Chest radiography versus chest CT in the evaluation for pulmonary metastases in patients with Wilms' tumor: a retrospective review

Background. Determination of the presence of pulmonary metastases in childr en with Wilms' tumor is an important part of staging and treatment. We soug ht to compare the efficacy of chest radiography (CXR) and chest CT in the e valuation for pulmonary metastases in patients with Wilms' tumor. Materials and methods. This retrospective study included 83 children with W ilms' tumor diagnosed between 1980 and 1993. All patients with pulmonary no dules (n = 12) as well as 14 Wilms' tumor patients without pulmonary metast ases (control group) had blinded review of the CXR and chest CTs by three p ediatric radiologists. Presence, size, and certainty of metastatic diagnosi s were recorded. Medical records were reviewed. The remaining 57 patients h ad review of their medical and imaging records to confirm the absence of pu lmonary metastases. Results. Ten of the 12 with pulmonary masses had imaging available for revi ew. Eight had both positive CXR and chest CT examinations. Two patients had pulmonary nodules seen by CT only: one had a right cardiophrenic angle mas s and died as a result of liver metastases. The other had a solitary nodule , which proved to be a plasma-cell granuloma. Overall, the CXR and chest CT data concur in 79/81 (98 %). Conclusion. CXR alone appears adequate for the diagnosis or exclusion of pu lmonary metastases in patients with Wilms' tumor.