Diagnostic Strategies for Neuroblastoma in Children With Horner Syndrome: A Proposed Diagnostic Algorithm

Neuroblastoma constitutes the most frequent solid tumor in children under 2 years of age. It is most often located in the abdomen; however, it may also be found in the mediastinum or the neck, and its first and only symptom may be Horner syndrome (HS). Because various imaging and laboratory examinations may be employed in order to detect the tumor, the objective of our study was to assess their sensitivity in detecting neuroblastoma in children with HS. The study comprised data from 14 oncologic departments in Poland and involved children with a clinical diagnosis of neuroblastoma. In total, 729 patients were included in the analysis who were diagnosed between 2004 and 2022. HS occurred before the neuroblastoma diagnosis in 3.29% of cases. The study evaluated the sensitivity of lactate dehydrogenase (LDH), ferritin and neuron-specific enolase (NSE) serum concentration, dopamine and vanillylmandelic acid urinary levels, as well as of chest radiography in the detection of neuroblastoma tumor. The combination of urinary catecholamines demonstrated a low sensitivity (72.57%). However, chest radiography proved to be highly effective in identifying lesions associated with neuroblastoma (92.31% sensitivity in patients with HS on the first presentation), which may be further enhanced by means of performing LDH, ferritin, and NSE blood concentration tests (100% sensitivity). Our findings indicate that chest radiography and serum laboratory tests may represent valuable tools in the primary diagnosis of HS etiology. In contrast, urinary catecholamines test should not be considered a diagnostic criterion.