PMID- 16148643
OWN - NLM
STAT- MEDLINE
DCOM- 20051027
LR  - 20190622
IS  - 0022-5347 (Print)
IS  - 0022-5347 (Linking)
VI  - 174
IP  - 4 Pt 2
DP  - 2005 Oct
TI  - Fate of bilateral renal lesions missed on preoperative imaging: a report from the 
      National Wilms Tumor Study Group.
PG  - 1519-21; discussion 1521
AB  - PURPOSE: In children undergoing nephrectomy for Wilms tumor exploration of the 
      contralateral kidney has been recommended to detect occult tumors missed on 
      preoperative evaluation. In this review of the National Wilms Tumor Study (NWTS) 
      4 cases of bilateral Wilms tumors (BWT) we evaluate incidence and outcome of 
      missed bilateral lesions. MATERIALS AND METHODS: NWTS-4 enrolled 3,335 patients 
      from August 1986 through September 1994. There were 188 patients with BWT or 5.6% 
      of the total registered. The operative records, pathology and imaging reports 
      were reviewed. RESULTS: In 11 cases synchronous BWT was diagnosed at surgical 
      exploration, which represents 5.9% of the bilateral cases but only 0.3% of all 
      NWTS-4 cases. Two patients did not undergo preoperative imaging and were excluded 
      from analysis. The size of the missed lesions was less than 1 cm in 6 patients 
      and 1 to 2 cm in 3. Computerized tomography was performed in all patients except 
      one who entered early in the study. Management of missed lesions included 
      enucleation in 2 cases, biopsy in 6 and no surgery in 1. No patient underwent 
      irradiation. The postoperative chemotherapy regimen consisted of doxorubicin, 
      dactinomycin and vincristine in 6 children, and dactinomycin and vincristine in 
      3. Median followup was 9 years. There were no recurrences in any kidney with a 
      missed lesion. All 9 patients were alive and disease-free at last followup. 
      CONCLUSIONS: Routine contralateral renal exploration will identify few occult 
      tumors not detected on preoperative imaging. Omission of routine exploration will 
      not likely affect the outcome or management of newly diagnosed Wilms tumor 
      provided preoperative computerized tomography or magnetic resonance imaging is 
      performed. The outcome in these patients was excellent.
FAU - Ritchey, Michael L
AU  - Ritchey ML
AD  - Division of Urology, University of Texas Houston Medical School, Houston, Texas, 
      USA. michael.ritchey@gmail.com
FAU - Shamberger, Robert C
AU  - Shamberger RC
FAU - Hamilton, Thomas
AU  - Hamilton T
FAU - Haase, Gerald
AU  - Haase G
FAU - Argani, Pedram
AU  - Argani P
FAU - Peterson, Susan
AU  - Peterson S
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Urol
JT  - The Journal of urology
JID - 0376374
RN  - 1CC1JFE158 (Dactinomycin)
RN  - 5J49Q6B70F (Vincristine)
RN  - 80168379AG (Doxorubicin)
SB  - IM
MH  - Antineoplastic Combined Chemotherapy Protocols/therapeutic use
MH  - Child
MH  - Dactinomycin/administration & dosage
MH  - Disease-Free Survival
MH  - Doxorubicin/administration & dosage
MH  - Humans
MH  - Kidney Neoplasms/*diagnosis/drug therapy/*surgery
MH  - Neoplasms, Second Primary/*diagnosis/drug therapy/*surgery
MH  - Nephrectomy
MH  - Retrospective Studies
MH  - Tomography, X-Ray Computed
MH  - Vincristine/administration & dosage
MH  - Wilms Tumor/*diagnosis/drug therapy/*surgery
EDAT- 2005/09/09 09:00
MHDA- 2005/10/28 09:00
CRDT- 2005/09/09 09:00
PHST- 2005/09/09 09:00 [pubmed]
PHST- 2005/10/28 09:00 [medline]
PHST- 2005/09/09 09:00 [entrez]
AID - 00005392-200510020-00003 [pii]
AID - 10.1097/01.ju.0000179536.97629.c5 [doi]
PST - ppublish
SO  - J Urol. 2005 Oct;174(4 Pt 2):1519-21; discussion 1521. doi: 
      10.1097/01.ju.0000179536.97629.c5.