Neuroblastoma staging: Difference between revisions
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{{Neuroblastoma}} | {{Neuroblastoma}} | ||
{{CMG}} | {{CMG}} {{AE}}{{HL}} | ||
==Overview== | ==Overview== | ||
The staging of neuroblastoma is based on the International Neuroblastoma Staging System (INSS). According to a newly proposed International Neuroblastoma Risk Group Staging System (INRGSS), there are four stages of neuroblastoma based on the extent of dissemination and image findings. Neuroblastoma patients are risk stratified into a low risk group, an intermediate risk group, and a high risk group based on the [[tumor]] INSS stage, the patient's age, tumor grade, and the amplification of ''MYCN'' gene.<ref name="wiki">Neuroblastoma. Wikipedia (2015) https://en.wikipedia.org/wiki/Neuroblastoma Accessed on October, 5 2015</ref><ref name="pmid22248965">{{cite journal| author=Davidoff AM| title=Neuroblastoma. | journal=Semin Pediatr Surg | year= 2012 | volume= 21 | issue= 1 | pages= 2-14 | pmid=22248965 | doi=10.1053/j.sempedsurg.2011.10.009 | pmc=PMC3261589 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22248965 }} </ref> | |||
==Staging == | ==Neuroblastoma Staging== | ||
Neuroblastoma is | ===International Neuroblastoma Staging System (INSS)=== | ||
The staging of neuroblastoma is based on the International Neuroblastoma Staging System (INSS).<ref name="wiki">Neuroblastoma. Wikipedia (2015) https://en.wikipedia.org/wiki/Neuroblastoma Accessed on October, 5 2015</ref><ref name="pmid22248965">{{cite journal| author=Davidoff AM| title=Neuroblastoma. | journal=Semin Pediatr Surg | year= 2012 | volume= 21 | issue= 1 | pages= 2-14 | pmid=22248965 | doi=10.1053/j.sempedsurg.2011.10.009 | pmc=PMC3261589 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22248965 }} </ref> | |||
{| style="cellpadding=0; cellspacing= 0; width: 950px;" | |||
|- | |||
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align=center |'''T'''||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''Description''' | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=center |'''Stage 1''' || style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=left | | |||
* Localized tumor | |||
* Complete gross excision | |||
* Ipsilateral lymph nodes involvement negative under microscopic examination | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=center |'''Stage 2A''' ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=left | | |||
* Localized tumor | |||
* Incomplete gross resection | |||
* Ipsilateral lymph nodes involvement negative under microscopic examination | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=center |'''Stage 2B''' ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=left | | |||
* Localized tumor | |||
* | * Complete or incomplete gross resection | ||
* Ipsilateral lymph nodes involvement positive under microscopic examination | |||
* Enlarged contralateral lymph nodes but with negative involvement under microscopic examination | |||
|- | |||
*Stage 4S: Localized primary tumor as defined | |style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=center |'''Stage 3''' ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=left | | ||
* Localized unilateral tumor with contralateral lymph nodes involvement positive under microscopic examination | |||
<center>'''or'''</center> | |||
* Unresectable unilateral tumor infiltrating across the midline with positive or negative regional lymph node involvement | |||
<center>'''or'''</center> | |||
* Unresectable midline tumor with bilateral infiltration or lymph node involvement | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=center |'''Stage 4''' ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=left | | |||
* Metastasis of the tumor to distant lymph nodes | |||
* Metastasis of the tumor to liver, skin, bone and/or other organs (except as defined by Stage 4S) | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=center |'''Stage 4S''' ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=left | | |||
* Limited to infants <1 year of age | |||
* Localized primary tumor (as defined for stage 1, 2A, or 2B) | |||
* Metastasis of the tumor '''limited''' to skin, liver and/or bone marrow | |||
* Bone marrow involvement in stage 4S should be '''minimal''' (<10% of total nucleated cells identified as malignant on bone marrow biopsy) | |||
|} | |||
===International Neuroblastoma Risk Group Staging System (INRGSS)=== | |||
According to a newly proposed International Neuroblastoma Risk Group Staging System (INRGSS), there are four stages of neuroblastoma based on the extent of dissemination and image findings.<ref name="wiki">Neuroblastoma. Wikipedia (2015) https://en.wikipedia.org/wiki/Neuroblastoma Accessed on October, 5 2015</ref> | |||
{| style="cellpadding=0; cellspacing= 0; width: 800px;" | |||
|- | |||
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align=center |'''Stage:'''||style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF" align=center |'''Description''' | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=center |'''Stage L1'''||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=left | | |||
* Localized disease without image-defined risk factors | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=center |'''Stage L2''' ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=left | | |||
* Localized disease with image-defined risk factors | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=center |'''Stage M''' ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=left | | |||
* Metastatic disease | |||
|- | |||
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=center |'''Stage MS''' ||style="font-size: 100; padding: 0 5px; background: #F5F5F5" align=left | | |||
* Metastatic disease '''limited''' to skin, liver and/or bone marrow | |||
* Bone marrow involvement in stage 4S should be '''minimal''' (<10% of total nucleated cells identified as malignant on bone marrow biopsy) | |||
|} | |||
==Risk Stratification== | |||
* Neuroblastoma patients are risk stratified into a low risk group, an intermediate risk group, and a high risk group based on the [[tumor]] INSS stage, the patient's age, tumor grade, and the amplification of ''MYCN'' gene.<ref name="pmid22248965">{{cite journal| author=Davidoff AM| title=Neuroblastoma. | journal=Semin Pediatr Surg | year= 2012 | volume= 21 | issue= 1 | pages= 2-14 | pmid=22248965 | doi=10.1053/j.sempedsurg.2011.10.009 | pmc=PMC3261589 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22248965 }} </ref> | |||
* '''Low risk neuroblastoma groups''' include: | |||
:* Patients with stage 1 tumor irrespective of the age, grade, and molecular pathway | |||
:* Patients with stage 2A/2B (>50% resected), irrespective of age, irrespective of the grade, ''MYCN''not amplified | |||
:* Patients with Stage 4S, <365 days of age, favorable histology, DNA index >1 , ''MYCN'' not amplified | |||
* '''Intermediate risk neuroblastoma groups''' include: | |||
:* '''Group 1''' | |||
::* Patients with stage 2A/2B (<50% resected or Bx only) tumor, 0-12 years of age, irrespective of the grade, ''MYCN''not amplified | |||
::* Patients with stage 3 tumor, <365 days of age, favorable histology, DNA index >1, ''MYCN'' not amplified | |||
::* Patients with stage 3 tumor, 1-12 years of age, favorable histology, ''MYCN''not amplified | |||
::* Patients with symptomatic stage 4S, <365 days of age, favorable histology, DNA index >1, ''MYCN''not amplified | |||
:* '''Group 2''' | |||
::* Patients with stage 3 tumor, <365 days of age, unfavorable histology, DNA index=1, ''MYCN'' not amplified | |||
::* Patients with stage 4 tumor, <365 days of age, favorable histology, DNA index >1, ''MYCN'' not amplified | |||
::* Patients with stage 4S tumor, <365 days of age, unfavorable histology, DNA index=1, ''MYCN'' not amplified | |||
:* '''Group 3''' | |||
::* Patients with stage 4 tumor, <365 days of age, unfavorable histology, DNA index=1, ''MYCN'' not amplified | |||
::* Patients with stage 3 tumor, 365-547 days of age, unfavorable histology, ''MYCN'' not amplified | |||
::* Patients with stage 4 tumor, 365-547 days of age, favorable histology, DNA index >1, ''MYCN'' not amplified | |||
* '''High risk neuroblastoma groups''' include: | |||
:* Patients with stage 2A/2B, 3, 4, or 4S tumor, irrespective of the age, irrespective of the grade, ''MYCN'' amplified | |||
:* Patients with stage 3 tumor, ≥ 547 days of age, unfavorable histology, ''MYCN'' not amplified | |||
:* Patients with stage 4 tumor, 365-547 days of age, unfavorable histology, DNA index=1, ''MYCN'' not amplified | |||
:* Patients with stage 4 tumor, >547 days of age, irrespective the grade and ''MYCN'' amplification state | |||
==References== | ==References== |
Revision as of 17:06, 7 October 2015
Neuroblastoma Microchapters |
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Neuroblastoma staging On the Web |
American Roentgen Ray Society Images of Neuroblastoma staging |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Haytham Allaham, M.D. [2]
Overview
The staging of neuroblastoma is based on the International Neuroblastoma Staging System (INSS). According to a newly proposed International Neuroblastoma Risk Group Staging System (INRGSS), there are four stages of neuroblastoma based on the extent of dissemination and image findings. Neuroblastoma patients are risk stratified into a low risk group, an intermediate risk group, and a high risk group based on the tumor INSS stage, the patient's age, tumor grade, and the amplification of MYCN gene.[1][2]
Neuroblastoma Staging
International Neuroblastoma Staging System (INSS)
The staging of neuroblastoma is based on the International Neuroblastoma Staging System (INSS).[1][2]
T | Description |
Stage 1 |
|
Stage 2A |
|
Stage 2B |
|
Stage 3 |
|
Stage 4 |
|
Stage 4S |
|
International Neuroblastoma Risk Group Staging System (INRGSS)
According to a newly proposed International Neuroblastoma Risk Group Staging System (INRGSS), there are four stages of neuroblastoma based on the extent of dissemination and image findings.[1]
Stage: | Description |
Stage L1 |
|
Stage L2 |
|
Stage M |
|
Stage MS |
|
Risk Stratification
- Neuroblastoma patients are risk stratified into a low risk group, an intermediate risk group, and a high risk group based on the tumor INSS stage, the patient's age, tumor grade, and the amplification of MYCN gene.[2]
- Low risk neuroblastoma groups include:
- Patients with stage 1 tumor irrespective of the age, grade, and molecular pathway
- Patients with stage 2A/2B (>50% resected), irrespective of age, irrespective of the grade, MYCNnot amplified
- Patients with Stage 4S, <365 days of age, favorable histology, DNA index >1 , MYCN not amplified
- Intermediate risk neuroblastoma groups include:
- Group 1
- Patients with stage 2A/2B (<50% resected or Bx only) tumor, 0-12 years of age, irrespective of the grade, MYCNnot amplified
- Patients with stage 3 tumor, <365 days of age, favorable histology, DNA index >1, MYCN not amplified
- Patients with stage 3 tumor, 1-12 years of age, favorable histology, MYCNnot amplified
- Patients with symptomatic stage 4S, <365 days of age, favorable histology, DNA index >1, MYCNnot amplified
- Group 2
- Patients with stage 3 tumor, <365 days of age, unfavorable histology, DNA index=1, MYCN not amplified
- Patients with stage 4 tumor, <365 days of age, favorable histology, DNA index >1, MYCN not amplified
- Patients with stage 4S tumor, <365 days of age, unfavorable histology, DNA index=1, MYCN not amplified
- Group 3
- Patients with stage 4 tumor, <365 days of age, unfavorable histology, DNA index=1, MYCN not amplified
- Patients with stage 3 tumor, 365-547 days of age, unfavorable histology, MYCN not amplified
- Patients with stage 4 tumor, 365-547 days of age, favorable histology, DNA index >1, MYCN not amplified
- High risk neuroblastoma groups include:
- Patients with stage 2A/2B, 3, 4, or 4S tumor, irrespective of the age, irrespective of the grade, MYCN amplified
- Patients with stage 3 tumor, ≥ 547 days of age, unfavorable histology, MYCN not amplified
- Patients with stage 4 tumor, 365-547 days of age, unfavorable histology, DNA index=1, MYCN not amplified
- Patients with stage 4 tumor, >547 days of age, irrespective the grade and MYCN amplification state
References
- ↑ 1.0 1.1 1.2 Neuroblastoma. Wikipedia (2015) https://en.wikipedia.org/wiki/Neuroblastoma Accessed on October, 5 2015
- ↑ 2.0 2.1 2.2 Davidoff AM (2012). "Neuroblastoma". Semin Pediatr Surg. 21 (1): 2–14. doi:10.1053/j.sempedsurg.2011.10.009. PMC 3261589. PMID 22248965.