Investigations

Radiology:

• plain abdominal radiology - typical microcalcification of tumour noted in 50% of cases
• chest radiology - for evidence of metastases
• abdominal CT with intravenous contrast - helps to distinguish neuroblastoma from Wilm's tumour
• chest CT should be performed to look for metastases
• isotope bone scan for metastases

Biochemistry: (2)

• urinary excretion of catecholamine metabolites - levels of vanillylmandelic acid, homovanillic acid raised in 75% of cases
• the ratio of a spot VMA concentration to urinary creatinine may be helpful where a 24 hour collection is impractical

Reference

1. Whittle SB, Smith V, Doherty E, et al; Overview and recent advances in the treatment of neuroblastoma. Expert Rev Anticancer Ther. 2017 Apr;17(4):369-386
2. Barco S, Gennai I, Reggiardo G, et al. Urinary homovanillic and vanillylmandelic acid in the diagnosis of neuroblastoma: report from the Italian Cooperative Group for Neuroblastoma. Clin Biochem. 2014 Jun;47(9):848-52.