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Tests for neuroblastoma

Your child will need a number of tests if their doctor suspects they have neuroblastoma. Your child might have more than one test on the same day. And they only have the tests their team think are needed.

These tests aren’t generally painful. But, your child will have to keep still for some of them.

The team caring for your child are used to helping children have these tests. They will do everything they can to prepare them, and you.

Tests

For some types of test, your child might need sedation or a general anaesthetic. Tests for neuroblastoma might include:

Blood tests can:

  • check your child’s general health, including liver, kidneys and heart function
  • check numbers of blood cells
How

A doctor, nurse or person specialising in taking blood (a phlebotomist) takes a small amount of blood from your child. This is usually from the back of the hand, the inside of the elbow or wrist area.

Most blood tests take a couple of minutes. 

The specially trained staff will help your child feel as comfortable as possible. Things that can make it easier for your child include:

Local anaesthetic

The phlebotomist might use a local anaesthetic (numbing spray or cream) before the test. This should mean it’s less painful for your child, although they might still feel the needle go in.

Distraction

Distraction could be singing, counting, watching something on your mobile phone or a DVD.

Sitting with your child

Holding your child while they are having their blood test can make them feel safe and secure. And you can give them a cuddle afterwards if you’re unable to hold them during their test.

After their blood test

Your child can usually eat, drink and play as normal after a blood test.

Ultrasound scans use high frequency sound waves to build up a picture of the inside of the body. They are used in pregnancy to check on the baby’s development.

How

Ultrasound scans are completely painless. Your child has the test in the hospital x-ray department by a person who specialises in doing them called a sonographer. First, they put some cold gel on the area of skin over where they want to scan. They gently press the microphone on your child’s skin.

The sound waves bounce off the organs inside the body, and the microphone picks them up. The microphone links to a computer that turns the sound waves into a picture on the screen. This can help doctors to understand what an unusual lump might be.

The hospital will let you know how to help your child prepare for the test. For some types of ultrasound, it helps if your child has a full bladder.

After

Your child can usually eat, drink and play as normal after an ultrasound scan.

X-rays use high energy rays to take pictures of the inside of your body. Chest x-rays can show:

  • fluid
  • signs of infection
  • an enlarged heart
  • tumours in the chest
How

There is no special preparation for an x-ray. Your child usually has a chest x-ray standing up against the x-ray machine if they are old enough to stand. They have it lying on the x-ray couch if they are younger or unable to stand.

X-rays are painless and quick. Your child won’t feel or see anything. You are usually able to stay in the room when your child is having their x-ray. You need to wear a lead apron to protect you from the small amount of radiation.

Your child’s specialist makes sure the benefits of having an x-ray outweighs the risks of the small amount of radiation.

Photograph of Child having a chest x-ray
After

Your child can usually eat, drink and play as normal after a chest x -ray.

CT stands for computed tomography. A CT scan uses x-rays and a computer to create detailed pictures of the inside of your body. It takes pictures of the body from different angles. A computer then puts them together to give a series of pictures. It can help doctors find out what an unusual lump might be.

The scan itself is painless. Your specialist team will let you know how:

  • to help your child prepare
  • long your child needs to not eat or drink before their sedation
  • long the scan is likely to be
How

Your child might have an injection of contrast medium (a type of dye) through a small thin tube (cannula) in their hand or arm.

Many young children have a medicine to make them feel sleepy and relaxed (sedative) to help them lie still on the couch for the scan. The couch slowly slides backwards and forwards through the hole of the scanner. The machine takes pictures as it moves.

After

Your child stays on the day unit or the children's ward for a couple of hours after the scan. This is so the team can be sure they have recovered and are awake enough from the sedation. 

The nurses on the unit usually check that your child has:

  • had something to drink
  • had something to eat or some milk
  • had a wee

This can help the nurses see if your child has recovered from the sedative drugs.

MRI stands for magnetic resonance imaging. An MRI scan creates pictures using magnetism and radio waves.

Photograph of a child having an MRI scan
How

It produces pictures from angles all around the body and shows up soft tissues very clearly. It can help doctors find out what an unusual lump might be. It can also measure blood flow.

Many young children have a sedative or general anaesthetic to help them lie still on the couch for the scan. Most MRI scans involve around 30 minutes of lying still. Your child might have an injection of a special dye before or during the scan to help make the pictures clearer. 

After

Your child stays on the day unit or children's ward for a couple of hours after the scan. This is so the team can be sure they have recovered and are awake enough from the sedation. 

The nurses on the unit usually check that your child has:

  • had something to drink
  • had something to eat or some milk
  • had a wee

This can help the nurses see if your child has recovered from the sedative drugs.

A bone scan shows up changes or abnormalities in the bones. Your child might have this test to help doctors find out if the neuroblastoma has spread to the bone. 

How

First, a technician gives your child an injection of a radioactive liquid called a radionuclide. They inject it through a small tube (cannula) into their bloodstream. It’s a very small amount and doesn’t harm your child. The injection might make them feel hot and flushed for a minute or two but this is normal.

Your child waits on the ward for about 4 hours while the radioactive liquid travels through the blood and collects in the bones. They can play as normal during this time. It’s important that they have lots to drink, so that they can have a wee just before the scan starts.

They then lie down on an x-ray couch and need to keep very still. Some children have a sedative drug to make sure they are sleepy and can lie still. Other children have sandbags around them to help keep them in the same position for the scan.

A camera moves around your child. It takes pictures of the bones in their whole body.

The liquid tends to collect more in areas where the bone is breaking down and repairing itself. These areas of activity (called hot spots) show up on the scan. They look darker than other areas of bone.

Diagram showing bone scan hot spots
After

Your child has a small amount of radiation in their body after the scan. The exposure to radiation is similar to the amount that we get from the environment in 2 years. It can increase your risk of developing cancer in the future by an extremely small amount. Talk to your doctor if this worries you.

Your child’s body gets rid of the radionuclide through the urine, usually within 24 hours. And your child’s radiographer or doctor will explain all the risks and benefits to you before you consent to the scan.

Your child stays on the day unit or children’s ward for a couple of hours after the test. This is so the team can be sure they have recovered and are awake enough from the sedation or anaesthetic. The nurses on the unit usually check that your child has:

  • had something to drink
  • had something to eat or some milk
  • had a wee

Your child can usually go home the same day, unless they are staying in hospital for other tests.

Neuroblastoma cells absorb a substance called mIBG. An mIBG scan looks for this absorption in the body. So, it helps doctors diagnose neuroblastoma.

How

Doctors attach a very small amount of radioactive iodine to mIBG and then inject this into the bloodstream. Doctors call this injection the tracer. The neuroblastoma cells pick up the mIBG and then the radioactive iodine attached to it shows up on the scan.

Having a radioactive injection might sound scary. But, the dose is as low as possible to provide good pictures. An mIBG scan is a safe test. Your doctor will go through the risks and benefits of your child having the test with you.

This test is done over 2 days. On the first day, your child has the injection of the tracer and a scan a few hours later. On the second day, your child has more detailed pictures taken during a second scan. Distraction can help older children keep still for the scan. Younger children often need a sedative to make them sleepy and help them lie still. Or they might have a general anaesthetic for the test.

Some of the tracer can be absorbed by the thyroid gland. To help prevent this your child has some potassium iodide medicine to take. They have this medicine:

  • the day before the scan
  • on the day
  • the day after their scan
After

The radioactive tracer comes out of your child’s body over the next few days in the wee and poo. Your child’s team let you know the best ways to look after your child over the next few days.

Let your child’s team know if you are, or think you could be, pregnant. The amount of radioactive tracer is small but pregnant women should avoid close contact with anyone having any this type of scan.  So, if you are pregnant you might need someone else to care for your child for the short time during and after a mIBG scan.

Your child has this test to check whether there are neuroblastoma cells in the bone marrow. Bone marrow is spongy tissue and fluid that is inside your bones. It makes your blood cells.

How

A doctor or specialist nurse removes a sample of bone marrow cells or an area of bone marrow in one piece. Doctors can then look at the cells or tissue under a microscope.

Doctors might take a sample from both hips, when they are testing the bone marrow for neuroblastoma cells.

Diagram of a babys bone marrow test

Or, if your child is very young, they might have the sample taken from a bone in their leg.

Diagram showing a baby bone marrow aspirate on the leg

Your child usually has this test in the outpatient department of the hospital. Most children and young people have this test under general anaesthetic. Or they might have a medicine to make them feel sleepy and relaxed (sedative). This helps them to lie still on the couch while they have the test.

Some older children might have gas and air (Entonox) instead of sedation to help them relax.

After

Your child stays on the day unit or children’s ward for a couple of hours after the test. This is so the team can be sure they have recovered and are awake enough from the sedation or anaesthetic. The nurses on the unit usually check that your child has:

  • had something to drink
  • had something to eat or some milk
  • had a wee
  • a clean and dry dressing over the site of the test

A bone marrow biopsy is a safe test. Your child’s doctor or nurse talks with you about any possible problems they might have after it. They give you a phone number to call if you have any problems after, if in doubt, give the number a call.

It’s likely your child can go home the same day, unless they are staying in hospital for other tests.

Your child’s doctor might want to take a sample of an abnormal area seen on a scan. This is called a biopsy. A specialist doctor called a pathologist looks at the cells down a microscope to find out exactly what is causing the lump.

How

Your child is likely to have a general anaesthetic for this test. This means they are asleep and can’t feel anything during the test.

An experienced doctor takes a small sample of cells using a needle. The doctor uses a scan to help them choose the best place to biopsy.

After

Your child stays on the day unit or children’s ward for a couple of hours after the biopsy. This is so the team can be sure they have recovered and are awake enough from the anaesthetic. The nurses on the unit usually check that your child has:

  • had something to drink
  • had something to eat or some milk
  • had a wee
  • a clean and dry dressing over the site of the test

Children might go home the same day. Or they might stay in hospital overnight for other tests.

A biopsy is a safe test. Your child’s doctor goes through the risks and benefits with you. The most common risks are bleeding from the site or infection. Your team gives you a telephone number to call if you have any problems at home. If in doubt, give them a call.

Doctors can use urine tests to help diagnose neuroblastoma. The waste products from chemical messengers, called catecholamines, made by neuroblastoma cells are passed out of the body in the urine. Doctors can then test for these for chemicals.

They are called HMA (homovanillic acid) and VMA (vanillylmandelic acid).

How

Your doctor asks your child to give a urine sample into a pot if they are old enough or able to. There are different ways to collect urine from younger children, or from children who might find this difficult. These include:

  • using a urine collection bag – these are designed with a sticky edge so you can attach them easily. They peel off when your child has had a wee. The wee can be poured into the sample container
  • putting a layer of sterile cotton wool or gauze inside a fresh nappy – you can use a syringe to draw up the sample when your child has passed urine
  • taking a clean sample from your child’s catheter, if they have one – the nurses at the hospital should be able to do this for you
After

Your child can usually eat, drink and play as normal after giving a urine sample.

Scans for infants

Your doctor might suggest you give your baby a feed as normal and then wrap them in a soft towel or blanket. This can help your baby lie still for their CT or MRI scan.

Babies that have had a feed and wrap scan don't need the same level of monitoring after. This is because they haven't had any medicine to make them feel sleepy.

Last reviewed: 
16 May 2018
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    Brisse HJ and others

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  • MIBG in Neuroblastoma Diagnostic Imaging and Therapy

    SE Sharp and others

    RSNA Radiographics, 2016

    Volume 36

  • Imaging in neuroblastoma: An update

    A Kembhavi and others

    Indian Journal of Radiology and Imaging, 2015

    Volume 25, Issue 2

  • Needle core vs open biopsy for diagnosis of intermediate and high-risk neuroblastoma in children

    SF Hassan and others

    Journal of Pediatric Surgery, 2012

    Volume 47, Issue 6

  • Neuroblastoma (Clinical Updates)

    J Shohet and J Foster

    The BMJ, 2017

    Volume 357

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