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    Neuroblastoma Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage Information for Neuroblastoma


    Other staging tests and procedures

    Other tests and procedures used to stage neuroblastoma include the following:

    • Bone marrow aspiration and biopsy: Bone marrow is assessed by bilateral iliac crest marrow aspirates and trephine (core) bone marrow biopsies to exclude bone marrow involvement. To be considered adequate, core biopsy specimens must contain at least 1 cm of marrow, excluding cartilage. Bone marrow sampling may not be necessary for tumors that are otherwise stage 1.[10]
    • Lumbar puncture: Lumbar puncture is avoided because central nervous system (CNS) metastasis at diagnosis is rare,[11] and lumbar puncture may be associated with an increased incidence of subsequent development of CNS metastasis.[12]
    • Lymph node assessment: Palpable lymph nodes are clinically examined and histologically confirmed if indicated for staging.[1]
    • CT and magnetic resonance imaging (MRI) scan:
      • Three-dimensional (3-D) imaging of the primary tumor and potential lymph node drainage sites is done using CT scans and/or MRI scans of the chest, abdomen, and pelvis. Ultrasound is generally considered suboptimal for accurate 3-D measurements.
      • Paraspinal tumors may extend through neural foramina to compress the spinal cord. Therefore, MRI of the spine adjacent to any paraspinal tumor is part of the staging evaluation.
      • A brain/orbit CT and/or MRI is performed if clinically indicated by examination and/or uptake on mIBG scan.

    International Neuroblastoma Staging Systems

    International Neuroblastoma Staging System (INSS)

    The INSS combines certain features from each of the previously used Evans and Pediatric Oncology Group (POG) staging systems [1,13] and is described in Table 3. This represented the first step in harmonizing disease staging and risk stratification worldwide. The INSS is a postoperative staging system that was developed in 1988 and used the extent of surgical resection to stage patients. This led to some variability in stage assignments in different countries because of regional differences in surgical strategy and, potentially, because of limitations in access to experienced pediatric surgeons. As a result of further advances in the understanding of neuroblastoma biology and genetics, a risk classification system was developed that incorporates clinical and biological factors in addition to INSS stage to facilitate risk group and treatment assignment for COG studies.[1,13,14,15]

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