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

UMMS Affiliation

Department of Radiation Oncology

Date

4-2012

Document Type

Article

Medical Subject Headings

Adult; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Kidney Neoplasms; Male; Multidetector Computed Tomography; Nephrectomy; Renal Veins; Sensitivity and Specificity; Thrombosis; Ultrasonography, Doppler, Color; Wilms Tumor

Disciplines

Neoplasms | Oncology | Radiology

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.

PROCEDURE: 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.

Rights and Permissions

Citation: Khanna G, Rosen N, Anderson JR, Ehrlich PF, Dome JS, Gow KW, Perlman E, Barnhart D, Karolczuk K, Grundy P. Evaluation of diagnostic performance of CT for detection of tumor thrombus in children with Wilms tumor: a report from the Children's Oncology Group. Pediatr Blood Cancer. 2012 Apr;58(4):551-5. doi: 10.1002/pbc.23222. Epub 2011 Jun 14. PubMed PMID: 21674767; PubMed Central PMCID: PMC3175263. Link to article on publisher's site

Comments

This study was supported in part by Grant CA-29511 from the National Cancer Institute for the IROC Rhode Island (QARC), a quality assurance vehicle and data management service for diagnostic imaging and radiation oncology for the National Cancer Institute Clinical Trials Program. QARC is a research program within the University of Massachusetts Medical School led by Dr. Thomas (TJ) FitzGerald of the Department of Radiation Oncology.

Related Resources

Link to Article in PubMed