Do the Radiological Criteria With the Use of Risk Factors Impact the Forecasting of Abdominal Neuroblastic Tumor Resection in Children?

Abstract

Background: The treatment of neuroblastoma is dependent on exquisite staging; is performed postoperatively and is dependent on the surgeon’s expertise. The use of risk factors through imaging on diagnosis appears as predictive of resectability, complications and homogeneity in staging. Aim: To evaluate the traditional resectability criteria with the risk factors for resectability, through the radiological images, in two moments: on diagnosis and in pre-surgical phase. Were analyzed the resectability, surgical complications and relapse rate. Methods: Retrospective study of 27 children with abdominal and pelvic neuroblastoma stage 3 and 4, with tomography and/or resonance on the diagnosis and pre-surgical, identifying the presence of risk factors. Results: The mean age of the children was 2.5 years at diagnosis, where 55.6% were older than 18 months, 51.9% were girls and 66.7% were in stage 4. There was concordance on resectability of the tumor by both methods (INSS and IDRFs) at both moments of the evaluation, at diagnosis (p=0.007) and post-chemotherapy (p=0.019); In this way, all resectable patients by IDRFs in the post-chemotherapy had complete resection, and the unresectable ones, 87.5% incomplete. There was remission in 77.8%, 18.5% relapsed and 33.3% died. Conclusions: Resectability was similar in both methods at both pre-surgical and preoperative chemotherapy; preoperative chemotherapy increased resectability and decreased number of risk factors, where the presence of at least one IDRF was associated with incomplete resections and surgical complications; relapses were irrelevant.

Gadolinium‐based contrast media does not improve the staging of neuroblastoma image‐defined risk factors at diagnosis

“…26 Of the studies included in the meta-analysis, five reported a single radiologist-interpreted images to determine the absence or presence of IDRFs, five reported using consensus reviews by a radiologist(s), surgeon(s), and oncologist(s), and the remainder did not describe how the presence of IDRFs was determined, providing no data on interobserver agreement. 4,9,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] We found that regarding the presence or absence of IDRFs, a defining feature of L1 versus L2 disease, there was substantial variability in the frequency of reported IDRFs among radiologists for 50 patients (21-38 detected IDRFs on non-contrast examinations and 24-37 with contrast). Overall interobserver agreement on the binary presence or absence of IDRFs kappa = .5 [95% CI: .39-.61] without contrast and kappa = .63 [95% CI: .52-.75] with contrast.…”

“…A 2020 meta‐analysis concluded that IDRF‐positive patients have a significantly higher risk of incomplete resection (2.45 risk ratio), surgical complications (2.3 risk ratio), and worse event‐free survival (2.08 hazard ratio) and overall survival (2.44 hazard risk ratio) compared to IDRF‐negative patients 26 . Of the studies included in the meta‐analysis, five reported a single radiologist‐interpreted images to determine the absence or presence of IDRFs, five reported using consensus reviews by a radiologist(s), surgeon(s), and oncologist(s), and the remainder did not describe how the presence of IDRFs was determined, providing no data on interobserver agreement 4,9,27–41 . We found that regarding the presence or absence of IDRFs, a defining feature of L1 versus L2 disease, there was substantial variability in the frequency of reported IDRFs among radiologists for 50 patients (21–38 detected IDRFs on non‐contrast examinations and 24–37 with contrast).…”

Association of Image-Defined Risk Factors with Clinical, Biological Features and Outcome in Neuroblastoma

“…The association of positive IDRFs at the time of initial diagnosis with poor outcome is a subject of controversy, with many authors suggesting that the IDRF status could change after chemotherapy, and as such, a new evaluation should be performed right before surgery, as it may have a different prognosis [ 19 , 20 , 21 , 22 ].…”