Diagnostic Errors in Wilms' Tumors: Learning From Our Mistakes.

Area of Science:

• Pediatric Oncology
• Diagnostic Imaging
• Nephrology

Background:

• Accurate diagnosis of pediatric renal masses is crucial for appropriate treatment.
• Wilms tumor (WT) is a common pediatric kidney cancer, but other pathologies can mimic its presentation.
• Misdiagnosis can lead to delayed or incorrect treatment, impacting patient outcomes.

Purpose of the Study:

• To analyze clinical and imaging findings in patients initially diagnosed with Wilms tumor (WT) but later found to have other pathologies.
• To compare these cases with confirmed WT and neuroblastoma (NBL) cases.
• To identify key features that can improve diagnostic accuracy in pediatric renal masses.

Main Methods:

• Retrospective review of clinical data, laboratory tests, and imaging (CT) of patients initially treated for WT.
• Comparison of clinical characteristics and imaging findings with confirmed WT and neuroblastoma (NBL) cohorts.
• Statistical analysis of presenting symptoms and imaging features.

Main Results:

• Five patients initially treated for WT were diagnosed postoperatively with neuroblastoma (NBL).
• Abdominal mass or swelling was highly suggestive of WT (p=0.011).
• Elevated urinary catecholamines were observed in NBL cases misdiagnosed as WT, aiding differential diagnosis.

Conclusions:

• Certain pathologies, particularly NBL, can be misdiagnosed as WT, especially with nonspecific symptoms and ambiguous imaging.
• Diagnostic accuracy for pediatric renal masses can be enhanced through careful evaluation of clinical presentation and specific tests.
• Collecting urinary catecholamines at presentation is recommended for differentiating NBL from WT.