CT in children with abdominal cancer: should we routinely include the pelvis?
Sakthivel Gnanasambandam1, Øystein Erlend Olsen
1Radiology Department, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK. olseno@gosh.nhs.uk
Insights
Routine pelvic imaging during abdominal CT scans for pediatric upper abdominal malignancies offers minimal diagnostic benefit. Most pelvic abnormalities found do not impact clinical management or staging, suggesting this practice is not routinely justified.
Area of Science:
- Pediatric Radiology
- Oncology Imaging
Background:
- Routine inclusion of the pelvis in abdominal CT scans for children is debated.
- The diagnostic value of pelvic CT in pediatric abdominal malignancies remains unclear.
Purpose of the Study:
- To assess the diagnostic yield and clinical benefit of pelvic CT findings in children with upper abdominal malignant tumors.
Main Methods:
- Retrospective review of abdominal CT scans including the pelvis in children with primary upper abdominal tumors (1997-2004).
- Tabulation and analysis of pelvic abnormalities and their impact on clinical management and staging.
Main Results:
- Six out of 230 children (2.6%) had pelvic abnormalities, none affecting clinical management.
- Four children (1.7%) had findings potentially influencing staging, but only one was not detected by other methods.
Conclusions:
- Diagnostically significant pelvic findings in pediatric upper abdominal malignancies are rare.
- Routine inclusion of the pelvis in abdominal CT scans for these pediatric patients is not routinely justified.
Background:
It has been suggested that the pelvis should not be habitually included on abdominal CT examinations, but the potential benefit of such a practice in childhood abdominal malignancies is unknown.
Objective:
To estimate the yield and potential diagnostic benefit of abnormal findings on CT of the pelvis in children with malignant primary tumours in the upper abdomen.
Materials And Methods:
From a paediatric tertiary referral hospital we retrospectively included patients having abdominal CT for primary upper abdominal tumours (1997-2004), the scan range routinely including the pelvis. We reviewed and tabulated any pelvic abnormality, and calculated group proportions with 95% confidence intervals.
Results:
We identified 230 children (2 days to 17 years old, median 2.9 years). Six (2.6%; 95% CI 0.5-4.7%) had abnormalities in the pelvis that would not have affected clinical management. Four (1.7%; 95% CI 0.1-3.4%) had findings that might have influenced staging, but only one was not detected by other modalities within 1 week of the CT.
Conclusions:
Our data suggest that diagnostically significant findings in the pelvis are rare; consequently, the habitual inclusion of the pelvis on abdominal CT for primary malignant tumours in the abdomen is not justified.
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