Current controversy: is computed tomography scan of the chest needed in patients with Wilms' tumor?

Purpose: Reports from the National Wilms' Tumor Study (NWTS) Group on the subject of chest computed tomography (CT) versus chest radiograph for the detection of lung metastases from Wilms tumor are reviewed.

Patients and methods: Thirty-two patients with lung nodules detected by CT, with negative chest radiographs, were identified. Five patients were excluded from further analysis. Of the remaining 27 patients, 18 were treated as stage IV, receiving therapy with three drugs and lung irradiation; the other nine were treated with less intensive therapy and no lung irradiation. The investigators found no significant difference between the overall survival between these two groups of patients (94% and 88%, respectively). In an earlier study, four of 11 children (36%) with normal chest radiographs and positive chest CT results were treated by ignoring the CT findings. These data compared with a relapse rate of only 20% in a control population.

Results: The studies do not statistically address the question of the impact of CT of the chest on survival.

Conclusions: All children should have the benefit of the most sensitive imaging available, including CT, to detect tumor spread.