{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T11:16:39Z","timestamp":1788261399360,"version":"build-2803163510"},"reference-count":39,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004622","name":"Dutch Cancer Society","doi-asserted-by":"publisher","award":["16145"],"award-info":[{"award-number":["16145"]}],"id":[{"id":"10.13039\/501100004622","id-type":"DOI","asserted-by":"publisher"}]},{"award":["16145"],"award-info":[{"award-number":["16145"]}],"id":[{"id":"https:\/\/ror.org\/0368jnd28","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Localization of non-palpable, non-visible, and difficult location tumors in children can be surgically complex. Incomplete resections upstage the tumor, leading to a significant reduction in survival and the intensification of adjuvant treatment, affecting quality of life. Surgical navigation set-ups showed promising results in adults but have not yet been validated in complex pediatric oncology surgery. In this study, an in-house developed electromagnetic surgical navigation set-up was evaluated in a pre-clinical cadaver study. Methods: Pediatric oncology surgeons (n = 8) performed navigated tumor resection in eight simulated surgeries. Embalmed piglets with tumors simulated through insertion underwent preoperative CT imaging for 3D modeling. Navigation was initialized with an ultrasound-based registration procedure. During the procedures, the surgeons had to localize and remove the simulated tumors using the navigation set-up, and the ease of use was evaluated by the system usability score (SUS). The registration and localization accuracies were calculated with the surface and target registration errors, respectively. Results: The registration was successful in 7\/8 experiments. The median surface and target registration errors were &lt;2 mm and &lt;3 mm, respectively. The surgeons scored above average acceptance of the navigation set-up with a median SUS of 72 (IQR: 62\u201380). Conclusions: The navigation set-up was successful overall, with surgeons being satisfied concerning the usability and accuracy of the technique. This study supports progression toward clinical evaluation.<\/jats:p>","DOI":"10.3390\/cancers18172831","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T10:32:18Z","timestamp":1788258738000},"page":"2831","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Electromagnetic Surgical Navigation for Accurate Pediatric Tumor Localization: A Preclinical Animal Cadaver Study"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9144-8852","authenticated-orcid":false,"given":"Jasper M. van der","family":"Zee","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery, Princess M\u00e1xima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7362-8515","authenticated-orcid":false,"given":"Marijn A. J.","family":"Hiep","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vera J.","family":"van Boheemen","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Princess M\u00e1xima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands"},{"name":"Technical Medicine, University of Twente, 7522 NB Enschede, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guus M. J.","family":"B\u00f6kkerink","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Princess M\u00e1xima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wout J.","family":"Heerink","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0515-7691","authenticated-orcid":false,"given":"Matthijs","family":"Fitski","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Princess M\u00e1xima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9156-7656","authenticated-orcid":false,"given":"Michiel A. J.","family":"van de Sande","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Princess M\u00e1xima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands"},{"name":"Department of Orthopedics, Leiden University Medical Center, 2333 ZG Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefanie","family":"Veraa","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Division of Diagnostic Imaging, Faculty of Veterinary Medicine, Utrecht University, 3584 CL Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc H. W. A.","family":"Wijnen","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Princess M\u00e1xima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3587-566X","authenticated-orcid":false,"given":"Harald C.","family":"Groen","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0168-7513","authenticated-orcid":false,"given":"Alida F. W. van der","family":"Steeg","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Princess M\u00e1xima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/S1470-2045(19)30672-2","article-title":"A Risk-Based Treatment Strategy for Non-Rhabdomyosarcoma Soft-Tissue Sarcomas in Patients Younger than 30 Years (ARST0332): A Children\u2019s Oncology Group Prospective Study","volume":"21","author":"Spunt","year":"2020","journal-title":"Lancet Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"11719","DOI":"10.1002\/cam4.5671","article-title":"The Significance of Margins in Pediatric Non-Rhabdomyosarcoma Soft Tissue Sarcomas: Consensus on Surgical Margin Definition Harmonization from the INternational Soft Tissue SaRcoma ConsorTium (INSTRuCT)","volume":"12","author":"Ferrari","year":"2023","journal-title":"Cancer Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3229","DOI":"10.1200\/JCO.21.00278","article-title":"Revised Neuroblastoma Risk Classification System: A Report From the Children\u2019s Oncology Group","volume":"39","author":"Irwin","year":"2021","journal-title":"J. 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