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Could CT scan Accurately Stage Childhood Renal Tumors?
Ahmed Abdelhalim, MRCS, M. Sc., Ahmed M. Harraz, MRCS, M. Sc., Tamer E. Helmy, M. D., Mohamed S. Dawaba, M. D., Ashraf T. Hafez, M. D..
Mansoura Urology and Nephrology Center, Mansoura, Egypt.

Background: Staging of childhood renal tumors is crucial to outline the treatment plan. This study aimed to identify whether CT scan can accurately determine the local staging of pediatric renal tumors.
Materials and Methods: We retrospectively reviewed our database for patients diagnosed with childhood renal tumors. Patients in whom preoperative CT scan was not available were excluded from the study. Preoperative abdomino-pelvic CT scans were reviewed by a senior radiologist. Local CT staging was performed according to National Wilms’ tumor study (NWTS) group staging V. Patients with metastatic disease (stage IV) were staged according to the local CT stage. Patients with bilateral tumors (stage V) were excluded from the study. Children who received preoperative therapy were staged according to the latest CT images immediately before surgery. The results were compared to the clinico-pathological staging.
Results: 246 children were diagnosed with renal tumors in our institute between August 1990 and March 2013. Of them, 173 patients met the inclusion criteria. According to the pathologic staging, 122 patients had stage I disease, 18 had stage II and 33 patients had stage III disease. The local CT stage matched the pathologic stage in 102 patients (59%). CT scan overstaged 38.5% (47/122) of patients with pathologic stage I and 55.6% (10/18) of patients with pathological stage II. On the contrary, CT scan understaged 22.2% (4/18) of patients with pathological stage II and 30.3% (10/33) of patients with pathological stage III. Table (1) shows the correlation between the pathologic stage and the local CT stage.
Pathologic stageLocal CT stageTotal number of patients
Stage IStage IIStage III
Stage I75 (61.5%)23 (18.9%)24 (19.7%)122
Stage II4 (22.2%)4 (22.2%)10 (55.6%)18
Stage III8 (24.2%)2 (6.1%)23 (69.7%)33

Conclusions: CT staging poorly correlates with pathologic staging. Treatment strategy should be based only on surgical findings and pathologic evaluation.


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