title: Evaluation of diagnostic performance of CT for detection of tumor thrombus in children with Wilms tumor: a report from the Children's Oncology Group.
abstract: BACKGROUND
  Pre-operative assessment of intravascular extension of Wilms tumor is essential to guide management. Our aim is to evaluate the diagnostic performance of multidetector CT in detection of tumor thrombus in Wilms tumor.
  
  
  METHODS
  The study population was drawn from the first 1,015 cases in the AREN03B2 study of the Children's Oncology Group. CT scans of children with (n = 62) and without (n = 111) tumor thrombus at nephrectomy were independently reviewed by two radiologists, blinded to patient information. Doppler sonography results were obtained from institutional radiology reports, as Doppler requires real-time evaluation. The diagnostic performance of CT and Doppler for detection of tumor thrombus was determined using nephrectomy findings as reference standard.
  
  
  RESULTS
  In the primary nephrectomy group, tumor thrombus detection sensitivity, specificity of CT was 65.6, 84.8%, and Doppler was 45.8, 95.7%, respectively. In this group, sensitivity of CT, Doppler for detection of cavoatrial thrombus was 84.6 and 70.0%, respectively. In the secondary nephrectomy group, tumor thrombus detection sensitivity, specificity of CT was 86.7, 90.6%, and Doppler was 66.7, 100.0%, respectively. In this group, sensitivity of CT, Doppler for detection of cavoatrial thrombus was 96.0 and 68.8%, respectively. Pre-operative Doppler evaluation performed in 108/173 cases, detected 3 cases with intravenous extension (2 in renal vein, 1 in IVC at renal vein level) that were missed at CT.
  
  
  CONCLUSIONS
  CT can accurately identify cavoatrial tumor thrombus that will impact surgical approach. Routine Doppler evaluation, after CT has already been performed, is not required in Wilms tumor.
authors.affiliation: Mallinckrodt Institute of Radiology, St. Louis, Missouri 63110, USA. khannag@mir.wustl.edu
authors.forename: Geetika
authors.initials: G
authors.lastname: Khanna
authors.forename: Nancy
authors.initials: N
authors.lastname: Rosen
authors.forename: James R
authors.initials: JR
authors.lastname: Anderson
authors.forename: Peter F
authors.initials: PF
authors.lastname: Ehrlich
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Dome
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Gow
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Perlman
authors.forename: Douglas
authors.initials: D
authors.lastname: Barnhart
authors.forename: Kathryn
authors.initials: K
authors.lastname: Karolczuk
authors.forename: Paul
authors.initials: P
authors.lastname: Grundy
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods*; D009392:Nephrectomy; D012082:Renal Veins / Q000000981:diagnostic imaging / Q000601:surgery; D012680:Sensitivity and Specificity; D013927:Thrombosis; D018615:Ultrasonography, Doppler, Color; D009396:Wilms Tumor / Q000000981:diagnostic imaging* / Q000601:surgery