Abstract
The main strategy in the treatment of nephroblastoma, as described in protocol SIOP 9/GPO, is preoperative chemotherapy for patients between 6 months and 16 years of age. Before treatment the diagnosis is made only by diagnostic imaging without biopsy. From July 1988 to February 1991, 130 children with the tentative diagnosis of nephroblastoma were treated preoperatively. The initial diagnostic images (excretory urography, ultrasound, CT, MRI) have been analysed both prospectively and retrosperatively and the findings correlated with the intraoperative and histological results. Of the preoperatively treated patients 93.8% had a Wilms' tumour or one of its variants. Five patients had a different malignant tumour and 3 patients, i.e. 2.3% of those preoperatively treated or 1.6% of all registered patients, had benign tumours of the kidney. Wilms' tumour generally presented as a well-defined mass with an inhomogeneous morphology on CT. On ultrasound only 24% of the tumours were homogeneous. Intratumoral haemorrhage and cystic areas occurred frequently; calcifications were rare (8%). With regard to caval involvement only ultrasound and MRI enabled the correct diagnosis, while CT could not differentiate compressions from invasion. The pretherapeutic diagnostic imaging was of sufficient accuracy to start preoperative chemotherapy without diagnostic biopsy.
Similar content being viewed by others
References
Haaf HG, Kaatsch P, Michaelis J (1990) Jahresbericht 1989 des Kinderkrebsregisters Mainz. University of Mainz
Schmidt D (1989) Nephroblastome (Wilms-tumoren) und Nephroblastom — Sondervarianten. Fischer, Stuttgart
D'Angio GJ, Breslow N, Beckwith JB, Evans A, Baum B, de Loimier A., Fernbach D, Hrabrovsky E, Jones B, Kelalis, P, Biemann H, Othersen M, Tefft P, Thomas RM (1989) The treatment of Wilms' tumor: results of the Third National Wilms' Tumor Study. Cancer 64: 349–360
Tournade MF (1988) Wilms tumor trial and study. SIOP no. 6, committee report. Paris
Gutjahr P, Kaatsch P, Spaar HJ, Niethammer D, Göbel U, Henze G, Ludwig R, Kühl J, Erttmann R, Harms D, Hohenfellner R (1990) Klinik, Therapie und Prognose bei 373 Kindern mit Wilmstumoren: Ergebnisse der bundesweiten Studie 1980–1988. Aktuel Urol 21: 132–141
Evans EA, Norkool P, Evans I, Breslow N, D'Angio J (1991) Late effects of treatment for Wilms' tumor: a report from the National Wilms' Tumor Study Group. Cancer 15: 331–336
Pfeil J, Niethard FV, Oppermann HC, Scheibel P, Willich E (1986) Strahlenschäden der Wirbelsäule nach Radiatio wegen eines Wilms-Tumors im Kleinkindesalter: Verlaufsuntersuchungen bei 82 Kindern. Orthopäd Praxis 22: 863–870
Bielack S, Erttmann R, Winkler K, Landbeck G (1989) Doxorubicin: effect of different schedules on toxicity and anti-tumor efficacy. Eur J Cancer Clin Oncol 25: 873–882
Ludwig R (1989) Studienprotokoll “Nephroblastomstudie” der International Society of Pediatric Oncology/Gesellschaft für Pädiatrische Onkologie. SIOP no. 9. GPO, Heidelberg
White KS, Grossmann H (1991) Wilms' and associated renal tumors in childhood. Pediatr Radiol 21: 81–88
Reimann TAH, Siegel MJ, Shackelford GD (1986) Wilms' tumor in children: abdominal CT and US evaluation. Radiology 160: 501–505
Madewell JE, Goldmann SM, Davis CJ, Hartmann DS, Feigin DS, Lichtenstein JE (1983) Multilocular cystic nephroma: a radiographic-pathologic correlation of 58 patients. Radiology 146: 309–321
Billiet I, Van Poppel H, Baert L (1988) Actual approach to cystic nephroma. Eur J Urol 14: 280–286
Joshi VV, Beckwith JB (1989) Multilocular cyst of the kidney (cystic nephroma) and cystic partially differentiated nephroblastoma: terminology and criteria for diagnosis. Cancer 64: 466–479
Christiansen LV, Langfeldt S (1991) Multilokuläres zystisches Nephrom. Radiologe 31: 66–67
Alterman K (1989) Extrarenal nephroblastoma. J Cancer Res Clin Oncol 115: 409–417
Broecker BH, Caldamone AA, McWilliams N, Maurer H, Salzberg A (1989) Primary extrarenal Wilms' tumor in children. J Ped Surg 24: 1283–1288
Mancini AF, Paolucci G (1989) Renal cell carcinoma in childhood. Med Pediatr Oncol 17: 53–57
Leuschner I, Harms D, Schmidt D (1991) Renal cell carcinoma in children: histology, immunohistochemistry and follow-up of 10 cases. Med Pediatr Oncol 19: 33–41
Ritchey ML, Kelalis PP, Breslow NE, Offord KP, Shochat SJ, D'Angio GJ (1988) Intracaval and atrial involvement with nephroblastoma: review of National Wilms' Tumor Study 3. J Urol 140: 1113–1118
Weese DL, Applebaum H, Taber P (1991) Mapping of intravascular extension of Wilms' tumor with magnetic resonance imaging. J Pediatr Surg 26: 64–67
Di Stefano, Helenon O, Cornud F, Chiche JF, Chretien Y, Trifard F, Dufour B, Michel JR, Moreau JF (1990) Cancers du rein: bilan d'extension veineuse en imagerie par resonance magnetique. Ann Urol (Paris) 24: 122–126
Horan JJ, Robertson CN, Choyke PL, Frank JA, Miller DL, Pass HI, Linehan WM (1989) The detection of renal carcinoma extension into the renal vein and inferior vena cava: a prospective comparison of venacavography and magnetic resonance imaging. J Urol 142: 943–948
Glazer GM, Callen PW, Parker JJ (1981) CT diagnosis of tumor thrombus in the inferior vena cava: avoiding the false-positive diagnosis. AJR 173: 1265–1267
Slovis DL, Philippart AI, Cushing B, Das L, Perlmutter AD, Reed JO, Wilner HI, Kroovand RL, Farooki ZQ (1981) Evaluation of the inferior vena cava by sonography and venography in children with renal and hepatic tumors. Radiology 140: 767–772
Author information
Authors and Affiliations
Additional information
Correspondence to: K. Rieden
Rights and permissions
About this article
Cite this article
Rieden, K., Weirich, A., Tröger, J. et al. Accuracy of diagnostic imaging in nephroblastoma before preoperative chemotherapy. Eur. Radiol. 3, 115–122 (1993). https://doi.org/10.1007/BF00169783
Issue Date:
DOI: https://doi.org/10.1007/BF00169783