biopsy (Ep 2)
- [22:26](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=1346) Cervical Lymphadenopathy: Workup and Biopsy Indications (Ep 2)
- [36:16](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=2176) Atypical Mycobacterial Lymphadenitis (Ep 2)
- [46:24](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=2784) Skin Abscess Management: Drainage Techniques and Antibiotics (Ep 2)
- [55:08](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=3308) Adolescent Breast Fibroadenoma: Observation versus Excision (Ep 2)
- [0:00](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=0) Introduction and Epidemiology of Wilms Tumor (Ep 4)
- [1:17](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=77) Clinical Presentation and Diagnostic Workup (Ep 4)
- [2:55](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=175) Staging System for Wilms Tumor (Ep 4)
- [4:03](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=243) Treatment of Unilateral Wilms Tumor (Ep 4)
- [6:49](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=409) Management of Bilateral Wilms Tumor (Ep 4)
- [8:37](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=517) Management of Intravascular Tumor Extension (Ep 4)
- [9:53](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=593) Treatment of Metastatic Disease (Ep 4)
- [11:03](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=663) Summary and Closing (Ep 4)
- [0:00](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=0) Introduction and Prenatal Diagnosis Approach (Ep 5)
- [4:00](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=240) Postnatal Workup and Observation Strategy (Ep 5)
- [9:07](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=547) Surveillance Protocol and Long-term Follow-up (Ep 5)
- [11:03](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=663) Surgical Approach and Stage MS Disease (Ep 5)
- [14:44](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=884) Workup of Older Child with Abdominal Mass (Ep 5)
- [21:50](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=1310) Tissue Biopsy Techniques and Adequacy (Ep 5)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Predominantly cystic ovarian masses have approximately 3-4% malignancy risk" — Frederick Rescorla (epidemiological) [Ep 6 · 4:03](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=243)
- "Heterogeneous ovarian masses have 15-20% malignancy rate" — Frederick Rescorla (epidemiological) [Ep 6 · 4:25](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=265)
- "Solid ovarian masses have over 25% malignancy risk" — Frederick Rescorla (epidemiological) [Ep 6 · 4:32](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=272)
- "Approximately 10% or less of all pediatric ovarian tumors are malignant" — Frederick Rescorla (epidemiological) [Ep 6 · 5:03](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=303)
- "Among malignant pediatric ovarian tumors, germ cell tumors predominate at greater than 50%, possibly up to 80% in some series" — Frederick Rescorla (epidemiological) [Ep 6 · 5:18](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=318)
- "Among benign pediatric ovarian tumors, mature teratoma comprises at least half of cases" — Frederick Rescorla (epidemiological) [Ep 6 · 5:43](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=343)
- "Immature teratoma accounts for approximately 10-15% of benign ovarian tumors" — Frederick Rescorla (epidemiological) [Ep 6 · 5:51](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=351)
- "In a study of 20 stage III ovarian tumors, 5 were stage III only because peritoneal fluid was positive for malignant cells; without checking washings they would have been considered stage I with likely higher recurrence" — Frederick Rescorla (host_summary) [Ep 6 · 8:10](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=490)
- "For ovarian tumor surgery, six oncologic steps are recommended: peritoneal washings, tumor removal, contralateral ovary inspection (biopsy only if abnormal), omental assessment (remove if adherent to tumor), peritoneal cavity assessment for implants, and retroperitoneal lymph node palpation (remove only if enlarged)" — Frederick Rescorla (guideline) [Ep 6 · 10:40](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=640)
- "Contralateral ovarian biopsy is now recommended only if the ovary appears abnormal, not routinely" — Frederick Rescorla (guideline) [Ep 6 · 10:54](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=654)
- "For large predominantly cystic ovarian masses with normal markers, the malignancy risk is much less than 1%" — Frederick Rescorla (epidemiological) [Ep 6 · 15:57](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=957)
- "Pre-menarchal girls have a higher risk of ovarian torsion compared to post-menarchal adolescents" — Frederick Rescorla (host_summary) [Ep 6 · 26:57](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1617)
- "Oophoropexy is recommended for pre-menarchal girls with ovarian torsion or for patients with recurrent torsion of the same ovary" — Frederick Rescorla (host_summary) [Ep 6 · 27:12](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1632)
- "Stage I malignant germ cell ovarian tumors have 96% overall survival" — Frederick Rescorla (epidemiological) [Ep 6 · 30:20](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1820)
- "Stage I germ cell tumors managed with observation alone have approximately 50% relapse rate" — Frederick Rescorla (epidemiological) [Ep 6 · 30:33](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1833)
- "Salvage rate for relapsed stage I germ cell tumors is nearly 100%" — Frederick Rescorla (epidemiological) [Ep 6 · 30:43](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1843)
- "Stage II and III germ cell ovarian tumors have 97% survival with chemotherapy" — Frederick Rescorla (epidemiological) [Ep 6 · 30:55](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1855)
- "Stage IV germ cell ovarian tumors have approximately 80% overall survival" — Frederick Rescorla (epidemiological) [Ep 6 · 31:15](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1875)
- "Stage IV germ cell tumors in patients under 11 years have 92% survival" — Frederick Rescorla (epidemiological) [Ep 6 · 31:23](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1883)
- "Stage IV germ cell tumors in patients over 11 years have 60% survival" — Frederick Rescorla (epidemiological) [Ep 6 · 31:33](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1893)
- "Standard chemotherapy for intermediate-risk germ cell tumors is platinum, etoposide, and bleomycin" — Frederick Rescorla (guideline) [Ep 6 · 32:00](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1920)
- "Metastatic sites in stage IV germ cell tumors do not require biopsy if clearly metastatic on imaging; they are followed with imaging" — Frederick Rescorla (clinical) [Ep 6 · 32:13](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1933)
- "Black, torsed ovaries should not be removed; detorsion alone is appropriate" — Frederick Rescorla (clinical) [Ep 6 · 32:32](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1952)
- "Ovarian-preserving procedures (partial oophorectomy) are appropriate for cystic or mixed cystic-solid masses; oophorectomy is reserved for solid tumors" — Frederick Rescorla (clinical) [Ep 6 · 32:44](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1964)
- "Alpha-fetoprotein (AFP) is the primary tumor marker for pediatric ovarian tumors; HCG is unlikely to be elevated in young children but is checked routinely" — Frederick Rescorla (clinical) [Ep 6 · 3:25](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=205)
- "Chest CT is required for staging of malignant ovarian tumors and should be obtained preoperatively" — Frederick Rescorla (guideline) [Ep 6 · 20:53](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1253)
- "For malignant ovarian tumors amenable to resection, primary surgical resection is preferred even if metastases are present" — Frederick Rescorla (clinical) [Ep 6 · 21:31](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1291)
- "Fallopian tube preservation during oophorectomy is optional; the tube should be preserved if not encased by tumor but can be removed if adherent or difficult to separate" — Frederick Rescorla (clinical) [Ep 6 · 21:42](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1302)
- "Peritoneal washings are the main factor that can upstage an otherwise apparent stage I tumor to a higher stage" — Frederick Rescorla (clinical) [Ep 6 · 22:48](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1368)
- "Pediatric surgeons manage primarily germ cell tumors (chemo-responsive) while gynecologic oncologists manage primarily epithelial tumors, explaining differences in surgical approach including lymph node dissection" — Frederick Rescorla (clinical) [Ep 6 · 23:20](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1400)
- "Omental biopsy is not routine; omentum should be removed only if adherent to tumor or if abnormal on palpation" — Frederick Rescorla (guideline) [Ep 6 · 24:07](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1447)
- "Radiation therapy has no role in treatment of pediatric germ cell ovarian tumors" — Frederick Rescorla (clinical) [Ep 6 · 24:16](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1456)
- "Ovarian cryopreservation is not currently standard practice but may be considered in the future for patients receiving chemotherapy" — Frederick Rescorla (opinion) [Ep 6 · 24:32](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1472)
- "For acute ovarian torsion with unclear mass characteristics, detorsion can be performed and the ovary left in place with delayed resection after obtaining markers and better imaging" — Frederick Rescorla (clinical) [Ep 6 · 26:57](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1617)
- "A one-week delay for re-operation after detorsion makes no oncologic difference and allows for proper workup and ovarian-preserving surgery" — Frederick Rescorla (clinical) [Ep 6 · 28:50](https://qa.library.globalcastmd.com/watch/ovarian-tumors-video-podcast-1979?t=1730)
- "Pyogenic granuloma surgical resection has approximately 3% recurrence rate with gross negative margins" — Danielle Walsh (clinical) [Ep 2 · 4:47](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=287)
- "Shave excision with curettage of pyogenic granuloma has 9.5% recurrence rate" — Danielle Walsh (clinical) [Ep 2 · 5:04](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=304)
- "Silver nitrate treatment for pyogenic granuloma has 15% recurrence rate, the highest among treatment options" — Danielle Walsh (clinical) [Ep 2 · 5:20](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=320)
- "Retinoid medications for acne are significantly associated with development of pyogenic granulomas; removal of medication often resolves the lesion" — Danielle Walsh (clinical) [Ep 2 · 4:14](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=254)
- "In a large study, 80% of characteristic Spitz nevi involuted spontaneously" — Danielle Walsh (epidemiological) [Ep 2 · 8:28](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=508)
- "Half of pediatric dermatologists would observe classic Spitz nevi without excision, waiting for spontaneous resolution" — Danielle Walsh (clinical) [Ep 2 · 8:44](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=524)
- "In a series of 30 patients with incompletely removed Spitz nevi, 24 were observed and none recurred; 6 were re-excised and only 1 had residual disease" — Danielle Walsh (clinical) [Ep 2 · 9:43](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=583)
- "In a retrospective study with 1-3mm margins for Spitz nevi, 20% had positive margins on re-excision" — Danielle Walsh (clinical) [Ep 2 · 10:23](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=623)
- "Barnhill recommends 3-5mm margins for classic Spitz nevi, 1cm for atypical, and melanoma-protocol margins for severely atypical based on depth" — Danielle Walsh (guideline) [Ep 2 · 10:45](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=645)
- "About one-third of Spitz nevi cases had nodal micrometastases on sentinel lymph node biopsy in combined adult and pediatric series" — Danielle Walsh (epidemiological) [Ep 2 · 11:56](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=716)
- "In 8 series, 39% of Spitz nevi with sentinel lymph node biopsy were positive, but all patients remained disease-free at 3-year follow-up without further intervention" — Danielle Walsh (clinical) [Ep 2 · 12:18](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=738)
- "Pediatric melanoma ABCDE criteria capture only 40% of cases in children under 10 and 60% in children over 11" — Danielle Walsh (epidemiological) [Ep 2 · 18:28](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=1108)
- "Melanoma margin recommendations: 5mm for in situ, 1cm for ≤1mm thick, 1-2cm for 1-2mm thick, 2cm for >2mm thick" — Danielle Walsh (guideline) [Ep 2 · 19:35](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=1175)
- "Cochrane review suggests 2cm margins are adequate for thick melanomas; no benefit demonstrated for 4cm margins" — Danielle Walsh (clinical) [Ep 2 · 19:50](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=1190)
- "Giant congenital nevi (>20cm) have 8% melanoma risk, higher if hairy; 60% of melanomas occur in first decade, reported as young as 3 years" — Danielle Walsh (epidemiological) [Ep 2 · 20:12](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=1212)
- "Pediatric melanoma has higher metastatic rate to lymph nodes (about 25%) than adults, especially in children younger than 10 and with thicker lesions" — Danielle Walsh (epidemiological) [Ep 2 · 20:35](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=1235)
- "If sentinel node is negative in melanoma, probability of subsequent recurrence is only about 5%" — Danielle Walsh (clinical) [Ep 2 · 21:02](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=1262)
- "If sentinel node is negative in melanoma, probability of non-sentinel node being positive is low but not zero" — Danielle Walsh (clinical) [Ep 2 · 21:08](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=1268)
- "Acute unilateral cervical lymphadenopathy is mostly bacterial (strep and staph); acute bilateral is usually viral" — Danielle Walsh (clinical) [Ep 2 · 30:57](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=1857)
- "Chronic/subacute unilateral lymphadenopathy suggests atypical mycobacteria, Bartonella, tuberculosis, or toxoplasmosis" — Danielle Walsh (clinical) [Ep 2 · 31:30](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=1890)
- "Chronic/subacute bilateral lymphadenopathy suggests EBV, CMV, or HIV" — Danielle Walsh (clinical) [Ep 2 · 31:45](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=1905)
- "Lymphadenopathy may persist 6-8 weeks after antibiotic treatment" — Danielle Walsh (clinical) [Ep 2 · 32:43](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=1963)
- "Biopsy indications for cervical lymphadenopathy include: >3cm, hard/fixed, supraclavicular or epitrochlear location, multiple nodal groups, systemic symptoms, hepatosplenomegaly, significantly abnormal labs, or abnormal imaging" — Danielle Walsh (clinical) [Ep 2 · 34:22](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=2062)
- "FNA for lymph nodes has 90% sensitivity and specificity but 10% false rate, with higher false-negative rate in Hodgkin lymphoma" — Danielle Walsh (clinical) [Ep 2 · 34:58](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=2098)
- "Malignancy rate in cervical lymph node biopsies varies 10-25% overall but ranges 12-80% depending on referral patterns and specialty" — Danielle Walsh (epidemiological) [Ep 2 · 35:39](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=2139)
- "Atypical mycobacterial lymphadenitis is a local problem in immunocompetent children, usually age 1-5 years, enters through oropharynx, and is not considered contagious" — Danielle Walsh (clinical) [Ep 2 · 38:00](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=2280)
- "In a randomized multicenter trial for atypical mycobacterial lymphadenitis, surgery had 96% cure rate versus 66% cure rate with antibiotics alone" — Danielle Walsh (clinical) [Ep 2 · 38:31](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=2311)
- "In a series of 55 patients with confirmed atypical mycobacteria, 45 started on antibiotics and 30 (67%) resolved without surgery" — Danielle Walsh (clinical) [Ep 2 · 38:56](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=2336)
- "Neonatal breast mastitis occurs mostly in term or near-term infants due to estrogen exposure; very uncommon in preemies because estrogen levels don't rise" — Danielle Walsh (clinical) [Ep 2 · 50:31](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=3031)
- "Peak age for neonatal mastitis is 2-4 weeks; majority are staph but gram negatives reported" — Danielle Walsh (epidemiological) [Ep 2 · 50:44](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=3044)
- "Parenteral antibiotics for 7-14 days may be needed for neonatal mastitis because infants have delayed absorption and delayed antibiotic efficacy" — Danielle Walsh (clinical) [Ep 2 · 51:26](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=3086)
- "In two small series of neonatal mastitis with I&D, breast deformity occurred in 2 of 5 patients (40%) in one study and 2 of 7 patients (29%) in another" — Danielle Walsh (clinical) [Ep 2 · 52:39](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=3159)
- "Fibroadenomas are the most common breast lesion in the under-20 age group, representing an exaggerated response to estrogen" — Danielle Walsh (clinical) [Ep 2 · 63:11](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=3791)
- "About 10-15% of fibroadenomas are multiple and 10% are bilateral" — Danielle Walsh (epidemiological) [Ep 2 · 63:20](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=3800)
- "Fibroadenomas typically increase in size over 6-12 months, then stabilize and can regress completely" — Danielle Walsh (clinical) [Ep 2 · 63:27](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=3807)
- "Excisional biopsy for fibroadenoma is recommended if continuing to grow, changing, over 5cm, symptomatic, complex on ultrasound, unreliable follow-up, or severe family anxiety" — Danielle Walsh (clinical) [Ep 2 · 64:17](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=3857)
- "Juvenile fibroadenomas are larger lesions with rapid growth, greater than 5cm, but only 10% reach that size" — Danielle Walsh (clinical) [Ep 2 · 65:00](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=3900)
- "Juvenile fibroadenomas larger than 5cm are difficult to distinguish from cystosarcoma phyllodes, even on percutaneous biopsy" — Danielle Walsh (clinical) [Ep 2 · 65:14](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=3914)
- "Simple fibroadenomas (isolated, well-demarcated, solid) have no increased cancer risk if no family history and no adjacent breast tissue abnormality" — Danielle Walsh (clinical) [Ep 2 · 65:57](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=3957)
- "Complex fibroadenomas (with cysts, calcifications, or abnormal surrounding tissue) carry a slight increased risk of future breast cancer up to 20 years after diagnosis" — Danielle Walsh (clinical) [Ep 2 · 66:14](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=3974)
- "Malignant breast disease in pediatric patients is rare and more commonly metastatic from other sites than primary breast tumors" — Danielle Walsh (epidemiological) [Ep 2 · 66:42](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=4002)
- "Lymphoma patients treated with chest radiation at young ages have up to 25% higher incidence of malignant breast disease" — Danielle Walsh (epidemiological) [Ep 2 · 66:53](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=4013)
- "American Society of Clinical Oncology discourages BRCA genetic testing before age 20 due to lack of timely medical benefit and psychosocial risks" — Danielle Walsh (guideline) [Ep 2 · 67:05](https://qa.library.globalcastmd.com/watch/lumps-bumps-soft-tissue-masses-and-lesions-628?t=4025)
- "The study was a multi-center prospective study conducted by PeaceOC evaluating indocyanine green (ICG) for identifying sentinel lymph nodes in pediatric patients with skin and soft tissue malignancies" — Sophia Schermerhorn (clinical) [Ep 14 · 0:05](https://qa.library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056?t=5)
- "Peritumoral injection of ICG demonstrated almost 80% sensitivity for detecting a sentinel node" — Sophia Schermerhorn (clinical) [Ep 14 · 0:21](https://qa.library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056?t=21)
- "All sentinel nodes that contained malignancy were ICG avid" — Sophia Schermerhorn (clinical) [Ep 14 · 0:28](https://qa.library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056?t=28)
- "ICG diagnostic performance is similar to smaller pediatric studies previously evaluating ICG and sentinel lymph node biopsy" — Sophia Schermerhorn (clinical) [Ep 14 · 0:33](https://qa.library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056?t=33)
- "ICG may outperform blue dye localization based on previously reported literature" — Sophia Schermerhorn (opinion) [Ep 14 · 0:33](https://qa.library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056?t=33)
- "The study did not directly compare the effectiveness of ICG to blue dye localization" — Sophia Schermerhorn (clinical) [Ep 14 · 0:45](https://qa.library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056?t=45)
- "ICG in most cases was used in conjunction with standard localization techniques such as technetium" — Sophia Schermerhorn (clinical) [Ep 14 · 0:49](https://qa.library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056?t=49)
- "No adverse reactions to ICG were identified within 30 days of surgery" — Sophia Schermerhorn (clinical) [Ep 14 · 0:58](https://qa.library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056?t=58)
- "Blue dye can cause permanent tattooing" — Sophia Schermerhorn (clinical) [Ep 14 · 1:02](https://qa.library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056?t=62)
- "ICG has a favorable safety profile and lacks the permanent tattooing associated with blue dye, making it an attractive visualization adjunct for pediatric sentinel lymph node biopsy" — Sophia Schermerhorn (opinion) [Ep 14 · 1:02](https://qa.library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056?t=62)
- "Pediatric melanoma has approximately 500 new cases diagnosed annually in children less than or equal to 18 years old" — Stephen Scoville (epidemiological) [Ep 10 · 3:01](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=181)
- "Childhood melanoma is associated with delayed diagnosis and more frequently has nodal involvement compared to adults" — Stephen Scoville (clinical) [Ep 10 · 3:01](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=181)
- "Management of pediatric melanoma is based on adult studies despite differences in disease mechanisms" — Stephen Scoville (clinical) [Ep 10 · 3:01](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=181)
- "Tumors less than 8 millimeters thick are largely managed with wide local excision" — Stephen Scoville (guideline) [Ep 10 · 3:01](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=181)
- "Tumors greater than or equal to 8 millimeters or less than 8 millimeters with high risk features without metastatic involvement typically undergo wide local excision with sentinel lymph node biopsies" — Stephen Scoville (guideline) [Ep 10 · 3:01](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=181)
- "Two adult trials (Decog SLT and MSLT2) showed no significant difference in outcomes for patients with positive sentinel lymph node biopsies followed with ultrasound observation versus completion lymph node dissections" — Stephen Scoville (clinical) [Ep 10 · 3:01](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=181)
- "There is no pediatric data to support ultrasound observation versus completion lymph node dissection" — Stephen Scoville (clinical) [Ep 10 · 3:01](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=181)
- "Study included 252 patients less than or equal to 18 years old diagnosed with cutaneous melanoma between 2010 and 2020 from 14 institutions" — Stephen Scoville (clinical) [Ep 10 · 4:10](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=250)
- "Breslow depth ranged from 2 millimeters to 20 millimeters with a median of 2.55 millimeters" — Stephen Scoville (clinical) [Ep 10 · 4:10](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=250)
- "Of 227 patients who underwent wide local excision with sentinel lymph node biopsies, 115 had positive sentinel lymph node biopsies (approximately 51%)" — Stephen Scoville (clinical) [Ep 10 · 5:20](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=320)
- "Patients who underwent completion lymph node dissection were significantly older and more likely to receive adjuvant therapy" — Stephen Scoville (clinical) [Ep 10 · 6:30](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=390)
- "There was no significant difference in recurrence or death from disease between ultrasound observation and completion lymph node dissection groups" — Stephen Scoville (clinical) [Ep 10 · 6:30](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=390)
- "Positive sentinel lymph node biopsies had significantly higher rate of disease recurrence at 18% compared to 3% for negative sentinel lymph node biopsy group" — Stephen Scoville (clinical) [Ep 10 · 7:30](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=450)
- "Only 21% of those who underwent completion lymph node dissection had additional positive nodal disease" — Stephen Scoville (clinical) [Ep 10 · 7:30](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=450)
- "Rate of recurrence was not significantly different between completion lymph node dissection patients with or without additional nodal burden" — Stephen Scoville (clinical) [Ep 10 · 7:30](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=450)
- "Recurrence was associated with positive nodal disease, deeper Breslow depth, greater use of adjuvant therapy, and higher rate of death" — Stephen Scoville (clinical) [Ep 10 · 8:00](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=480)
- "Pediatric melanoma presents as advanced disease with nearly 50% positive sentinel lymph node biopsy rate" — Stephen Scoville (clinical) [Ep 10 · 8:31](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=511)
- "Management of nodal disease had no significant impact on disease outcomes with respect to recurrence or death from disease" — Stephen Scoville (clinical) [Ep 10 · 8:31](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=511)
- "Before the Decog and MSLT2 trials, there was a much higher rate of completion lymph node dissection in children, and after those trials the rate has gone down but is still higher than in adults" — Stephen Scoville (clinical) [Ep 10 · 9:15](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=555)
- "For most children with positive sentinel lymph nodes, observation is appropriate without moving forward with completion lymph node dissection" — Stephen Scoville (opinion) [Ep 10 · 9:15](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=555)
- "Not all patients with positive sentinel lymph nodes receive adjuvant therapy; decision depends on genetic makeup of melanoma and overall risk factors including tumor size" — Stephen Scoville (clinical) [Ep 10 · 10:45](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=645)
- "If a lymph node becomes clinically positive during ultrasound surveillance, the likely approach would be to move forward with systemic therapy rather than completion lymph node dissection" — Stephen Scoville (opinion) [Ep 10 · 11:46](https://qa.library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=706)
- "When performing nephrectomy for Wilms tumor, lymph node sampling is mandatory according to protocols." (host_summary) [Ep 1 · 1:54](https://qa.library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=114)
- "If histologically negative lymph nodes are not documented during Wilms tumor nephrectomy, they are assumed to be positive, which increases the stage and requires increased chemotherapy." (host_summary) [Ep 1 · 2:01](https://qa.library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=121)
- "Failure to sample lymph nodes during Wilms tumor nephrectomy is an identified practice gap by the Cancer Committee and COG publications." (host_summary) [Ep 1 · 2:19](https://qa.library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=139)
- "The management approach discussed is based on US protocols, which differ from European SIOP protocols." (guideline) [Ep 1 · 2:30](https://qa.library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=150)
- "In Hong Kong, for Wilms tumor they tend to follow American protocols, though for various tumors they use either European or American protocols." — Ken Wong (clinical) [Ep 1 · 3:15](https://qa.library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=195)
- "The presence of metastatic disease in the lung does not preclude treating the primary tumor with nephrectomy, because this affects whether radiation therapy is required." (host_summary) [Ep 1 · 4:07](https://qa.library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=247)
- "There is both a local stage and a patient stage for Wilms tumor." (host_summary) [Ep 1 · 4:25](https://qa.library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=265)
- "On the ACS pediatric surgery blog, a similar question showed that overwhelmingly the presence of lymph node metastases led people to choose biopsy and chemotherapy, which is incorrect." (host_summary) [Ep 1 · 4:33](https://qa.library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=273)
- "Regardless of pulmonary metastatic disease, if the primary tumor can be removed without removing other organs, nephrectomy should be performed because it decreases radiation therapy requirements." (host_summary) [Ep 1 · 4:44](https://qa.library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=284)
- "The child will receive stage 4 metastatic chemotherapy regardless, but performing biopsy counts as local spillage and requires radiation therapy to the flank or abdomen." (host_summary) [Ep 1 · 5:04](https://qa.library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=304)
- "Local disease should be treated differently than systemic disease in Wilms tumor." (host_summary) [Ep 1 · 5:17](https://qa.library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=317)
- "When there are multiple lung masses, a correct assumption can be made that they represent metastases without biopsy." (clinical) [Ep 1 · 5:33](https://qa.library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=333)
- "Oncologists want measurable disease to assess response to chemotherapy." (host_summary) [Ep 1 · 5:45](https://qa.library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=345)
- "If you treat the patient and lung nodules go away, you presume that represents metastatic disease; if there is a residual nodule after treatment, that is an indication to resect it." (clinical) [Ep 1 · 6:03](https://qa.library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=363)
- "Previously, if a nodule was not present on plain film it was not considered significant even if seen on CT, but now CT is the diagnostic test of choice and impacts therapy." (clinical) [Ep 1 · 6:24](https://qa.library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=384)
- "For a single lung nodule, patients are treated and if it resolves, it is presumed to be metastatic Wilms tumor." (clinical) [Ep 1 · 6:41](https://qa.library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=401)
- "According to Dr. Shamberger, there are radiographic criteria for single lung nodules; if it looks like a metastasis you proceed, but if it does not look like a metastasis you can biopsy it to prove it is not a met and avoid chemotherapy." (host_summary) [Ep 1 · 6:54](https://qa.library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=414)
- "What is avoided by proving a nodule is not metastatic is radiation therapy to the lungs, not chemotherapy." (clinical) [Ep 1 · 7:12](https://qa.library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=432)
- "If lung nodules resolve after 6 weeks of treatment, regardless of how many there are, no radiation to the lungs is given." (guideline) [Ep 1 · 7:18](https://qa.library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=438)
- "For lung nodules to avoid radiation therapy, they must completely disappear; if there is a residual nodule, you cannot distinguish scar from active tumor and must biopsy or continue therapy with radiation." (clinical) [Ep 1 · 7:43](https://qa.library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=463)
- "In SIOP protocols, they perform percutaneous biopsy of the primary tumor and treat with chemotherapy." — Todd Ponsky (host_summary) [Ep 1 · 8:01](https://qa.library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=481)
- "APSA has addressed the lymph node sampling practice gap through expert questions, the NAT exam, and annual meeting educational efforts." (clinical) [Ep 1 · 9:29](https://qa.library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=569)
- "The American College of Surgeons registry data shows improvement with fewer patients receiving nephrectomies without lymph node sampling since educational efforts began." (host_summary) [Ep 1 · 9:29](https://qa.library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=569)
- "Thyroid nodules are less common in children than adults, but when detected in children, they are more likely to be malignant." — Diana Deason (epidemiological) [Ep 8 · 6:23](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=383)
- "When children present with thyroid cancer, they are more likely to have extension outside of the thyroid, regional lymph node involvement, and distant metastasis compared to adults." — Diana Deason (clinical) [Ep 8 · 6:31](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=391)
- "Risk factors for thyroid nodules and cancer include previous exposure to radiation or alkylating agents, such as treatment for Hodgkin's lymphoma, leukemia, or CNS tumors." — Diana Deason (clinical) [Ep 8 · 4:08](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=248)
- "Some thyroid conditions and thyroid cancers have familial predisposition, including MEN syndromes, PTEN hamartoma tumor syndromes, and APC-associated polyposis syndromes." — Diana Deason (clinical) [Ep 8 · 4:27](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=267)
- "If TSH is suppressed, a nuclear thyroid scan should be obtained to identify hyperfunctioning nodules, which do not need to be biopsied if they are going to be resected." — Diana Deason (guideline) [Ep 8 · 7:24](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=444)
- "Suspicious ultrasound features for thyroid malignancy include hypoechoic mass, irregular margins, increased blood flow, microcalcifications, or association with abnormal lymph nodes." — Diana Deason (clinical) [Ep 8 · 9:57](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=597)
- "In pediatric patients, size cutoffs used in adults (1 cm) cannot be applied for biopsy decisions; ultrasound characteristics and clinical context determine whether FNA is warranted." — Diana Deason (guideline) [Ep 8 · 11:21](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=681)
- "Total or near-total thyroidectomy is recommended for papillary thyroid cancer due to risk of bilateral disease (up to 30%), multifocal disease (up to 65%), increased risk of recurrence with lobectomy alone, and ability to optimize for radioactive iodine and use thyroglobulin as a tumor marker." — Diana Deason (guideline) [Ep 8 · 15:00](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=900)
- "Nerve monitoring is used routinely during thyroidectomy, and while it does not decrease the risk of nerve injury, it is helpful in identifying the recurrent laryngeal nerve, especially in patients with bulky cervical disease." — Diana Deason (opinion) [Ep 8 · 17:07](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1027)
- "There is no evidence to support prophylactic lateral neck dissection in thyroid cancer; lateral neck dissection is performed only when lateral nodes are pathologically positive." — Diana Deason (guideline) [Ep 8 · 18:33](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1113)
- "After total thyroidectomy, PTH levels less than 10 to 15 in recovery indicate higher risk for hypocalcemia, prompting initiation of calcium replacement or calcitriol." — Diana Deason (clinical) [Ep 8 · 19:37](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1177)
- "Low-risk papillary thyroid cancer patients (disease confined to thyroid, no nodal involvement, T1B N0) require only thyroglobulin surveillance with TSH suppression to 0.5-1, ultrasound at 6 months postoperatively, then annually for 5 years." — Diana Deason (guideline) [Ep 8 · 21:12](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1272)
- "Intermediate-risk patients (extensive central neck disease or any lateral neck disease) and high-risk patients (extensive regional disease, local invasion, or distant metastases) may require radioactive iodine postoperatively." — Diana Deason (guideline) [Ep 8 · 21:48](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1308)
- "Follicular lesions represent about one-third of thyroid FNA results and are indeterminate specimens." — Diana Deason (epidemiological) [Ep 8 · 23:05](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1385)
- "For follicular lesions of undetermined significance, the risk of malignancy in adults is 5-15%, but in pediatric literature it is approximately 28%." — Diana Deason (epidemiological) [Ep 8 · 24:07](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1447)
- "For follicular neoplasms, the reported malignancy rate was 15-30%, but more recent data suggests it is between 50% and 60% in children." — Diana Deason (epidemiological) [Ep 8 · 24:18](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1458)
- "Current ATA recommendations are that all indeterminate (follicular) lesions in children be resected, typically with lobectomy and removal of the isthmus." — Diana Deason (guideline) [Ep 8 · 23:50](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1430)
- "Frozen section cannot distinguish follicular adenoma from follicular carcinoma, but can identify papillary components." — Diana Deason (clinical) [Ep 8 · 25:04](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1504)
- "For follicular carcinoma with significant vascular invasion or tumor greater than 4 cm, completion thyroidectomy is recommended; smaller tumors with minimal vascular invasion can be monitored." — Diana Deason (guideline) [Ep 8 · 26:10](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1570)
- "About 30% of patients who undergo lobectomy may develop hypothyroidism at some point, so thyroid function monitoring is important even after partial thyroidectomy." — Diana Deason (epidemiological) [Ep 8 · 27:01](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1621)
- "TSH suppression goals vary by ATA pediatric risk level: low-risk patients have a TSH goal of 0.5-1, while high-risk patients have a TSH goal of less than 0.1." — Diana Deason (guideline) [Ep 8 · 27:31](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1651)
- "For benign thyroid nodules greater than 4 cm, the sensitivity and specificity of FNA is decreased, so it is important to follow these lesions with repeat ultrasound in 6-12 months and repeat biopsy if enlarging or developing suspicious features." — Diana Deason (clinical) [Ep 8 · 28:49](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1729)
- "Inadequate FNA specimens occur in roughly 1-3% of cases and should be repeated in 3-6 months to avoid picking up atypia from trauma of the initial FNA." — Diana Deason (clinical) [Ep 8 · 29:49](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1789)
- "Sporadic medullary thyroid cancer is unusual in children, so routine calcitonin monitoring is not recommended for every child with a thyroid nodule." — Diana Deason (guideline) [Ep 8 · 31:34](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1894)
- "For medullary thyroid cancer, if initial calcitonin level is greater than 500, imaging should be performed to exclude metastatic disease, including CT of neck and chest, MRI or CT of abdomen (looking at liver), and bone scan." — Diana Deason (guideline) [Ep 8 · 33:01](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1981)
- "MEN 2A patients can develop medullary thyroid cancer, pheochromocytomas, and hyperparathyroidism." — Diana Deason (clinical) [Ep 8 · 33:36](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2016)
- "MEN 2B patients can develop medullary thyroid cancer, pheochromocytomas, mucosal neuromas, and a Marfanoid habitus with elongated features and joint laxity." — Diana Deason (clinical) [Ep 8 · 33:47](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2027)
- "MEN 2B patients with RET 918 mutation present with thyroid cancer very early, as young as 3 months of age, and require thyroidectomy before 1 year of age." — Diana Deason (guideline) [Ep 8 · 34:11](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2051)
- "MEN 2A high-risk patients (most commonly RET 634 mutation) should have total thyroidectomy before age 5, with surveillance starting at age 3 including calcitonin, CEA, and ultrasounds; if calcitonin or ultrasound abnormalities develop, thyroidectomy should be performed at that time." — Diana Deason (guideline) [Ep 8 · 36:03](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2163)
- "If calcitonin levels exceed 40 in MEN patients undergoing surveillance, central neck dissection is recommended at the time of thyroidectomy." — Diana Deason (guideline) [Ep 8 · 36:27](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2187)
- "Children under age 10 have increased risk of complications from thyroidectomy, including hypoparathyroidism and nerve injury, due to smaller anatomy and smaller parathyroid glands." — Diana Deason (clinical) [Ep 8 · 36:52](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2212)
- "For MEN 2A moderate-risk patients, total thyroidectomy is recommended when serum calcitonin becomes elevated or if parents do not want to proceed with frequent surveillance." — Diana Deason (guideline) [Ep 8 · 36:59](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2219)
- "MEN 2A moderate-risk patients do not tend to develop pheochromocytomas until their twenties or above, so screening begins at age 16; MEN 2A high-risk patients begin pheochromocytoma screening at age 11." — Diana Deason (guideline) [Ep 8 · 37:47](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2267)
- "For prophylactic thyroidectomy in MEN patients, if performed before calcitonin levels exceed 40, central lymph node dissection is not necessary." — Diana Deason (guideline) [Ep 8 · 39:03](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2343)
- "After thyroidectomy for medullary cancer, if calcitonin levels are undetectable or normal, surveillance includes physical exam and neck ultrasounds every 6 months for 1 year, then annually." — Diana Deason (guideline) [Ep 8 · 40:08](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2408)
- "If postoperative calcitonin levels are greater than 150, imaging should be performed to detect metastasis, including CT neck and chest, MRI or CT abdomen, bone scan, and MRI of pelvis and axial skeleton." — Diana Deason (guideline) [Ep 8 · 40:22](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2422)
- "Systemic therapy for medullary thyroid cancer (tyrosine kinase inhibitors, external beam radiation) has significant side effects and is reserved for patients with progressive disease not treatable with surgery, not for all patients with elevated calcitonin." — Diana Deason (guideline) [Ep 8 · 41:38](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2498)
- "For Graves' disease in young children, thyroidectomy is often preferred over radioactive iodine due to concerns about risks of secondary malignancies from radioactive iodine." — Diana Deason (opinion) [Ep 8 · 42:29](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2549)
- "Some pediatric patients with papillary thyroid cancer present with diffuse infiltration of the thyroid rather than a discrete nodule, often with clinically suspicious lymph nodes, which is a characteristic more common in children." — Diana Deason (clinical) [Ep 8 · 43:52](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2632)
- "Wilms tumor is the second most common intra-abdominal tumor in children and fifth most common tumor in children overall." (host_summary) [Ep 4 · 0:00](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=0)
- "Approximately 75% of Wilms tumor cases occur in children younger than 5 years of age, with a peak incidence at 2 to 3 years of age." — Andrew Davidoff (epidemiological) [Ep 4 · 0:28](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=28)
- "Survival for patients with Wilms tumor, when considered as a whole, is currently greater than 90%." — Andrew Davidoff (epidemiological) [Ep 4 · 0:28](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=28)
- "Histology is a critical prognostic factor that profoundly impacts outcome in Wilms tumor, divided into favorable and unfavorable (anaplastic) histology." — Andrew Davidoff (clinical) [Ep 4 · 0:28](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=28)
- "Anaplastic histology comprises only about 10% of Wilms tumor cases but contributes to over 50% of Wilms tumor mortality." — Andrew Davidoff (epidemiological) [Ep 4 · 0:28](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=28)
- "Children with Wilms tumor typically present with an asymptomatic abdominal mass." — Andrew Davidoff (clinical) [Ep 4 · 1:20](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=80)
- "Associated signs and symptoms such as malaise, pain, microscopic or gross hematuria are found in only about 25% of children with Wilms tumor, as is hypertension." — Andrew Davidoff (clinical) [Ep 4 · 1:20](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=80)
- "The workup of a child with an intra-abdominal mass suspected of being Wilms tumor usually begins with ultrasound." — Andrew Davidoff (guideline) [Ep 4 · 1:46](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=106)
- "CT of the abdomen and pelvis is generally the definitive imaging study of choice for patients suspected of having a renal tumor based on ultrasound." — Andrew Davidoff (guideline) [Ep 4 · 1:46](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=106)
- "CT will confirm the presence of a solid renal mass and afford the opportunity to visualize the contralateral kidney to confirm its presence and function and to exclude synchronous bilateral disease." — Andrew Davidoff (clinical) [Ep 4 · 1:46](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=106)
- "Intravascular tumor extension occurs in about 6% of Wilms tumor cases." — Andrew Davidoff (epidemiological) [Ep 4 · 1:46](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=106)
- "Intravascular tumor extension should be specifically investigated in preoperative evaluation as it may alter the timing and conduct of surgery." — Andrew Davidoff (guideline) [Ep 4 · 1:46](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=106)
- "If intracardiac extension of tumor thrombus is suspected, this can be assessed by echocardiography." — Andrew Davidoff (guideline) [Ep 4 · 1:46](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=106)
- "The most common site of metastatic spread of Wilms tumor is the lungs." — Andrew Davidoff (clinical) [Ep 4 · 2:44](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=164)
- "A chest CT should be included in the initial evaluation of a child suspected of having Wilms tumor." — Andrew Davidoff (guideline) [Ep 4 · 2:44](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=164)
- "The Children's Oncology Group uses a surgical pathologic staging system in which localized Wilms tumors confined within the renal capsule are stage 1." — Andrew Davidoff (guideline) [Ep 4 · 2:59](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=179)
- "Wilms tumors that penetrate the renal capsule but are resected with negative margins are stage 2." — Andrew Davidoff (guideline) [Ep 4 · 2:59](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=179)
- "Circumstances that make Wilms tumor stage 3 include biopsy or rupture (preoperative or intraoperative), positive resection margin or gross residual disease, lymph node involvement, or the administration of preoperative chemotherapy." — Andrew Davidoff (guideline) [Ep 4 · 2:59](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=179)
- "Metastatic disease, which occurs in about 12% of Wilms tumor patients, is considered stage 4." — Andrew Davidoff (guideline) [Ep 4 · 2:59](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=179)
- "For stage 4 disease, the local stage should also be evaluated as this will determine whether abdominal radiation is indicated and to what field." — Andrew Davidoff (guideline) [Ep 4 · 2:59](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=179)
- "Patients with synchronous bilateral Wilms tumor are stage 5, but local stage for each side should still be evaluated." — Andrew Davidoff (guideline) [Ep 4 · 2:59](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=179)
- "For unilateral tumors, upfront resection with regional lymph node sampling (generally radical nephrectomy) is currently the recommendation from the Children's Oncology Group." — Andrew Davidoff (guideline) [Ep 4 · 4:06](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- "Although Wilms tumors can grow to a large size, even large tumors rarely invade surrounding structures, so most Wilms tumors are resectable at presentation." — Andrew Davidoff (clinical) [Ep 4 · 4:06](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- "Failure to perform upfront resection but instead administering neoadjuvant chemotherapy in the COG results in classification of a tumor as stage 3, thus mandating the use of flank irradiation and doxorubicin, each associated with significant long-term toxicities." — Andrew Davidoff (guideline) [Ep 4 · 4:06](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- "Treatment of favorable histology Wilms tumor stage 1 or 2 is limited to vincristine and actinomycin D." — Andrew Davidoff (guideline) [Ep 4 · 4:06](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- "In rare circumstances when the tumor is stage 1, weighs less than 550 grams (tumor weight plus kidney), and the patient is less than 2 years of age, no adjuvant chemotherapy is given." — Andrew Davidoff (guideline) [Ep 4 · 4:06](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- "Raising the age and weight limits for observation without adjuvant chemotherapy are currently being considered for study by COG." — Andrew Davidoff (guideline) [Ep 4 · 4:06](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- "Careful lymph node sampling is a critical part of any operation for Wilms tumor because the presence of nodal involvement is associated with an increased incidence of tumor relapse and a poorer prognosis." — Andrew Davidoff (clinical) [Ep 4 · 4:06](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- "Lymph node sampling should be performed even in the absence of abnormal nodes on preoperative imaging or on gross inspection during operative exploration, since these circumstances don't reliably predict lymph node negativity." — Andrew Davidoff (guideline) [Ep 4 · 4:06](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- "Partial nephrectomy for patients with unilateral, non-syndromic disease and laparoscopic nephrectomy are not currently standard of care and should generally only be performed in the context of a clinical trial." — Andrew Davidoff (guideline) [Ep 4 · 4:06](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- "Anaplastic histology is associated with a significantly worse outcome and is treated with more intensive chemotherapy." — Andrew Davidoff (clinical) [Ep 4 · 4:06](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- "A distinction is made between focal and diffuse anaplasia when determining specific adjuvant therapy." — Andrew Davidoff (guideline) [Ep 4 · 4:06](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- "About 5% of children with Wilms tumor will present with synchronous bilateral disease or stage 5 disease." — Andrew Davidoff (epidemiological) [Ep 4 · 6:53](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=413)
- "Children with bilateral Wilms tumor receive neoadjuvant chemotherapy with three drugs (as used for stage 3 or 4 favorable histology) to shrink tumors prior to surgery and facilitate preservation of normal renal parenchyma, due to increased risk of renal failure." — Andrew Davidoff (guideline) [Ep 4 · 6:53](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=413)
- "Patients with Wilms tumor arising in a solitary kidney or those with unilateral Wilms tumor at increased risk for developing metachronous tumor are also treated with neoadjuvant chemotherapy, though these patients usually don't receive doxorubicin." — Andrew Davidoff (guideline) [Ep 4 · 6:53](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=413)
- "A biopsy is not required in children with bilateral solid renal masses as bilateral Wilms tumor is the very likely diagnosis." — Andrew Davidoff (guideline) [Ep 4 · 6:53](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=413)
- "Studies have shown that biopsies of bilateral renal masses rarely detect anaplasia even when it does exist in the tumor mass." — Andrew Davidoff (clinical) [Ep 4 · 6:53](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=413)
- "A biopsy, if performed in bilateral disease, doesn't mandate subsequent radiation as it does in patients with unilateral Wilms tumor." — Andrew Davidoff (guideline) [Ep 4 · 6:53](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=413)
- "Bilateral nephron-sparing surgery should be considered in all patients with bilateral Wilms tumor and should be performed after either 6 or 12 weeks of neoadjuvant chemotherapy." — Andrew Davidoff (guideline) [Ep 4 · 6:53](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=413)
- "Longer courses of preoperative chemotherapy (beyond 12 weeks) are definitely discouraged in bilateral Wilms tumor." — Andrew Davidoff (guideline) [Ep 4 · 6:53](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=413)
- "It should be determined by preoperative imaging whether there is intravascular tumor extension, then its presence or absence confirmed intraoperatively." — Andrew Davidoff (guideline) [Ep 4 · 8:42](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=522)
- "Tumor extension into the renal vein and proximal inferior vena cava can in most cases be removed en bloc with the kidney and tumor." — Andrew Davidoff (clinical) [Ep 4 · 8:42](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=522)
- "Thrombus that extends further into the vena cava can be withdrawn from the IVC after gaining proximal and distal control." — Andrew Davidoff (clinical) [Ep 4 · 8:42](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=522)
- "Proximal control can generally be achieved if the superior extent of the thrombus is below the level of the hepatic veins." — Andrew Davidoff (clinical) [Ep 4 · 8:42](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=522)
- "Primary resection of tumors with extension above the level of the hepatic veins or especially into the atrium is associated with higher operative morbidity, so neoadjuvant chemotherapy is generally used in these circumstances." — Andrew Davidoff (guideline) [Ep 4 · 8:42](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=522)
- "Thrombus that extends above the hepatic veins and persists to this extent after neoadjuvant chemotherapy probably requires cardiopulmonary bypass to safely remove the full extent of disease." — Andrew Davidoff (clinical) [Ep 4 · 8:42](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=522)
- "About 12% of Wilms tumor patients will have evidence of hematogenous metastases at diagnosis with 80% of these being pulmonary metastases." — Andrew Davidoff (epidemiological) [Ep 4 · 9:58](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=598)
- "A new response-based approach is being used for patients with stage 4 disease in the Children's Oncology Group." — Andrew Davidoff (guideline) [Ep 4 · 9:58](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=598)
- "Stage 4 patients treated with three-drug chemotherapy who have radiographic disappearance of their lung metastases or tissue confirmation that residual nodules don't contain viable tumor at week 6 imaging re-evaluation will be considered rapid responders, will continue on three-drug chemotherapy, but won't receive pulmonary irradiation." — Andrew Davidoff (guideline) [Ep 4 · 9:58](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=598)
- "Patients who don't have complete resolution of pulmonary nodules at 6 weeks will be considered slow or incomplete responders, will be switched to more intensive chemotherapy regimen, and will receive whole lung irradiation." — Andrew Davidoff (guideline) [Ep 4 · 10:47](https://qa.library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=647)
- "Neuroblastoma is the most common extracranial solid tumor in children, with the majority occurring in children less than a year old." — Rae Hanke (host_summary) [Ep 3 · 0:00](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=0)
- "In younger patients, neuroblastoma is often picked up either prenatally on ultrasound, or in younger kids (two-year-old or three-year-old) as a solid abdominal mass." — Daniel von Allmen (clinical) [Ep 3 · 0:41](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=41)
- "When neuroblastoma patients have metastatic disease, they may present with either bony pain or potentially neurologic symptoms from cord compression." — Daniel von Allmen (clinical) [Ep 3 · 0:41](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=41)
- "When considering neuroblastoma as part of the differential diagnosis, it is important to get catecholamines (either urine or serum) as one of the most diagnostic laboratory tests for this tumor." — Daniel von Allmen (clinical) [Ep 3 · 1:07](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=67)
- "Most children with suspected neuroblastoma would get a cross-sectional imaging study, either a CT scan or an MRI." — Daniel von Allmen (clinical) [Ep 3 · 1:39](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=99)
- "If imaging suggests neuroblastoma (central abdominal mass or adrenal mass rather than kidney mass), the next test would be a nuclear medicine study, typically an MIBG study." — Daniel von Allmen (clinical) [Ep 3 · 1:39](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=99)
- "The MIBG study is helpful for confirming the diagnosis of neuroblastoma and can also demonstrate metastatic disease." — Daniel von Allmen (clinical) [Ep 3 · 1:39](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=99)
- "About 10% of neuroblastomas are MIBG negative." — Daniel von Allmen (clinical) [Ep 3 · 2:20](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=140)
- "Some centers, including Cincinnati Children's Hospital, would get a PET scan looking for tumor uptake as well as potential metastatic disease." — Daniel von Allmen (clinical) [Ep 3 · 2:20](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=140)
- "Based on the most recent iteration of the neuroblastoma staging system (INRGSS), it is possible to assign a stage before any invasive procedure is performed." — Daniel von Allmen (guideline) [Ep 3 · 2:45](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=165)
- "In the INRGSS system, tumors that are localized are categorized as L1; if localized but have image-defined risk factors (encasing nerves or vessels), they are L2; if they have metastatic disease, they are M." — Daniel von Allmen (guideline) [Ep 3 · 2:45](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=165)
- "There is a special category MS for children less than 18 months of age who have metastases to either the bone marrow or the skin." — Daniel von Allmen (guideline) [Ep 3 · 2:45](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=165)
- "The INRGSS pre-biopsy staging system was specifically created to allow studies from different centers in different countries to be compared based on the pre-surgical staging of the patient." — Daniel von Allmen (guideline) [Ep 3 · 3:36](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=216)
- "The prior neuroblastoma staging system required tissue diagnosis before assigning a stage." — Daniel von Allmen (guideline) [Ep 3 · 3:36](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=216)
- "A child with an adrenal mass on the right side and a positive MIBG scan but no evidence of metastases could potentially be treated with a primary resection of the mass via laparotomy." — Daniel von Allmen (clinical) [Ep 3 · 4:06](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=246)
- "Some surgeons would approach resection of a localized neuroblastoma with laparoscopy depending on the size of the tumor." — Daniel von Allmen (opinion) [Ep 3 · 4:06](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=246)
- "For very large masses that encase the aorta, cava, or other major vasculature, all you really want is tissue for diagnosis, which can be obtained through open biopsy, laparoscopic biopsy, or core needle biopsies done by an interventional radiologist." — Daniel von Allmen (clinical) [Ep 3 · 4:44](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=284)
- "The most important biologic risk determinant to obtain from neuroblastoma biopsy tissue is the NMIC status." — Daniel von Allmen (clinical) [Ep 3 · 5:14](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=314)
- "In addition to NMIC status, you want to look for 1P and 11Q deletions and Shimada histology in neuroblastoma biopsy tissue." — Daniel von Allmen (clinical) [Ep 3 · 5:14](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=314)
- "Biologic risk determinants from biopsy will tell you what risk category the patient falls into: very low risk, low risk, intermediate risk, or high risk." — Daniel von Allmen (clinical) [Ep 3 · 5:45](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=345)
- "Neuroblastoma risk is divided about 50-50 between the low risk categories and the high risk category, with a smaller percentage being intermediate risk." — Daniel von Allmen (epidemiological) [Ep 3 · 5:45](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=345)
- "NMIC amplification and age greater than 18 months are the most important prognostic determinants for neuroblastoma." — Daniel von Allmen (clinical) [Ep 3 · 6:11](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=371)
- "Patients with high risk neuroblastoma receive aggressive chemotherapy including peripheral stem cell transplant times 2, aggressive surgery with the goal of greater than 90% resection of the tumor, followed by radiation, immunotherapy after chemotherapy, and potentially retinoic acid therapy." — Daniel von Allmen (clinical) [Ep 3 · 6:11](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=371)
- "Intermediate risk neuroblastoma tumors get varying cycles of chemotherapy based on the biologic risk factors they have." — Daniel von Allmen (clinical) [Ep 3 · 6:51](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=411)
- "For intermediate risk neuroblastoma, the goal at the time of debulking or resecting the primary tumor is to achieve at least a 50% response from the initial volume of the primary tumor through the combination of neoadjuvant chemotherapy and surgical resection." — Daniel von Allmen (clinical) [Ep 3 · 6:51](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=411)
- "The low risk neuroblastoma group, depending on the actual age of the patient and how it is diagnosed, could potentially be followed simply with observation." — Daniel von Allmen (clinical) [Ep 3 · 7:22](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=442)
- "Jed Nocturne led a study through the Children's Oncology Group looking at patients less than six months of age with either a prenatally diagnosed or shortly postnatally diagnosed localized mass, showing these patients can be observed with the expectation that the vast majority will avoid any type of surgical procedure." — Daniel von Allmen (clinical) [Ep 3 · 7:22](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=442)
- "Patients with metastatic neuroblastoma typically receive four or five cycles of neoadjuvant chemotherapy and then are reassessed." — Daniel von Allmen (clinical) [Ep 3 · 7:55](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- "If the tumor and metastatic disease are responding to neoadjuvant chemotherapy, one would attack the primary tumor site with a resection, with many advocating for attempting a greater than 90% resection." — Daniel von Allmen (clinical) [Ep 3 · 7:55](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- "If the metastatic disease is progressing on neoadjuvant chemotherapy, then surgery is not indicated." — Daniel von Allmen (clinical) [Ep 3 · 7:55](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- "MS disease is specifically for patients who have a primary site with metastatic disease to the liver, the skin, or the bone marrow (specifically not bone, not cortical bone) and is less than 18 months of age." — Daniel von Allmen (clinical) [Ep 3 · 7:55](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- "In patients with MS disease, simple observation can be the treatment path." — Daniel von Allmen (clinical) [Ep 3 · 7:55](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- "If MS disease patients progress or develop respiratory issues because of an enlarging liver mass, treatment might be elected because of the complication of the size of the tumor, but the tumor itself usually does not have to be treated." — Daniel von Allmen (clinical) [Ep 3 · 7:55](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- "You can biopsy the skin lesions in MS disease and that will give you the diagnosis." — Daniel von Allmen (clinical) [Ep 3 · 8:55](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=535)
- "Adrenal hemorrhage is the most common cause of prenatal suprarenal mass, especially with history of fetal stress" — Daniel von Allmen (clinical) [Ep 5 · 2:00](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=120)
- "Familial neuroblastoma occurs in approximately 1% of patients" — Tony Sandler (epidemiological) [Ep 5 · 3:27](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=207)
- "The GetNucturne study showed that prenatal/neonatal neuroblastomas can be safely observed with careful ultrasound surveillance, with many patients spared surgery" — Daniel von Allmen (clinical) [Ep 5 · 7:24](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=444)
- "In the GetNucturne observation study of 84 patients, 16 (approximately 20%) underwent resection for growth or family preference, with 98% event-free survival and 100% overall survival" — Tony Sandler (clinical) [Ep 5 · 9:09](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=549)
- "Surveillance protocol for observed neonatal masses: ultrasound and catecholamines at birth, 3 weeks, 6 weeks, 12 weeks, then spacing out through first year, then every 6 months, then yearly" — Erika Newman (guideline) [Ep 5 · 9:58](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=598)
- "Criteria for surgery in observed neonatal neuroblastoma: >50% volume increase or >50% increase in VMA or HVA" — Erika Newman (guideline) [Ep 5 · 13:20](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=800)
- "Five centimeters is the size cutoff where most experts recommend surgical resection of neonatal neuroblastoma" — Tony Sandler (opinion) [Ep 5 · 12:43](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=763)
- "Lymph node status in neuroblastoma does not change therapy, unlike Wilms tumor" — Daniel von Allmen (clinical) [Ep 5 · 14:21](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=861)
- "Stage MS (formerly 4S) neuroblastoma with liver and skin metastases in neonates has good biology and can be observed unless respiratory compromise develops from hepatomegaly" — Erika Newman (clinical) [Ep 5 · 14:50](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=890)
- "Treatment options for MS neuroblastoma with respiratory compromise include chemotherapy, radiation, or emergent decompressive laparotomy" — Erika Newman (clinical) [Ep 5 · 15:42](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=942)
- "Approximately 10% of neuroblastomas are not MIBG-avid, which is when PET scan may be useful" — Daniel von Allmen (clinical) [Ep 5 · 22:12](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=1332)
- "Open biopsy via retroperitoneal approach allows adequate tissue for NMEC amplification, ALK mutation, ploidy, and 11q status" — Tony Sandler (clinical) [Ep 5 · 23:50](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=1430)
- "Approximately 50% of children's hospitals now use percutaneous biopsy for suspected neuroblastoma" — Erika Newman (epidemiological) [Ep 5 · 26:56](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=1616)
- "Percutaneous biopsy is equivalent to open biopsy for diagnosis and NMEC determination but may fail for 11q loss of heterozygosity assessment" — Erika Newman (clinical) [Ep 5 · 28:04](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=1684)
- "Optimized percutaneous biopsy technique requires 10-12 cores, higher gauge needle, and pathologist present for frozen section to confirm viable tumor" — Erika Newman (clinical) [Ep 5 · 28:55](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=1735)
- "Open biopsy patients have higher risk of blood transfusion, higher narcotic use, and more frequent hospital admission compared to percutaneous biopsy" — Erika Newman (clinical) [Ep 5 · 29:45](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=1785)
- "NMEC amplification automatically means high-risk neuroblastoma regardless of other factors" — Tony Sandler (clinical) [Ep 5 · 31:38](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=1898)
- "Loss of heterozygosity at 11q is the most common segmental chromosomal alteration in neuroblastoma and can elevate risk category" — Erika Newman (clinical) [Ep 5 · 33:49](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2029)
- "Age cutoff for neuroblastoma risk stratification is 18 months (previously was 12 months)" — Tony Sandler (guideline) [Ep 5 · 35:25](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2125)
- "High-risk neuroblastoma patients require double-lumen external catheter (not port) for bone marrow transplant" — Erika Newman (clinical) [Ep 5 · 37:20](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2240)
- "Stem cell harvesting for high-risk neuroblastoma typically occurs after cycle 2 of chemotherapy" — Tony Sandler (clinical) [Ep 5 · 45:31](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2731)
- "Tumor shrinkage in neuroblastoma plateaus after cycle 2-3 of chemotherapy per LaQuaglia and Von Allman studies" — Daniel von Allmen (clinical) [Ep 5 · 43:17](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2597)
- "After 5-6 cycles of chemotherapy, neuroblastomas become more fibrotic and harder to resect" — Erika Newman (clinical) [Ep 5 · 42:40](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2560)
- "COG high-risk study showed >90% resection improved event-free survival but not overall survival (approximately 245 patients)" — Daniel von Allmen (clinical) [Ep 5 · 44:04](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2644)
- "European neuroblastoma group study (approximately 1000 cases) showed >90% resection improved both event-free survival and overall survival" — Daniel von Allmen (clinical) [Ep 5 · 45:28](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2728)
- "Approximately 70% of high-risk neuroblastoma patients can achieve >90% resection" — Daniel von Allmen (epidemiological) [Ep 5 · 46:10](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2770)
- "Recent German/European publication stated unequivocally that extent of resection does not make a difference in neuroblastoma outcomes" — Tony Sandler (clinical) [Ep 5 · 46:50](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2810)
- "High-risk neuroblastoma patients die of metastatic disease, not local disease recurrence" — Tony Sandler (clinical) [Ep 5 · 47:40](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2860)
- "Neuroblastoma theoretically does not invade vessel adventitia, though invasion has been observed" — Daniel von Allmen (clinical) [Ep 5 · 50:54](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=3054)
- "There is zero correlation between surgeon operative note description of resection extent and post-operative imaging findings" — Daniel von Allmen (clinical) [Ep 5 · 51:30](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=3090)
- "Nephrectomy should be avoided in neuroblastoma resection because kidney removal requires chemotherapy dose reduction" — Tony Sandler (clinical) [Ep 5 · 53:13](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=3193)
- "Anti-GD2 monoclonal antibody improved high-risk neuroblastoma two-year survival from 46% to 60%" — Tony Sandler (clinical) [Ep 5 · 53:44](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=3224)
- "Checkpoint inhibitors have not been successful in neuroblastoma because it is not an immunogenic tumor" — Tony Sandler (clinical) [Ep 5 · 54:40](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=3280)
- "Colonoscopy is still the best test for colon cancer detection, finding the vast majority of cancers and polyps, though not perfect." — Conor Delaney (clinical) [Ep 7 · 1:16](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=76)
- "Serrated adenomas (previously misclassified as hyperplastic polyps, particularly large ones in the right colon) have genetic predisposition, tie into family cancer syndromes, and carry very high cancer risk." — Conor Delaney (clinical) [Ep 7 · 2:05](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=125)
- "Finding serrated adenomas requires family assessment for hereditary cancer syndromes and may necessitate changes in colonoscopy frequency and family member screening." — Conor Delaney (guideline) [Ep 7 · 2:42](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=162)
- "Serrated polyps can be flat and difficult to visualize; retroflexion in the cecum is increasingly used because they are often on the inferior or superior side of folds." — Conor Delaney (clinical) [Ep 7 · 3:27](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=207)
- "For rectal cancer, distal margin requirements are 5 cm if achievable, 2 cm if necessary, and 1 cm for very low tumors as long as they are not poorly differentiated." — Conor Delaney (clinical) [Ep 7 · 6:13](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=373)
- "The measurement '6 centimeters from the anal verge' varies significantly by patient body habitus and can represent different anatomical locations (anorectal ring vs. near dentate line)." — Conor Delaney (clinical) [Ep 7 · 7:25](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=445)
- "Distant staging for rectal cancer is best performed with CT abdomen (for liver metastases) and CT chest (replacing chest X-ray per current guidelines)." — Conor Delaney (guideline) [Ep 7 · 9:31](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=571)
- "MRI has become the standard for local staging of rectal cancer, with high-resolution, high-Tesla magnets using standardized protocols developed by Bill Heald and Gina Brown at the Royal Marsden." — Conor Delaney (clinical) [Ep 7 · 9:50](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=590)
- "MRI is 90 to mid-90s percent accurate for T-staging and high 80s to 90% accurate for nodal staging of rectal cancer." — Conor Delaney (clinical) [Ep 7 · 13:37](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=817)
- "Endoscopic ultrasound is only about 70% accurate for predicting nodal involvement in rectal cancer and is much more operator-dependent than MRI." — Conor Delaney (clinical) [Ep 7 · 13:56](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=836)
- "MRI is particularly good at distinguishing T3 and T4 tumors and assessing circumferential resection margins, though less accurate at distinguishing T1 from T2." — Conor Delaney (clinical) [Ep 7 · 10:27](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=627)
- "Historical local recurrence rates for rectal cancer from good institutions were 20–38%, with some series up to 50%." — Conor Delaney (epidemiological) [Ep 7 · 10:51](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=651)
- "With optimized surgery and imaging, local recurrence rates for rectal cancer should now be under 10%; Cleveland Clinic's rate over the last 10 years was about 3%." — Conor Delaney (epidemiological) [Ep 7 · 11:04](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=664)
- "Circumferential resection margin is the most important margin (or many think more important than distal margin) for preventing local recurrence in rectal cancer." — Conor Delaney (clinical) [Ep 7 · 10:39](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=639)
- "Total mesorectal excision (TME) can be performed with about 5 mL of blood loss because it follows a bloodless embryological plane; bleeding indicates wrong plane unless deliberately outside TME plane." — Conor Delaney (clinical) [Ep 7 · 12:24](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=744)
- "Neoadjuvant therapy for rectal cancer is indicated for T3 tumors (outside the rectal wall) or node-positive disease." — Conor Delaney (guideline) [Ep 7 · 12:54](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=774)
- "Stage 1 rectal cancer (node-negative, T1 or T2), particularly in the upper third of the rectum, does not require neoadjuvant therapy." — Conor Delaney (guideline) [Ep 7 · 13:18](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=798)
- "Short-course radiation (5×5 Gy over 5 days, surgery 1–2 weeks later) is commonly used in Europe; long-course chemoradiation (40–45 Gy over 6 weeks with 6–8 week wait) is standard in the US." — Conor Delaney (guideline) [Ep 7 · 18:04](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=1084)
- "25 Gy over a short period is radiotherapeutically equivalent to 40–45 Gy over a longer period, but long-course therapy may produce better tumor downstaging for bulky tumors." — Conor Delaney (clinical) [Ep 7 · 18:26](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=1106)
- "Transanal resection for rectal cancer is generally limited to T1 tumors less than one-third circumference and ideally less than 2 cm." — Conor Delaney (guideline) [Ep 7 · 14:35](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=875)
- "Historical local recurrence rates for transanally excised rectal cancers were about 18%, remarkably consistent across multiple centers." — Conor Delaney (epidemiological) [Ep 7 · 14:51](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=891)
- "Transanal endoscopic microsurgery (TEM) may produce better outcomes than traditional transanal excision, though it is unclear whether this is due to technology or improved surgical understanding." — Conor Delaney (opinion) [Ep 7 · 15:05](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=905)
- "For young, curable patients, radical resection is generally favored over transanal resection; transanal resection is typically reserved for patients unfit for radical surgery or those who would require permanent stoma." — Conor Delaney (guideline) [Ep 7 · 15:27](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=927)
- "For rectal cancer, full-thickness excision is required; ESD or EMR is never appropriate for proven cancer, only for benign polyps." — Conor Delaney (clinical) [Ep 7 · 16:24](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=984)
- "For colon cancer, at least 12 lymph nodes are required for adequate staging, though many surgeons aim for at least 16." — Conor Delaney (guideline) [Ep 7 · 19:51](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=1191)
- "High ligation of the inferior mesenteric artery (above the takeoff of the left colic artery) is standard for sigmoid colectomy, with protection of autonomic nerves to preserve sexual function." — Conor Delaney (clinical) [Ep 7 · 19:59](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=1199)
- "Total mesocolic excision for colon cancer should be performed with about 5 mL of blood loss in the embryological plane between retroperitoneal peritoneum (Toldt's fascia) and mesocolic peritoneum." — Conor Delaney (clinical) [Ep 7 · 20:18](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=1218)
- "Scandinavian data showed local recurrence rates for colon cancer were even higher than for rectal cancer (high 20s%) before focus on complete mesocolic excision technique." — Conor Delaney (epidemiological) [Ep 7 · 20:48](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=1248)
- "For cecal or ileocecal valve tumors, 10 cm of small bowel should be resected; for mid-ascending colon tumors, 5 cm of small bowel is adequate." — Conor Delaney (clinical) [Ep 7 · 23:12](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=1392)
- "Extracorporeal stapled anastomosis for right hemicolectomy achieved a leak rate of 0.8% over 1000 cases at Cleveland Clinic." — Conor Delaney (epidemiological) [Ep 7 · 24:00](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=1440)
- "Genetic assessment is indicated for colorectal cancer patients with Bethesda criteria risk factors, cancer under age 40, first-degree relatives with cancer, or multiple cancers in the family." — Conor Delaney (guideline) [Ep 7 · 24:56](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=1496)
- "Genetic diagnosis affects both family screening recommendations and surgical approach; patients with hereditary syndromes may require subtotal colectomy or proctocolectomy rather than segmental resection." — Conor Delaney (clinical) [Ep 7 · 25:33](https://qa.library.globalcastmd.com/watch/colon-cancer-with-conor-delaney-3443?t=1533)
- "In North America, the preferred approach for resectable Wilms tumor is primary nephrectomy (total nephrectomy and ureterectomy with lymph node sampling)." — Peter Ehrlich (guideline) [Ep 9 · 6:23](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=383)
- "Preoperative chemotherapy is recommended if tumor extends into the IVC beyond the infrahepatic vena cava, if tumor is so large it compromises respiratory status, if major liver or bowel resection would be required, if only one functioning kidney exists, or if bilateral tumors are present." — Peter Ehrlich (guideline) [Ep 9 · 7:01](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=421)
- "The 'claw sign' on CT—normal kidney displaced into a horseshoe pattern around a mass—is a classic feature of Wilms tumor." — Peter Ehrlich (clinical) [Ep 9 · 3:49](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=229)
- "Wilms tumor tends to push structures out of the way rather than growing into them, whereas neuroblastoma grows around structures like blood vessels." — Peter Ehrlich (clinical) [Ep 9 · 4:16](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=256)
- "If a tumor requires major liver or bowel resection, biopsy and preoperative chemotherapy are preferred because complication rates are higher when these organs are resected at the same time as the kidney, and most tumors will respond to chemotherapy." — Peter Ehrlich (clinical) [Ep 9 · 10:24](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=624)
- "Biopsy with residual gross tumor has always been treated as stage 3 abdominal disease, requiring three-drug chemotherapy plus flank radiation." — Peter Ehrlich (guideline) [Ep 9 · 11:18](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=678)
- "Evidence suggests higher risk of tumor rupture when tumors reach 13-15 centimeters or larger, which may warrant consideration of preoperative chemotherapy." — Peter Ehrlich (clinical) [Ep 9 · 14:33](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=873)
- "For biopsy, open biopsy provides large tissue sections; large-core needle biopsy (10-20 cores) has proven accurate in several series. Fine needle aspiration or single-pass true-cut biopsy cannot diagnose anaplasia and should not be used." — Peter Ehrlich (guideline) [Ep 9 · 17:19](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1039)
- "COG stage 1 is tumor limited to kidney, completely resected, no capsular invasion, no rupture or biopsy, vessels of renal sinus not involved, negative margins, and negative regional lymph nodes." — Peter Ehrlich (guideline) [Ep 9 · 20:00](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1200)
- "COG stage 2 is complete resection with negative margins but tumor extends beyond kidney through capsular penetration, renal sinus invasion, or blood vessel involvement within the nephrectomy specimen outside the primary kidney." — Peter Ehrlich (guideline) [Ep 9 · 20:28](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1228)
- "COG stage 3 includes: biopsy with gross residual tumor, positive lymph nodes, peritoneal surface penetration with implants, positive margins, microscopic residual from intraoperative spill, incomplete resection, piecemeal removal, or renal vein division with tumor present." — Peter Ehrlich (guideline) [Ep 9 · 21:00](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1260)
- "COG stage 4 is hematogenous metastasis to lung, liver (most common), bone, or brain. Stage 5 is bilateral renal tumor involvement." — Peter Ehrlich (guideline) [Ep 9 · 21:58](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1318)
- "Stage 1-2 abdominal disease without lung metastases receives two-drug chemotherapy (vincristine and dactinomycin) for shorter duration without abdominal radiation, significantly reducing late effects including renal failure, second malignancies, and cardiovascular disease." — Peter Ehrlich (guideline) [Ep 9 · 23:08](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1388)
- "If a patient has a lung lesion but stage 1-2 abdominal disease after primary nephrectomy with negative lymph nodes, the child avoids abdominal radiation (though still receives chemotherapy for the lung lesion)." — Peter Ehrlich (clinical) [Ep 9 · 24:15](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1455)
- "Recent COG data shows approximately 40% of patients with pulmonary metastases who have complete response at 6 weeks can avoid pulmonary radiation without affecting event-free or overall survival, with 80-85% not relapsing." — Peter Ehrlich (clinical) [Ep 9 · 26:24](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1584)
- "Fifteen percent of girls who receive pulmonary radiation for Wilms tumor develop breast cancer, a significant late effect." — Peter Ehrlich (epidemiological) [Ep 9 · 26:08](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1568)
- "For a single lung lesion remaining at 6 weeks that did not respond to chemotherapy, thoracoscopic biopsy is reasonable because 50-60% of such lesions may not be cancer (could be scar), and if benign, the patient would not need pulmonary radiation." — Peter Ehrlich (clinical) [Ep 9 · 28:09](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1689)
- "SIOP protocols use preoperative chemotherapy for all patients at higher doses than COG, with evaluation at 4 and 8 weeks, then resection followed by post-chemotherapy pathology-based risk stratification (low, intermediate, high risk)." — Peter Ehrlich (guideline) [Ep 9 · 30:16](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1816)
- "In SIOP protocols, predominantly blastema component after preoperative chemotherapy is a negative prognostic factor, but blastema percentage does not correlate with outcome in COG primary nephrectomy patients." — Peter Ehrlich (clinical) [Ep 9 · 31:19](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1879)
- "Outcomes for stage 1 and stage 2 patients are basically identical between COG and SIOP treatment approaches." — Peter Ehrlich (clinical) [Ep 9 · 33:58](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2038)
- "Some Wilms tumor patients present with low hemoglobin because the tumor ruptures internally and bleeds." — Peter Ehrlich (clinical) [Ep 9 · 34:46](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2086)
- "Acquired von Willebrand disease occurs in Wilms tumor patients; in most cases it is meaningless, but a few case series report significant intraoperative bleeding until tumor removal." — Peter Ehrlich (clinical) [Ep 9 · 35:11](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2111)
- "Right-sided tumors can cause complications including adrenal vein injury, duodenal injury (due to proximity), superior mesenteric artery injury, and IVC injury due to anatomic distortion." — Peter Ehrlich (clinical) [Ep 9 · 36:25](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2185)
- "Wilms tumors can cause intense inflammatory reaction making them adherent to diaphragm or liver; taking a rim of diaphragm or liver capsule to avoid tumor violation does not upstage the tumor if the tumor itself is not divided." — Peter Ehrlich (clinical) [Ep 9 · 42:31](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2551)
- "The main factor predicting outcome in stage 3 disease is whether lymph nodes are positive, along with genetic changes including loss of heterozygosity and 1Q gain." — Peter Ehrlich (clinical) [Ep 9 · 32:50](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1970)
- "Patients with loss of heterozygosity of both 1p and 16q (5-7% of patients) have significantly worse outcomes regardless of stage. Stage 1-2 patients with LOH have about 10% lower overall survival; stage 3-4 patients have 18% lower survival." — Peter Ehrlich (clinical) [Ep 9 · 54:41](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3281)
- "Patients with both 1p and 16q loss of heterozygosity receive augmented therapy: doxorubicin is added for stage 1-2 disease, and five-drug regimen M is used for stage 3-4 disease." — Peter Ehrlich (guideline) [Ep 9 · 55:07](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3307)
- "IVC tumor extension is not a negative prognostic factor if the tumor is completely resected." — Peter Ehrlich (clinical) [Ep 9 · 46:27](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2787)
- "Major complication rate for primary surgery with tumor extending beyond infrahepatic IVC is 26-30%, including mortality, increased transfusions, and ICU stay, supporting preoperative chemotherapy for these cases." — Peter Ehrlich (clinical) [Ep 9 · 48:49](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2929)
- "Favorable histology Wilms tumor has three components: blastema, stroma, and epithelial (triphasic tumor). Tumors with only two components are also considered favorable histology." — Peter Ehrlich (clinical) [Ep 9 · 52:39](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3159)
- "Unfavorable histology is classified as focal anaplasia or diffuse anaplasia based on number of high-power fields showing anaplasia, with different treatments for each." — Peter Ehrlich (clinical) [Ep 9 · 55:58](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3358)
- "Clear cell sarcoma of the kidney has reasonable treatment outcomes, particularly for low stages. Rhabdoid tumors have poor outcomes except for stage 1; most present at stage 3-4 with terrible outcomes." — Peter Ehrlich (clinical) [Ep 9 · 57:01](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3421)
- "Renal cell carcinoma in children has no good therapy, particularly for metastatic disease." — Peter Ehrlich (clinical) [Ep 9 · 56:51](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3411)
- "Bilateral Wilms tumors occur in 8-10% of all children with Wilms tumor." — Peter Ehrlich (epidemiological) [Ep 9 · 57:46](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3466)
- "The strategy for bilateral Wilms tumor is preoperative chemotherapy to shrink tumors enough to allow partial nephrectomy of at least one kidney (ideally both) to avoid dialysis." — Peter Ehrlich (guideline) [Ep 9 · 58:07](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3487)
- "Event-free survival for bilateral Wilms tumor on NWTS-5 was 61% compared to 88% for unilateral tumors; overall survival was 80% vs. 95%." — Peter Ehrlich (epidemiological) [Ep 9 · 58:40](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3520)
- "Maximum tumor response to chemotherapy in most children with Wilms tumor occurs by 12 weeks, and early response at 6 weeks predicts late response." — Peter Ehrlich (clinical) [Ep 9 · 59:37](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3577)
- "In children presenting under 36 months with bilateral renal tumors, it is almost universally Wilms tumor. In a recent COG study of 250 enrolled patients, only one turned out to have rhabdoid tumor." — Peter Ehrlich (epidemiological) [Ep 9 · 60:31](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3631)
- "Biopsy is recommended for bilateral tumors in older patients (8-10 years) or those with syndromes like von Hippel-Lindau where renal cell carcinoma is more likely." — Peter Ehrlich (guideline) [Ep 9 · 61:56](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3716)
- "If biopsying bilateral tumors, both kidneys should be biopsied because there is discordant pathology in up to 20% of patients." — Peter Ehrlich (clinical) [Ep 9 · 62:16](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3736)
- "A small subset of very young patients (<24 months) with stage 1 favorable histology tumors <550g can be treated with surgery alone without chemotherapy, with >95% overall survival. Those who relapse (about 10%) have 100% salvage with chemotherapy." — Peter Ehrlich (clinical) [Ep 9 · 43:32](https://qa.library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2612)
- "Pediatric melanoma has approximately 500 new cases diagnosed annually in children less than or equal to 18 years old." — Steven Scoville (epidemiological) [Ep 11 · 0:26](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=26)
- "Compared to adults, childhood melanoma is associated with delayed diagnosis and more frequently has nodal involvement." — Steven Scoville (clinical) [Ep 11 · 0:33](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=33)
- "Childhood melanoma has unique disease mechanisms compared to adult melanoma." — Steven Scoville (clinical) [Ep 11 · 0:42](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=42)
- "Management of pediatric melanoma is based on adult studies despite differences from adult disease." — Steven Scoville (guideline) [Ep 11 · 0:44](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=44)
- "Melanoma management is largely based on depth of the tumor and presence of metastatic disease." — Steven Scoville (guideline) [Ep 11 · 0:49](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=49)
- "Tumors less than 0.8 millimeters thick are largely managed with wide local excision." — Steven Scoville (guideline) [Ep 11 · 0:55](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=55)
- "Tumors greater than or equal to 0.8 millimeters or less than 0.8 millimeters with high risk features without metastatic involvement typically undergo wide local excision with sentinel lymph node biopsies." — Steven Scoville (guideline) [Ep 11 · 1:07](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=67)
- "If sentinel lymph node biopsy is positive, patients typically undergo ultrasound observation versus completion lymph node dissection, which has a high risk of morbidity." — Steven Scoville (guideline) [Ep 11 · 1:20](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=80)
- "Two adult trials (DCOG SLT and MSLT2) showed no significant difference in outcomes for low to intermediate risk patients with positive sentinel lymph node biopsies who were followed with ultrasound observation versus completion lymph node dissections." — Steven Scoville (clinical) [Ep 11 · 1:29](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=89)
- "There is no pediatric data to support ultrasound observation versus completion lymph node dissection for positive sentinel lymph node biopsies." — Steven Scoville (clinical) [Ep 11 · 1:47](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=107)
- "In this study of 252 pediatric melanoma patients, race was predominantly white, consistent with prior literature." — Steven Scoville (epidemiological) [Ep 11 · 2:10](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=130)
- "Breslow depth ranged from tumor in situ to 20 millimeters with a median of 2.55 millimeters." — Steven Scoville (clinical) [Ep 11 · 2:21](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=141)
- "Of 227 patients who underwent wide local excision with sentinel lymph node biopsies, 115 (approximately 51%) had positive sentinel lymph node biopsies." — Steven Scoville (clinical) [Ep 11 · 2:40](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=160)
- "Patients who underwent completion lymph node dissection were significantly older than those who underwent ultrasound observation." — Steven Scoville (clinical) [Ep 11 · 3:22](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=202)
- "Patients who underwent completion lymph node dissection were more likely to receive adjuvant therapy compared to ultrasound observation." — Steven Scoville (clinical) [Ep 11 · 3:22](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=202)
- "There was no significant difference in recurrence or death from disease between ultrasound observation and completion lymph node dissection groups." — Steven Scoville (clinical) [Ep 11 · 3:34](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=214)
- "Positive sentinel lymph node biopsies had significantly higher rate of disease recurrence at 18% compared to 3% for negative sentinel lymph node biopsy group." — Steven Scoville (clinical) [Ep 11 · 3:41](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=221)
- "Only 21% of patients who underwent completion lymph node dissection had additional positive nodal disease." — Steven Scoville (clinical) [Ep 11 · 3:52](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=232)
- "Rate of recurrence was not significantly different between completion lymph node dissection patients with or without additional nodal burden." — Steven Scoville (clinical) [Ep 11 · 4:01](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=241)
- "Recurrence was associated with positive sentinel lymph node disease, deeper Breslow depth, greater use of adjuvant therapy, and higher rate of death." — Steven Scoville (clinical) [Ep 11 · 4:11](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=251)
- "Pediatric melanoma presents as advanced disease with nearly 50% positive sentinel lymph node biopsy rate." — Steven Scoville (clinical) [Ep 11 · 4:23](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=263)
- "Management of nodal disease (ultrasound observation vs completion lymph node dissection) had no significant impact on disease outcomes with respect to recurrence or death from disease." — Steven Scoville (clinical) [Ep 11 · 4:30](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=270)
- "Findings of additional nodal disease in completion lymph node dissection did not significantly correlate with recurrence." — Steven Scoville (clinical) [Ep 11 · 4:38](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=278)
- "Recurrence most strongly associated with positive sentinel lymph node biopsies and deeper Breslow depth." — Steven Scoville (clinical) [Ep 11 · 4:47](https://qa.library.globalcastmd.com/watch/bob-ped-surg-2023-steven-scoville-ipso-presentation-6343?t=287)
- "The 12th annual update course in pediatric surgery was held in August 2024 and introduced a new classification system: green circle for established practice, blue square for promising newer practice, and black diamond for early adopter practice only." — Em Gootee (host_summary) [Ep 12 · 0:13](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=13)
- "Information from this session on image-guided surgery collaboration classifies as a blue square for promising newer practice." — Em Gootee (host_summary) [Ep 12 · 0:56](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=56)
- "Image-guided surgery uses real-time imaging (CT, MRI, ultrasound, or fluoroscopy) to help surgeons navigate during procedures with greater precision, improving accuracy and safety." — Em Gootee (host_summary) [Ep 12 · 1:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=75)
- "Surgeons and interventional radiologists may speak different languages regarding image guidance, with surgeons not knowing what's possible and radiologists not knowing what surgeons need." — John Ricardo (opinion) [Ep 12 · 1:32](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=92)
- "A hybrid operating room integrates advanced imaging technology and traditional surgical setup, eliminating the need to transport patients between radiology and surgical areas, which enhances efficiency, reduces complications, and improves patient outcomes." — Em Gootee (host_summary) [Ep 12 · 1:50](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=110)
- "A hybrid OR is not required for image-guided surgery; collaboration can occur in regular ORs with ultrasound machines or in dual settings where patients go to interventional radiology for localization then to the OR." — Daniel von Allmen (clinical) [Ep 12 · 2:12](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=132)
- "Cone beam CT is a CT scan performed on a C-arm fluoroscopy unit that rotates around the patient collecting multiple images which are stacked together to create a CT." — Amanda Bellingford (clinical) [Ep 12 · 2:44](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=164)
- "Cone beam CT provides excellent visualization of bony structures, making it valuable for maxillofacial, ENT, spine, and orthopedic surgeries." — Em Gootee (host_summary) [Ep 12 · 2:59](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=179)
- "Cone beam CT technology is available at many institutions even if they don't have a hybrid OR space, though people may not realize they have it." — Daniel von Allmen (clinical) [Ep 12 · 3:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=195)
- "Cincinnati Children's hybrid OR has been open for about 7 years with collaborative work between surgeons and interventional radiologists." — John Ricardo (clinical) [Ep 12 · 3:24](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=204)
- "Interventional radiologists at Cincinnati Children's help train pediatric surgery fellows including guidance for vascular access." — Em Gootee (host_summary) [Ep 12 · 3:35](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=215)
- "Having a program manager serve as liaison between surgeons and interventional radiologists is important because nobody will try something new if it's more complicated and takes longer than their normal practice." — Amanda Bellingford (opinion) [Ep 12 · 3:54](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=234)
- "Leadership engagement from both the chief of surgery (Doctor von Alman) and chief of radiology has been crucial support for the collaboration program." — Amanda Bellingford (opinion) [Ep 12 · 4:11](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=251)
- "The hybrid OR at Cincinnati Children's was built so any division can use the room, with collaborative cases being performed with urology, neurosurgery, pulmonary, and gynecology, often doing multiple procedures on patients." — Amanda Bellingford (clinical) [Ep 12 · 4:24](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=264)
- "For supraclavicular lymph nodes that are difficult to palpate, ultrasound-guided localization with a Copan's needle wire allows the surgeon to follow it down and find the lymph node easily, turning what could be a big dissection into a nice and easy one." — John Ricardo (clinical) [Ep 12 · 4:44](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=284)
- "For foreign body localization (such as glass), interventional radiologists can localize it with ultrasound before introduction of air, which makes things virtually invisible." — John Ricardo (clinical) [Ep 12 · 5:15](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=315)
- "During neuroblastoma excisions when dissecting near the aorta, ultrasound can be used every 5 minutes to identify the celiac takeoff and reorient the surgeon." — Daniel von Allmen (clinical) [Ep 12 · 5:40](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=340)
- "Ultrasound can be used at the end of cases to confirm vessel patency, such as looking at flow in kidney transplants, portal flow after Mesorex bypass, or renal flow after challenging neuroblastoma excisions where the renal hilum has been skeletonized." — Daniel von Allmen (clinical) [Ep 12 · 5:52](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=352)
- "Pulmonary nodule localization can be done with wire, coil, or dye depending on institutional preference." — Daniel von Allmen (clinical) [Ep 12 · 6:19](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=379)
- "At one institution (Laurie), pulmonary nodule localization is performed in two locations: first in pre-op CT where interventional radiologists use CT guidance to place a coil next to the nodule, then in the OR using fluoroscopy under two orthogonal planes to ensure accurate nodule identification and removal." — Daniel von Allmen (clinical) [Ep 12 · 6:35](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=395)
- "Using coil localization combined with dye eliminates the risk of wire displacement." — Daniel von Allmen (clinical) [Ep 12 · 6:56](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=416)
- "At Cincinnati Children's, pulmonary nodule localization uses a combination of methylene blue blood patch with cone beam CT performed with the patient in thoracoscopy position, involving one draping and prepping in the hybrid OR, tattooing the visceral pleura with methylene blue blood patch while deploying a Copan's wire." — John Ricardo (clinical) [Ep 12 · 7:03](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=423)
- "Vascular malformations are often managed in multidisciplinary VLC clinics where interventional radiologists offer sclerotherapy and pediatric surgeons offer resection, but sometimes a combination approach is best." — Daniel von Allmen (clinical) [Ep 12 · 7:38](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=458)
- "For vascular malformations not amenable to sclerotherapy alone, interventional radiologists can perform angiography, directly inject contrast, and place glue to ensure complete resection of small outpouchings or legs." — Daniel von Allmen (clinical) [Ep 12 · 7:52](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=472)
- "For transbronchial biopsies, cone beam CT is used to segment out 3D anatomy in about 1 minute, then live fluoroscopy is superimposed over the nodule in AP and lateral views so the pulmonology team always knows where they are performing the biopsy." — John Ricardo (clinical) [Ep 12 · 8:13](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=493)
- "Augmented reality technology uses holographic displays superimposed over patients on the table, taking pre-procedure CT or MRI imaging, segmenting it out, and co-registering it to the patient, with the ability to track instruments." — John Ricardo (clinical) [Ep 12 · 8:41](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=521)
- "In a hydrocephalic sheep model demonstration, MRI imaging was used to create a holographic overlay of anatomy, and by aligning key reference points (fiducials), the hologram matches perfectly with actual anatomy, allowing virtual slicing through the holographic image to view dilated ventricles for precise drain placement." — Em Gootee (host_summary) [Ep 12 · 9:03](https://qa.library.globalcastmd.com/watch/update-course-rewind-highlighting-collaboration-from-surgery-interventional-radiology-in-the-or-2024-10109?t=543)
- "Doctor Margaret Mutch's team has about 10 years of experience with chest wall reconstructions." — Margaret Mutch (clinical) [Ep 13 · 0:16](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=16)
- "Examination revealed an incomplete cord injury with absent lower limb reflexes and altered motor and sensation below the level of T6." — Margaret Mutch (clinical) [Ep 13 · 0:27](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=27)
- "The patient underwent an emergency posterior laminectomy and partial tumor debulking initially for cord decompression between the levels of T3 and T7." — Margaret Mutch (clinical) [Ep 13 · 0:42](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=42)
- "The histopathology report confirmed an aggressive osteosarcoma." — Lizzie Lee (host_summary) [Ep 13 · 0:51](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=51)
- "PET scan showed a PET avid lesion on the right-hand side just next to the sternum." — Margaret Mutch (clinical) [Ep 13 · 1:04](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=64)
- "Radio guided occult lesion localization using technetium 99 was performed, followed by anterior thoracotomy to remove the lesion, which confirmed aggressive osteosarcoma replacing a lymph node." — Margaret Mutch (clinical) [Ep 13 · 1:12](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=72)
- "Most of the reconstruction needs to be tailored to the needs of each individual, location and size of defects, and the particular type of material used." — Margaret Mutch (opinion) [Ep 13 · 1:32](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=92)
- "There is a lack of clear evidence-based guidelines for reconstructive materials, but the priority is long-term durability, aesthetics, function, and accommodating future growth." — Lizzie Lee (host_summary) [Ep 13 · 1:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=105)
- "A lot of the literature on chest wall reconstruction is coming from adults." — Margaret Mutch (epidemiological) [Ep 13 · 1:55](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=115)
- "The spinal surgeons removed all of the vertebral bodies between T4 and T7 and inserted a cage, and the thoracic team resected ribs 4 to 7." — Margaret Mutch (clinical) [Ep 13 · 2:06](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=126)
- "During surgery, a tumor thrombus was found in the azygos, which extended into the SVC." — Margaret Mutch (clinical) [Ep 13 · 2:28](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=148)
- "Doctor Mutch's team tends to use resorbable and biosynthetic materials to do the reconstruction." — Margaret Mutch (clinical) [Ep 13 · 2:44](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=164)
- "In Australia, two systems are used for chest wall reconstruction: one by Stryker and one by KLS, using resorbable plates that are molded in a water bath to reconstruct the rigid part of the chest wall." — Margaret Mutch (clinical) [Ep 13 · 2:51](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=171)
- "Instead of using screws that came packaged with the plates, they used a K-wire drill to drill through the remaining ribs and then used Prolene sutures to secure the implant." — Lizzie Lee (host_summary) [Ep 13 · 3:05](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=185)
- "Following plate placement, Permacol is placed on top of the implant, and subsequently a muscular flap, in this case the latissimus dorsi, is used to cover the Permacol." — Margaret Mutch (clinical) [Ep 13 · 3:14](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=194)
- "Permacol is a surgical implant made of a porcine dermal collagen matrix that allows device placement." — Lizzie Lee (host_summary) [Ep 13 · 3:29](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=209)
- "The delta plates or the sonic weld system are polylactide and polyglycolide and polylactide plates with a strength of 78% at 2 months and 50% at 6 months." — Margaret Mutch (clinical) [Ep 13 · 3:37](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=217)
- "The patient had a relapse 18 months following surgery close to his sternum." — Margaret Mutch (clinical) [Ep 13 · 4:05](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=245)
- "Doctor Mutch performed a further chest wall reconstruction where they excised the entire sternum, costochondral cartilages, and anterior ribs and replaced it with a cement mesh." — Lizzie Lee (host_summary) [Ep 13 · 4:12](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=252)
- "The patient is currently having adjuvant chemotherapy." — Margaret Mutch (clinical) [Ep 13 · 4:22](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=262)
- "In the team's 10-year experience, there was early postoperative wound infection in one patient, which was treated with IV antibiotics." — Margaret Mutch (clinical) [Ep 13 · 4:31](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=271)
- "There were sterile seromas in two patients in the early stages, one at 2 months and one at 8 months, both treated with IR drainage." — Margaret Mutch (clinical) [Ep 13 · 4:36](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=276)
- "There was one case of minor scoliosis on follow-up, which is being followed by the spinal team and so far has not needed intervention." — Lizzie Lee (host_summary) [Ep 13 · 4:45](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=285)
- "Bioengineering of tissue replacement and 3D printing may be the way of the future in chest wall reconstructions." — Lizzie Lee (host_summary) [Ep 13 · 5:17](https://qa.library.globalcastmd.com/watch/update-course-rewind-chest-wall-reconstruction-2024-10839?t=317)

## Changelog
- Sep 9: Summaries and takeaways published for 4 audiences
- Sep 7: Audit reverted — short clips unhidden
- Sep 7: 1 item hidden — never mention Soft Tissue Sarcoma (lymph nodes); unhide from the owner view
- Aug 31: 29 doctors auto-found from episode dossiers
- Aug 30: 20 doctors auto-found from episode dossiers
- Aug 30: 13 doctors auto-found from episode dossiers
- Aug 30: Members-only episodes removed from this collection
- Aug 29: 19 doctors auto-found from episode dossiers
- Aug 29: 19 doctors auto-found from episode dossiers
- Aug 29: Collection generated from campaign corpus: 16 items, 8 dossiers, summaries for 4 audience(s)
- Aug 29: Collection reviewed and published
- Aug 29: Collection generated from campaign corpus: 10 items, 8 dossiers, summaries for 1 audience(s)
- Aug 29: Collection generated from campaign corpus: 10 items, 8 dossiers, summaries for 3 audience(s)

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Educational content from recorded physician discussions — not medical advice. Cite the canonical URL or the ?t= deep link. Policy: https://qa.library.globalcastmd.com/ai