Imaging Features of Neuroblastoma at Initial Presentation Associated with Metastatic Spread and Poor Clinical Outcome: A Cross-Sectional Study
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Date
2024-12-01
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Addis Ababa University
Abstract
Background: Neuroblastoma (NB) is a tumor of the sympathetic nervous system which represents one of the most common malignancies in early childhood; initial imaging gives important information on the diagnosis of NB. Objective: This study aimed to assess imaging features of NB associated with metastatic disease at presentation and poor clinical outcome in a resource limiting setting. Methods: A hospital-based cross-sectional study was conducted. Computed Tomography (CT) images were reviewed and imaging appearances were evaluated in all patients with pathology confirmed cases of neuroblastoma in Tikur Anbessa Specialized Hospital (TASH) radiology department from January 2023-December 2024. Using Statistical Package for Social Sciences version 27 (SPSS) software program, data was analyzed. Association between imaging features variables like location, size and IDRFs with disease prognostic factor (metastasis) and clinical outcome were analyzed using Fisher’s exact test. Results: Among 42 participants, 22 were male (52.4%). The participants' age ranged from 1 to 120 months; a median age is 33 months. Twenty-four patients (57.1%) had tumor originating from the adrenal gland, followed by non-adrenal retroperitoneal in 13 (31%). Thirty-five cases (83.3 %) had a tumor size greater than 4 cm in longest diameter. Thirty-three cases (78.6%) had at least one image defined risk factor and intra-abdominal vascular encasement is seen in 27 cases (64.3%). Twenty-two cases (52.4%) had a metastatic disease at presentation and the most common single site of metastasis was bone in 8 patients (36.4%), followed by liver in 6 patients (27.3%). Nineteen cases (45.2%) had a metastatic NB. 6(14%) had improvement on follow up, 11(26%) were on palliative treatment, 5(12%) were lost on follow up and status unknown, and 20 (48%) patients died. 4 A statistically significant association was found between the primary tumor location and tumor size with tumor metastasis at initial presentation with a two-sided Fisher’s exact sig P value of 0.045 and 0.027 respectively. There is an association between metastatic disease at presentation and clinical outcome (P-value of 0.006). Conclusion: NB presents as a large intra-abdominal solid mass with calcification and roughly half of them having metastasis at initial presentation. Adrenal tumor origin and large tumors have more propensities to have metastatic disease at presentation. Metastatic spread at initial presentation has a poor clinical outcome.
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Adrenal tumor, CT scan, IDRFs, INGRSS, Neuroblastoma, Pediatric