WILMS-TUMOR - A RATIONAL USE OF PREOPERATIVE IMAGING

Objective-To determine whether a preoperative imaging protocol relying predominantly on a chest X-ray film (CXR) and ultrasound in patients with Wilms' tumor is adequate for patient management and to determine the frequency more sophisticated imaging, in particular, computed tomo graphy (CT), is required. Design and setting-Historical cohort study a t a tertiary pediatric hospital. Subjects-60 consecutive patients with Wilms' tumor treated at our institution between 1980 and 1990. Main o utcome measure-The preoperative imaging was recorded and 2- and 4-year survival were compared with the National Wilms' Tumor Study. Results- 100% of patients had a pre-operative CXR, 95% abdominal ultrasound, 5% abdominal CT, 13% chest CT, 47% abdominal X-ray, 2% aortography, 5% c avography, and 35% intravenous urography. The overall 2- and 4-year su rvivals of 92% and 90%, respectively, did not statistically differ fro m the National Wilms' Tumor Study 2- and 4-year survivals of 94% and 9 1%. Conclusions-A preoperative imaging protocol relying predominantly on a CXR and abdominal ultrasound does not reduce survival. Other more sophisticated imaging, in particular, CT, is not required in the majo rity of cases and is warranted only when a CXR or ultrasound is unable to resolve relevant management problems. (C) 1995 Wiley-Liss, Inc.