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Neuroblastoma staging

Staging of neuroblastoma as described by International Neuroblastoma Staging System (INSS) is for post-operative patients and mainly for prognosis. This is as follows 1

  • stage 1
    • localised tumour with complete gross excision with or without microscopic residual disease
    • contralateral and representative ipsilateral regional lymph nodes negative for disease (nodes attached to and removed with primary tumour may be positive)
  • stage 2a
    • localised tumour with incomplete gross excision
    • ipsilateral and contralateral nodes negative for tumour
  • stage 2b
    • localised tumour with complete or incomplete resection
    • positive ipsilateral (non-adherent) nodes
    • contralateral nodes negative for tumour
  • stage 3
    • unresectable lateral tumour that crosses the midline or
    • localized tumour with contralateral regional lymph node involvement
    •  midline tumour with bilateral extension by infiltration or by lymph node involvement
  • stage 4S
    • <1 year of age
    • localised tumour (stage 1, 2A or 2B)
    • distant metastases confined to skin, liver and/or bone marrow
  • stage 4
    • distant metastases not fulfilling stage 4S

In the majority of cases (60-80%), patients present with stage 3 or 4 tumours 2.

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