The European Wilms' tumor study has a long and successful tradition of preoperative chemotherapy where the initial diagnosis is based on radiological criteria only. Approximately 2% of 1603 histological-ly proven neuroblastomas have been pretreated wrongly according to the Wilms' tumor protocol (Hero et al. 2002). The poor outcome of these patients was related more to their unfavorable biological features than to the preoperative Wilms' chemotherapy. If the radiological criteria (Wilms' tumor: intrarenal, destruction of the renal pelvis; neuroblastoma: suprarenal, tumor calcifications) are unable to discriminate, careful observation of the tumor response to preoperative Wilms' tumor chemotherapy is important and, if inadequate, a strong indicator for mis-diagnosis.

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