Neuroblastoma (image-defined risk factors)

Last revised by Francis Fortin on 3 Mar 2020

Image-defined risk factors are imaging features seen at the time of neuroblastoma diagnosis that confer a poorer prognosis. The International Neuroblastoma Risk Group (INRG) suggested an update (2009) to the neuroblastoma staging with a list of features that, if present, upstages a patient with local disease from L1 to L2.

  • from one compartment to another (e,g. chest to neck, abdomen to chest, abdomen to pelvis)
  • through sciatic notch/foramen
Encasing vessels
  • carotid artery
  • vertebral artery
  • internal jugular vein
  • subclavian artery/vein
  • aorta
  • superior or inferior vena cava
  • celiac artery
  • superior mesenteric artery (including branches at the mesenteric root)
  • iliac artery or vein
  • trachea
  • primary bronchi
Encasing nerves
  • brachial plexus roots
Invading and infiltrating
  • to skull base
  • into spinal canal - defined as;
    • >1/3 of canal involved on an axial section
    • perimedullary leptomeningeal space not visible
    • signal change in the adjacent spinal cord
  • costovertebral junction from T9-T12
  • porta hepatis,  hepatoduodenal ligament or liver
  • renal pedicle or kidney
  • pericardium
  • duodenopancreatic block
  • mesentery

Practical points

  • encasement: in contact with >50% (artery or vein) or completely occluding a vein (n.b. <50% is "contact"; incomplete occlusion of a vein is "flattening")
  • compression: any cross-sectional narrowing of an airway
  • synchronous and metachronous tumors should be staged separately

See also

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