title: Guidelines for imaging and staging of neuroblastic tumors: consensus report from the International Neuroblastoma Risk Group Project.
abstract: Neuroblastoma is an enigmatic disease entity; some tumors disappear spontaneously without any therapy, while others progress with a fatal outcome despite the implementation of maximal modern therapy. However, strong prognostic factors can accurately predict whether children have "good" or "bad" disease at diagnosis, and the clinical stage is currently the most significant and clinically relevant prognostic factor. Therefore, for an individual patient, proper staging is of paramount importance for risk assessment and selection of optimal treatment. In 2009, the International Neuroblastoma Risk Group (INRG) Project proposed a new staging system designed for tumor staging before any treatment, including surgery. Compared with the focus of the International Neuroblastoma Staging System, which is currently the most used, the focus has now shifted from surgicopathologic findings to imaging findings. The new INRG Staging System includes two stages of localized disease, which are dependent on whether image-defined risk factors (IDRFs) are or are not present. IDRFs are features detected with imaging at the time of diagnosis. The present consensus report was written by the INRG Imaging Committee to optimize imaging and staging and reduce interobserver variability. The rationales for using imaging methods (ultrasonography, magnetic resonance imaging, computed tomography, and scintigraphy), as well as technical guidelines, are described. Definitions of the terms recommended for assessing IDRFs are provided with examples. It is anticipated that the use of standardized nomenclature will contribute substantially to more uniform staging and thereby facilitate comparisons of clinical trials conducted in different parts of the world.
authors.affiliation: Imaging Department, Institut Curie, Paris, France.
authors.forename: Hervé J
authors.initials: HJ
authors.lastname: Brisse
authors.forename: M Beth
authors.initials: MB
authors.lastname: McCarville
authors.forename: Claudio
authors.initials: C
authors.lastname: Granata
authors.forename: K Barbara
authors.initials: KB
authors.lastname: Krug
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Wootton-Gorges
authors.forename: Kimio
authors.initials: K
authors.lastname: Kanegawa
authors.forename: Francesco
authors.initials: F
authors.lastname: Giammarile
authors.forename: Matthias
authors.initials: M
authors.lastname: Schmidt
authors.forename: Barry L
authors.initials: BL
authors.lastname: Shulkin
authors.forename: Katherine K
authors.initials: KK
authors.lastname: Matthay
authors.forename: Valerie J
authors.initials: VJ
authors.lastname: Lewington
authors.forename: Sabine
authors.initials: S
authors.lastname: Sarnacki
authors.forename: Barbara
authors.initials: B
authors.lastname: Hero
authors.forename: Michio
authors.initials: M
authors.lastname: Kaneko
authors.forename: Wendy B
authors.initials: WB
authors.lastname: London
authors.forename: Andrew D J
authors.initials: AD
authors.lastname: Pearson
authors.forename: Susan L
authors.initials: SL
authors.lastname: Cohn
authors.forename: Tom
authors.initials: T
authors.lastname: Monclair
mesh_terms: D016543:Central Nervous System Neoplasms / Q000175:diagnosis*; D002648:Child; D003952:Diagnostic Imaging; D006801:Humans; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009447:Neuroblastoma / Q000175:diagnosis*; D012307:Risk Factors