Virginia Commonwealth University

VCU Massey Cancer Center

Diagnosis and staging

How is neuroblastoma diagnosed?

In addition to a complete medical and physical examination, diagnostic procedures for neuroblastoma may include the following methods:

  • Blood tests – including a complete blood count, blood chemistries, kidney and liver function tests, and a urinalysis.
  • Multiple imaging studies– to evaluate primary tumor and determine extent/location of any metastases, including:
    • Computed tomography scan (also called a CT or CAT scan) – a diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat and organs. CT scans are more detailed than general X-rays. 
    • Magnetic resonance imaging (MRI) – a diagnostic procedure that uses a combination of large magnets, radio frequencies and a computer to produce detailed images of organs and structures within the body. 
    • X-ray – a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs onto film. 
    • Ultrasound (also called sonography) – a diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues and organs. Ultrasounds are used to view internal organs as they function and to assess blood flow through various vessels. 
    • Bone scans – pictures or X-rays taken of the bone after a dye has been injected that is absorbed by bone tissue. These are used to detect tumors and bone abnormalities.
  • Bone marrow aspiration and/or biopsy – a procedure that involves taking a small amount of bone marrow fluid (aspiration) and/or solid bone marrow tissue (called a core biopsy), usually from the hip bones, to be examined for the number, size and maturity of blood cells and/or abnormal cells. 
  • Spinal tap/lumbar puncture – a special needle is placed into the lower back into the spinal canal (the area around the spinal cord). The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid can be removed and sent for testing to determine if there is an infection or other problems. Cerebral spinal fluid is the fluid that bathes your child's brain and spinal cord. 
  • Biopsy of primary tumor and/or metastatic lesions.

Diagnosing neuroblastoma also involves staging and classifying the disease, which determines treatment options and prognosis. Staging is the process of determining whether cancer has spread and, if so, how far. There are various staging systems that can be used for neuroblastoma. Always consult your child’s physician for information on staging. One method of staging neuroblastoma is the following:

  • Stage 1 – involves a tumor that does not cross the midline of the body, is completely resectable and has not spread to other areas of the body. The lymph nodes on the same side of the body as the tumor do not have cancer cells present.
  • Stage 2A – involves a tumor that does not cross the midline of the body, but is not completely resectable. This stage of tumor has not spread to other areas of the body, and lymph nodes on the same side as the tumor do not have tumor cells present. 
  • Stage 2B – involves a tumor that may or may not be completely resectable, has not spread to other areas of the body, but lymph nodes on the same side of the tumor have tumor cells present. Lymph nodes on the opposite side of the tumor must be negative for tumor cells in this stage of disease. 
  • Stage 3 – involves a tumor that crosses the midline of the body, is not completely resectable, and lymph nodes are positive for tumor cells. This stage also includes a tumor that does not cross the midline, but the lymph nodes on the opposite side also contain tumor cells. 
  • Stage 4 – involves a tumor that has metastasized (spread) to distant lymph nodes, bone marrow, liver, skin and/or other organs (except as defined in Stage 4S). 
  • Stage 4S – involves a tumor that has metastasized to liver, skin and/or bone marrow (includes minimal bone marrow involvement; more extensive bone marrow involvement should be classified as Stage 4).