Early detection of neuroblastoma in infants: Research? Yes. Routine Screening? No

The laparoscopic approach of neuroblastoma

Neuroblastoma is one of the most common solid tumors, and the biopsy and excision of this tumor are often required as part of a planned multimodal treatment. In 1995, Holcomb and coworkers first reported endosurgical procedures for the diagnosis and treatment of pediatric malignancies; however, the usefulness of laparoscopic procedures for abdominal neuroblastoma is still unclear. Twenty-five laparoscopic biopsies for advanced abdominal neuroblastoma and nine laparoscopic excisions for localized abdominal neuroblastoma performed at Saitama Children's Medical Center were evaluated. The laparoscopic procedures significantly reduce the time to start postoperative feeding as well as the time to start postoperative chemotherapy and the duration of hospital stay. Also, the blood loss of laparoscopic excision of localized neuroblastoma was significantly little compared with that of open excision. Precise indications of laparoscopic procedure for the diagnosis and treatment of abdominal neuroblastoma provide better prognosis and quality of life for infants and children.

Neuroblastoma detection using serum proteomic profiling: a novel mining technique for cancer?

BACKGROUND

Serum proteins in neuroblastoma (NB), such as neuron-specific enolase and lactate dehydrogenase, are used as nonspecific markers of disease severity. In this study, we have generated serum protein profiles that correlate with NB by applying proteomic technologies to uncover, at the protein level, serum polypeptide expression patterns in patients with NB.

METHODS

Surface-enhanced laser desorption/ionization-time-of-flight mass spectrometry was used to generate protein expression spectra in human NB (group I, n = 18) and healthy children (group II, n = 17) sera. Groups I and II mass spectral data were compared after baseline subtraction. Peaks with high signal-to-noise ratios were selected and grouped into bins with various intervals along mass-to-charge axis. Two-sample t test and 3-fold cross validation were used to identify differential biomarkers between groups I and II.

RESULTS

Significant differentially expressed proteins were identified between groups I and II (P < or = .05). The discriminatory features (proteomic patterns) of cancer from normal sera were successfully identified using the classification algorithm. The average classification performance after 3-fold cross validation was 87.26%.

CONCLUSION

Surface-enhanced laser desorption/ionization-time-of-flight mass spectrometry is suitable for preliminary assessment of NB and could potentially provide a noninvasive diagnosis of NB. We propose that surface-enhanced laser desorption/ionization provides a novel method for NB diagnosis because direct observations of spectral differences between normal and NB sera are possible.

Natural course of neuroblastoma detected by mass screening: s 5-year prospective study at a single institution

PURPOSE

To describe various favorable courses of neuroblastoma (NBL) detected by mass screening and to present our observation program as a temporary treatment option, to be used until a final decision is made regarding the mass screening program for 6-month-old infants.

PATIENTS AND METHODS

Between October 1993 and November 1999, 26 of 51 patients with NBL detected by mass screening were enrolled in our observation program. The criteria for observation included urinary vanillylmandelic acid (VMA) and homovanillic acid (HVA) levels less than 50 microg/mg creatinine, smaller tumor size (< 5.0 cm), preoperative status, and granted informed consent. Patients were divided into four groups according to changes in urinary VMA and HVA values and tumor size. Patients who no longer fulfilled criteria underwent surgery.

RESULTS

The observation period ranged from 4 to 73 months. Urinary VMA and HVA levels decreased in 19 of 26 patients, often by age 16 months. Eighteen patients had regressing tumors, and in 10 of these cases, the tumor was undetectable or barely detectable by imaging techniques. Four patients younger than 12 months had increased tumor marker levels and tumor volume, histologically reflecting neuroblastic proliferation. The remaining three patients, all older than 18 months, had varied tumor marker levels but increased tumor volume, histologically reflecting an increase in Schwann cells. No upgrading of tumor stage or unfavorable biologic factor was noted in any patient.

CONCLUSION

None of our patients showed evidence of transition from favorable to unfavorable prognosis, a finding that points to a reduction in the significance of screening as a public health measure. Until results of ongoing screening trials involving older patients have been evaluated, the observation program can be used as a temporary measure to avoid, with little risk, unnecessary surgical intervention.