PRENATAL DETECTION OF NEUROBLASTOMA - A 10-YEAR EXPERIENCE FROM THE ANA-FARBER-CANCER-INSTITUTE-AND-CHILDRENS-HOSPITAL

Objectives. To assess the relative frequency of, the clinical and path ological correlates in, and the prognosis of the subset of infants wit h neuroblastoma who were identified initially by prenatal ultrasonogra phy. Design. Retrospective review of all patients with neuroblastoma e valuated between 1982 and 1992. Setting. Large, urban, tertiary care c hildren's hospital in Boston, Massachusetts. Patients. Eleven infants with neuroblastoma initially detected with prenatal sonograms were ide ntified. Results. Nine patients had adrenal tumors; two had thoracic p araspinal tumors. Typical diagnostic evidence for neuroblastoma includ ing a palpable abdominal mass and elevations in urinary catecholamines were not commonly seen postnatally. These patients had multiple favor able prognostic indicators including low stage of disease (10/11), fav orable biological markers including cellular DNA content (5/5) and N-m yc oncogene copy number (5/5), and histopathology suggestive for neuro blastoma in situ (7/11). All patients were treated by surgical resecti on. One patient exhibited progression of disease postoperatively, but demonstrated a complete clinical response to multiagent chemotherapy. Overall survival in our population was excellent with no deaths seen a t a mean follow-up of 37 months (range 3 to 120 months). Conclusions. Patients with neuroblastoma identified by prenatal ultrasonography gen erally, although not exclusively, follow a clinically favorable course in which surgical resection is curative. Chemotherapy is not indicate d unless substantial progression of disease occurs.