PROBLEMS OF NEUROBLASTOMA SCREENING FOR 6-MONTH-OLDS AND RESULTS OF 2ND SCREENING FOR 18-MONTH-OLDS

Nationwide neuroblastoma mass screening for 8-month-old infants (first screening) was introduced in Japan in 1985. About 110 neuroblastoma c ases are detected annually by the first screening and treated, with a survival rate of 97%. Sensitivity of the first screening (positive cas es/positive cases + false negative cases) is about 75%, and the progno sis of false-negative cases is unfavorable. A second screening at 18 m onths of age was started to rescue false negative cases in Miyagi Pref ecture in May 1992. Of 62 neuroblastoma cases treated in our hospital since 1985, 40 cases had received the first screening. Twenty cases we re positive at first screening, 18 cases were false negative, and 2 ca ses were false negative and picked up by the second screening. Age dis tribution of false-negative cases ranged from 12 to 83 months and incl uded 12 cases younger than 36 months old. Only 5 of 18 false-negative cases are alive without the disease, From May 1992 to November 1993, 1 4,282 infants had received the second screening (compliance rate: abou t 75%), and 2 neuroblastoma cases were detected. The first case was st age III with paraortic lymph node metastases, Shimada UH, aneuploidy a nd negative N-myc amplification. The second case was stage II with Shi mada FH, aneuploidy, and negative N-myc amplification. Both cases are alive now without the disease after undergoing radical operation and c hemotherapy. The first screening is effective for early detection of n euroblastoma cases, but the sensitivity is insufficient; the authors r ecommend a second screening to rescue false-negative cases.