Neuroblastoma Staging

Based on The International Neuroblastoma Staging System (INSS, 1993):

Stage	Description
Stage 1 (surgicopathological)	Localized tumor with complete gross excision, with or without microscopic residual disease; representative ipsilateral lymph nodes are negative microscopically.
Stage 2 (surgicopathological)	Localized tumor with incomplete gross excision and representative ipsilateral non-adherent lymph nodes negative microscopically (2a). OR Localized tumor with or without complete gross excision, with ipsilateral non-adherent lymph nodes positive for tumor. Enlarged contralateral lymph nodes must be negative microscopically.
Stage 3 (role for radiology)	Unresectable unilateral tumor infiltrating across the midline, without regional lymph node involvement. OR Localized unilateral tumor with contralateral regional lymph node involvement. OR midline tumor with bilateral extension by infiltration or by lymph node involvement
Stage 4 (role for radiology)	Any primary tumor with dissemination to distant lymph nodes, bone, bone marrow, liver, skin and/or other organs (except as defined for stage 4S)
Stage 4S	Localized primary tumor (as defined for stages 1 or 2), with dissemination limited to the skin, liver and/or bone marrow (but no cortical disease). Limited to infants < 1 year of age.
Stage 4N (not part of INSS)	Extensive lymph node metastases (cervical, axillary, thoracic, abdominal, pelvic), but no extranodal metastases.

Midline extension is defined as tumor that reaches the contralateral pedicle.

References

• Hiorns MP, Owens CM. Radiology of neuroblastoma in children. Eur Radiol. 2001;11(10):2071-81.
• Rosen EM, Cassady JR, Frantz CN, Kretschmar CS, Levey R, Sallen SE. Stage IV-N: a favorable subset of children with metastatic neuroblastoma. Med Pediatr Oncol. 1985;13(4):194-8.