Problems in the imaging of three common paediatric solid tumours

The value of surgery in directing therapy for patients with Wilms' tumor with pulmonary disease. A report from the National Wilms' Tumor Study Group (National Wilms' Tumor Study 5)

“…The introduction of CT scanning changed the practice of many centers. In children, CT scans are sensitive and can identify smaller lesions than are visible on a standard chest radiograph, but these findings are not specific for malignant lesions [8,9,11,[14][15][16]. Furthermore, it was not established whether children with smaller lesions identified only on CT scan required the intensified therapy given to children with larger lesions seen on a chest radiograph.…”

“…The second has been to treat the child as if he/she were stage IV by chest radiograph [6][7][8][9][10]15]. The theoretical justification supporting the first approach is based on the supposition that patients with small volume pulmonary metastases have a smaller tumor burden and require less intensive therapy [11]. The alternative belief is that there is a continuum of pulmonary disease with bmicro-, mini-, and macrometastases,Q with imaging demonstrating only the larger lesions [11].…”

“…The theoretical justification supporting the first approach is based on the supposition that patients with small volume pulmonary metastases have a smaller tumor burden and require less intensive therapy [11]. The alternative belief is that there is a continuum of pulmonary disease with bmicro-, mini-, and macrometastases,Q with imaging demonstrating only the larger lesions [11]. The National Wilms' Tumor Study, the United Kingdom Wilms' Tumor Study WT9101, and the International Society of Paediatric Oncology Wilms' Tumor Group's most recent protocols all suggest that positive findings for pulmonary nodules on computed tomography (CT) but not shown on chest radiograph do not require pulmonary radiotherapy or DOX for adequate treatment [6,7,15].…”

“…The differential diagnosis of a pulmonary lesion seen in a child with WT is broad [8,11]. In addition to malignancy, it includes atelectasis, fibrosis, pneumonitis, subpleural lymph nodes, broundQ pneumonia, and other infectious or inflammatory lesions.…”

“…Pulmonary metastasis in children with WT has historically been identified on chest radiography [6,7]. Computed tomography (CT) of the chest frequently identifies lesions not visible on chest radiograph because of increased sensitivity [8][9][10][11]. The appropriate treatment of lesions identified only on CT is controversial.…”