Article Text

Preclinical diagnosis of abdominal tumours by ultrasound examination
  1. Oncology Unit
  2. First Department of Paediatrics
  3. University of Athens
  4. ‘Aghia Sophia’ Children’s Hospital
  5. 11527 Athens, Greece

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    Editor,—The purpose of this preliminary childhood population based study was to evaluate the use of abdominal ultrasound examination to determine the incidence of abdominal tumours and to investigate the possibility of early diagnosis of these tumours at a preclinical stage.

    This study in general population is very difficult because of organisational problems and high cost. Therefore, we studied children under 1 year of age who were referred by their paediatricians, for another reason, to an ultrasonography centre in order to have an ultrasound examination. The most common reasons for referral were the investigation of the urinary tract after a urinary tract infection and the investigation of vomiting for possible gastro-oesophageal reflux. The study was initiated on January 1992, when we asked the radiologists of this centre to examine the whole abdomen of the referred children. In a five year period (January 1992 to December 1996) 7500 infants were examined. None of these children had symptoms implying the presence of an abdominal tumour and their physical examination was normal.

    The results were as follows: seven infants (0.09%) were found to have an abdominal tumour. Six of them were under 4 months of age and one was 6 months. In five infants the tumour was located in the adrenal gland and in two in the sympathetic spinal chain. In two infants the tumour was <2 cm and they were followed up, with repeat ultrasound examinations, until the mass disappeared completely. They are now both 4 years of age and in good health. In the five remaining infants the tumour was 2.5–6 cm. In all cases, the tumour was completely removed and histology confirmed the diagnosis of neuroblastoma. These children are now all in good health and remain in complete remission.

    The incidence of neuroblastoma in children is about one in 7000.1 The incidence of seven in 7500 seems to be quite high and one could say that the examined infants comprise a ‘high risk’ group. It would be possible that the non-specific symptom of vomiting or the urinary tract infections in children might be more frequent and, somehow, associated with abdominal tumours. Abdominal ultrasound seems to be an excellent tool for the early diagnosis of abdominal tumours. As it is not a cheap investigation, it could be initially applied in children who are referred for an ultrasound examination for another reason.2 3 These preliminary results may justify its use as a screening method in the general population for the early diagnosis of abdominal tumours, especially neuroblastoma. In the meantime, we believe that physicians should be encouraged to have a low threshold in referring children for ultrasound examination, as it is non-invasive, painless, and safe.