Prenatal Detection of Neuroblastoma: A Ten-Year Experience From the Dana-Farber Cancer Institute and Children's Hospital
1 From the Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston Massachusetts
2 From the Department of Radiology, Children's Hospital, Boston Massachusetts
3 From the Department of Pathology, Children's Hospital, Boston Massachusetts
4 From the Department of Surgery, Children's Hospital, Boston Massachusetts
Objectives. To assess the relative frequency of, the clinical and pathological correlates in, and the prognosis of the subset of infants with neuroblastoma who were identified initially by prenatal ultrasonography.
Design. Retrospective review of all patients with neuroblastoma evaluated between 1982 and 1992.
Setting. Large, urban, tertiary care children's hospital in Boston, Massachusetts.
Patients. Eleven infants with neuroblastoma initially detected with prenatal sonograms were identified.
Results. Nine patients had adrenal tumors; two had thoracic paraspinal tumors. Typical diagnostic evidence for neuroblastoma including a palpable abdominal mass and elevations in urinary catecholamines were not commonly seen postnatally. These patients had multiple favorable prognostic indicators including low stage of disease (10/11), favorable biological markers including cellular DNA content (5/5) and N-myc oncogene copy number (5/5), and histopathology suggestive for neuroblastoma in situ (7/11). All patients were treated by surgical resection. One patient exhibited progression of disease postoperatively, but demonstrated a complete clinical response to multiagent chemotherapy. Overall survival in our population was excellent with no deaths seen at a mean follow-up of 37 months (range 3 to 120 months).
Conclusions. Patients with neuroblastoma identified by prenatal ultrasonography generally, although not exclusively, follow a clinically favorable course in which surgical resection is curative. Chemotherapy is not indicated unless substantial progression of disease occurs.
Key Words: neuroblastoma • prenatal diagnosis • ultrasonography • infant • malignancy
Submitted on February 8, 1993
Accepted on March 26, 1993
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