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MYCN amplification and International Neuroblastoma Risk Group stratification on fine-needle aspiration biopsy and their correlation to survival in neuroblastoma
  1. Neha Bhardwaj1,
  2. Manish Rohilla2,
  3. Amita Trehan3,
  4. Deepak Bansal3,
  5. Nandita Kakkar4,
  6. Radhika Srinivasan2
  1. 1Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  2. 2Cytology & Gynecological Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  3. 3Department of Pediatrics (Hematology-Oncology Division), Post Graduate Institute of Medical Education and Research, Chandigarh, India
  4. 4Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  1. Correspondence to Dr Radhika Srinivasan, Cytology & Gynecological Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, Chandigarh, India; drsradhika{at}gmail.com

Abstract

Aims Risk stratification as per the International Neuroblastoma Risk Group (INRG) stratification is important for management of neuroblastoma. INRG incorporates various parameters including histological category as per the International Neuroblastoma Pathology Classification (INPC) and MYCN amplification, which were evaluated in fine needle aspiration biopsy (FNAB) samples of neuroblastoma patients to ascertain their impact in our population.

Methods This was a retrospective study including 60 neuroblastoma cases diagnosed on FNAB, staged and stratified by INRG. Mitosis Karyorrhexis Index (MKI), INPC morphological category and MYCN status by fluorescence in situ hybridisation (n=46) were evaluated and correlated to outcome.

Results The mean age was 29 months (21 days to 9 years) with 27 and 33 children </≥18 months; male: female ratio of 1.6: 1; INRG stage-30(M), 20(L2), 2(L1) and 2(MS); INRG-36 high-risk, 13 intermediate-risk and 11 low-risk categories, respectively. MKI was high, intermediate and low in 39, 4 and 7 cases, respectively. INPC morphological type included 2 ganglioneuroblastomas and 58 neuroblastomas, graded further as 25 undifferentiated and 33 poorly differentiated tumours. MYCN was amplified in 48% (22/46) cases and correlated with undifferentiated morphology (p=0.01). At a mean follow-up of 469 (7-835) days, 22/50 were disease free and 28/50 had relapsed/died. The overall survival correlated with age (p=0.03), stage (p=0.01), INRG group (p=0.0001) and tumour grade (p=0.036). MYCN status independently did not correlate with age (p=0.5), INRG stage (p=0.2) and overall survival (p=0.4).

Conclusion FNAB is a complete modality for diagnosing neuroblastoma and providing all information required for risk stratification as per INRG including MKI, MYCN amplification, INPC category. Our cohort with predominant high-risk neuroblastoma cases highlights regional variation.

  • NEUROBLASTOMA
  • FISH
  • Pathology, Molecular

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. Any further information can be provided by the guarantor of the study upon reasonable request.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. Any further information can be provided by the guarantor of the study upon reasonable request.

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Footnotes

  • Handling editor Runjan Chetty.

  • Twitter @drsradhika

  • Contributors NB: study conceptualisation, data curation (clinical and pathology), formal analysis, statistics, manuscript original draft, editing and final draft. MR: data curation (cytopathology), FISH reporting, analysis, manuscript editing and final draft. AT: clinical data curation, analysis, manuscript editing and final draft. DB: clinical data curation, analysis, manuscript editing and final draft. NK: data curation (histopathology), manuscript editing and final draft. RS: study conceptualisation, data curation (pathology), analysis, statistics, manuscript drafting, editing and final draft. RS is the gurantor of the study.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.