(2) Bone marrow aspirate or trephine biopsy contains unequivocal tumor cells" (e.g., syncytia or immunocytologically positive clumps of cells) and increased urine or serum catecholamines or metabolites.6

aIf histology is equivocal, karyotypic abnormalities in tumor cells characteristic of other tumors [e.g., t(11;22)], excludes a diagnosis of neuroblastoma, whereas genetic features characteristic of neuroblastoma (1p deletion, MYCN amplification) would support this diagnosis.

6Includes dopamine, HVA, and/or VMA (levels must be >3.0 SD above the mean per-milligram creatinine for age to be considered increased, and at least two of these must be measured).

From Brodeur GM, Pritchard J, Bethold F, et al. Revisions of the International Criteria for Neuroblastoma Diagnosis, Staging, and Response to Treatment. J Clin Oncol 1993;11:1466, with permission.

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