title: Can computerized tomography accurately stage childhood renal tumors?
abstract: OBJECTIVE
  Staging of childhood renal tumors is crucial for treatment planning and outcome prediction. We sought to identify whether computerized tomography could accurately predict the local stage of childhood renal tumors.
  
  
  METHODS
  We retrospectively reviewed our database for patients diagnosed with childhood renal tumors and treated surgically between 1990 and 2013. Inability to retrieve preoperative computerized tomography, intraoperative tumor spillage and nonWilms childhood renal tumors were exclusion criteria. Local computerized tomography stage was assigned by a single experienced pediatric radiologist blinded to the pathological stage, using a consensus similar to the Children's Oncology Group Wilms tumor staging system. Tumors were stratified into up-front surgery and preoperative chemotherapy groups. The radiological stage of each tumor was compared to the pathological stage.
  
  
  RESULTS
  A total of 189 tumors in 179 patients met inclusion criteria. Computerized tomography staging matched pathological staging in 68% of up-front surgery (70 of 103), 31.8% of pre-chemotherapy (21 of 66) and 48.8% of post-chemotherapy scans (42 of 86). Computerized tomography over staged 21.4%, 65.2% and 46.5% of tumors in the up-front surgery, pre-chemotherapy and post-chemotherapy scans, respectively, and under staged 10.7%, 3% and 4.7%. Computerized tomography staging was more accurate in tumors managed by up-front surgery (p <0.001) and those without extracapsular extension (p <0.001).
  
  
  CONCLUSIONS
  The validity of computerized tomography staging of childhood renal tumors remains doubtful. This staging is more accurate for tumors treated with up-front surgery and those without extracapsular extension. Preoperative computerized tomography can help to exclude capsular breach. Treatment strategy should be based on surgical and pathological staging to avoid the hazards of inaccurate staging.
authors: Department of Urology and Department of Radiology (MEA), Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. Electronic address: a_halim_2010@yahoo.com.
authors: Ahmed
authors: A
authors: Abdelhalim
authors: Department of Urology and Department of Radiology (MEA), Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors: Tamer E
authors: TE
authors: Helmy
authors: Department of Urology and Department of Radiology (MEA), Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors: Ahmed M
authors: AM
authors: Harraz
authors: Department of Urology and Department of Radiology (MEA), Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors: Mohamed E
authors: ME
authors: Abou-El-Ghar
authors: Department of Urology and Department of Radiology (MEA), Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors: Mohamed E
authors: ME
authors: Dawaba
authors: Department of Urology and Department of Radiology (MEA), Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors: Ashraf T
authors: AT
authors: Hafez
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D009367:Neoplasm Staging / Q000379:methods; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: Wilms tumor; kidney neoplasms; neoplasm staging; tomography; x-ray computed