From the Guidelines
The workup for neuroblastoma in children should include a comprehensive evaluation starting with a thorough history and physical examination, followed by laboratory and imaging studies, as recommended by the NCCN Guidelines for Neuroblastoma 1. The initial laboratory tests should include:
- Complete blood count
- Comprehensive metabolic panel
- Urine catecholamines (vanillylmandelic acid and homovanillic acid)
- Serum neuron-specific enolase and ferritin Imaging studies should begin with:
- Ultrasound of the primary site
- CT or MRI of the primary tumor and chest/abdomen/pelvis to assess for metastases
- MIBG (metaiodobenzylguanidine) scintigraphy is essential for detecting metastatic disease, while bone marrow aspiration and biopsy from multiple sites are necessary to evaluate for bone marrow involvement Definitive diagnosis requires tumor tissue biopsy for:
- Histopathology
- Immunohistochemistry
- Molecular studies including MYCN amplification status, DNA ploidy, and chromosome 1p and 11q status Additional staging workup may include:
- Bone scan if MIBG is unavailable
- Bilateral posterior iliac crest bone marrow aspirates and biopsies This comprehensive approach allows for accurate diagnosis, risk stratification, and treatment planning based on the child's age, tumor stage, and biological characteristics, which ultimately guides the multidisciplinary management of neuroblastoma 1. The use of PET/CT with catecholaminergic tracers, such as [18F]mFBG, may offer advantages over traditional MIBG scintigraphy, including higher resolution and sensitivity, as well as reduced scanning time and need for sedation 1.