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Neuroblastoma Diagnosis, Staging, and Risk Groups

At Sheba Medical Center, we are dedicated to providing exceptional care for patients diagnosed with neuroblastoma, a type of pediatric cancer. Our team of specialists works tirelessly to ensure that each patient receives the highest standard of care, from the initial stages of diagnosis to the development of specialized treatment plans. Our multidisciplinary team, including oncologists, pediatric oncologists, radiation oncologists, pathologists, and other experts, collaborates closely to determine the precise diagnosis and stage of your child’s disease.

We are committed to providing comprehensive and personalized care for your child. Together, we will determine the most appropriate treatment plan based on your child’s unique situation, ensuring the best possible outcomes in their neuroblastoma journey.

Neuroblastoma Diagnosis

At Sheba, we have state-of-the-art facilities equipped with advanced testing and diagnostic equipment, allowing us to obtain accurate and prompt results throughout the diagnostic and treatment process. We understand the importance of timely action and swift decision-making, which is why we prioritize efficiency and precision at every stage.

During your child's diagnostic evaluation, our experienced team may perform a range of procedures to gather crucial information about the extent and characteristics of the neuroblastoma, including the following procedures:

Physical Exam

Physical exams play a crucial role in the diagnosis of neuroblastoma. At Sheba Medical Center, our experienced medical professionals conduct thorough physical examinations to evaluate the signs and symptoms that may indicate the presence of neuroblastoma. During the exam, the physician carefully examines the child's body, looking for any lumps, masses, or abnormalities. They assess the abdomen for the presence of a tumor or enlarged lymph nodes. In addition, they may check for other symptoms such as bone pain, unexplained bruising or bleeding, and changes in the eyes or skin.

These physical exams provide valuable information that helps guide further diagnostic investigations, such as imaging tests and biopsies, leading to an accurate diagnosis and appropriate treatment plan.

Laboratory Tests

At Sheba, our expert medical team employs a range of laboratory tests to aid in the identification and characterization of neuroblastoma. These tests involve the analysis of blood and urine samples, which provide valuable insights into specific markers and substances associated with the disease.

By assessing various biomarkers and genetic factors, these laboratory tests contribute to a comprehensive diagnostic approach, allowing our healthcare professionals to confirm the presence of neuroblastoma, determine its stage, and develop personalized treatment plans.

Blood Tests

Blood tests may include a complete blood count (CBC) to evaluate the levels of red and white blood cells, as well as platelets. Additionally, specific blood tests may be conducted to measure the levels of certain substances, such as catecholamines (norepinephrine and dopamine), which are released from sympathetic nervous system cells, and metabolites homovanillic acid (HVA) and vanillylmandelic acid (VMA), which are typically elevated in neuroblastoma cases.

Urine Tests

Like blood tests, urine tests evaluate levels of substances in the urine after they are excreted from the bloodstream, including catecholamines and their metabolites, such as HVA and VMA. By analyzing these urinary markers, our medical professionals can gain important insights into the presence and extent of neuroblastoma. Urine tests are non-invasive and relatively simple to perform, making them an essential component of the diagnostic process.

By leveraging the insights gained from blood and urine tests, combined with other diagnostics tools, our expert team can create a comprehensive evaluation of your child’s condition and develop a personalized treatment plan tailored to their needs, improving their chances of successful outcomes.

Imaging Tests

Imaging tests used in the diagnostic evaluation help doctors to determine if an area in the body is cancerous and whether cancer has spread, and if so, to what extent. During your child's diagnostic evaluation, our experienced team may perform a range of imaging tests, such as bone scans, x-rays, ultrasounds, positron emission tomography (PET) scans, computed tomography (CT) scans, magnetic resonance imaging (MRI), and metaiodobenzylguanidine (MIBG) scans.

Bone Scan

A bone scan is a diagnostic imaging tool used to evaluate if neuroblastoma has spread to the bones. This non-invasive procedure involves the injection of a small amount of a radioactive substance into the bloodstream. The substance then accumulates in areas of abnormal bone activity, indicating the presence of neuroblastoma metastasis. A bone scan helps our medical professionals determine the extent and location of the disease in the bones, assisting in staging and treatment planning.

Computed Tomography (CT) Scan

A CT scan utilizes X-ray technology and advanced computer processing to generate detailed cross-sectional images of the body. A CT scan is a valuable tool for diagnosing and staging neuroblastoma as it provides precise information about the size, location, and involvement of tumors in different organs. This imaging technique enables our medical experts to visualize the tumor's extent, nearby lymph nodes, and potential spread to other organs. By combining multiple X-ray images, a CT scan offers a comprehensive view, aiding in accurate diagnosis and treatment decision-making.

Magnetic Resonance Imaging (MRI)

MRI is a powerful imaging technique that uses a magnetic field and radio waves to create detailed images of the body's soft tissues. An MRI is commonly employed to assess neuroblastoma and its potential involvement in critical structures such as the adrenal glands, abdomen, and chest. This non-invasive procedure provides high-resolution images, allowing our medical professionals to precisely evaluate the size, location, and characteristics of neuroblastoma tumors. MRI plays a vital role in determining the extent of the disease and guiding treatment strategies.

Methyliodobenzylguanine (MIBG) Scan

MIBG scan is a specialized nuclear imaging test used to detect neuroblastoma cells. This procedure involves injecting a small amount of radioactive material, which is absorbed by neuroblastoma cells. At Sheba, the MIBG scan provides detailed images that help localize and assess the extent of neuroblastoma tumors. It is particularly effective in detecting and staging the disease, including identifying metastases to the bones, lymph nodes, or other distant sites. The MIBG scan aids in treatment planning, allowing our medical experts to target neuroblastoma cells accurately.

Positron Emission Tomography (PET) Scan

PET scans are valuable imaging tools used to detect areas of increased metabolic activity in the body. A PET scan can be combined with a CT scan to provide precise anatomical and functional information. By injecting a small amount of radioactive material into the bloodstream, the PET scan highlights areas with high glucose uptake, indicating active tumor cells. This imaging technique is helpful in determining the spread of neuroblastoma, evaluating treatment response, and monitoring disease progression.


Ultrasound imaging utilizes sound waves to create real-time images of internal organs and tissues. Ultrasounds are often used in the initial evaluation of neuroblastoma, particularly for infants and young children. It helps identify the primary tumor site, assess its characteristics, and evaluate nearby structures. Ultrasound is safe, non-invasive, and does not involve radiation exposure, making it an excellent choice for pediatric patients.

X-ray Scan

X-ray scans use low levels of radiation to create images of the body's structures, including the chest and bones. While X-rays alone may not provide a definitive neuroblastoma diagnosis, they are commonly used as a preliminary imaging tool to identify suspicious areas or evaluate bone involvement. At Sheba, X-ray scans are often complemented by other imaging modalities for a comprehensive evaluation of neuroblastoma.

These imaging tools, utilized at Sheba Medical Center, provide invaluable information for the diagnosis, staging, and treatment planning of neuroblastoma. Our dedicated team of specialists utilizes these advanced techniques to ensure accurate assessments and deliver personalized care to our patients.


A biopsy is an essential diagnostic procedure for neuroblastoma, providing definitive confirmation of the disease. At Sheba, our skilled medical professionals employ different biopsy techniques to obtain tissue samples for analysis, including:

Tumor Biopsy

Tumor biopsy involves the surgical removal of a small piece of the tumor mass, allowing pathologists to examine it under a microscope to confirm the presence of neuroblastoma cells. This procedure may be performed during surgery or through image-guided techniques, such as ultrasound or CT scans, for precise localization.

Bone Marrow Aspiration and Biopsy

Bone marrow aspiration and biopsy are often conducted to assess the extent of neuroblastoma and determine if it has spread to the bone marrow. Bone marrow aspiration involves extracting a small sample of bone marrow fluid using a needle. In contrast, bone marrow biopsy involves the removal of a small piece of bone and marrow tissue. These samples are then analyzed to identify any neuroblastoma cells present in the bone marrow.

Biopsy procedures are performed with utmost care and precision to minimize discomfort and complications. Since they are very painful tests, the child is either given medication to reduce pain or put to sleep for the duration of the procedure. The obtained tissue samples are examined by skilled pathologists who specialize in pediatric oncology, contributing to accurate diagnosis and informing the subsequent treatment plan.

At Sheba, our dedicated team ensures that patients receive the highest level of expertise and compassionate care throughout the biopsy process, aiding in the precise diagnosis and optimal management of neuroblastoma.

Neuroblastoma Staging

After a neuroblastoma diagnosis, physicians will try to figure out if the cancer has spread and, if so, how far. Our specialists gather all the information from diagnostic tests and may perform further tests for staging if necessary. The disease stage helps determine the severity of the cancer and gives a better idea of the patient’s prognosis.

Stage 1

Stage 1 neuroblastoma is characterized by a localized tumor that can be completely removed through surgery. The tumor is confined to its site of origin and has not spread to nearby lymph nodes or other distant organs. The prognosis for stage 1 neuroblastoma is generally favorable, with a high likelihood of successful treatment and long-term survival.

Stage 2A

Stage 2A neuroblastoma refers to a tumor that has spread to nearby lymph nodes on the same side of the body as the primary tumor. However, the tumor itself can still be completely removed through surgery. The prognosis for stage 2A neuroblastoma varies depending on specific factors, such as the patient's age and the tumor's characteristics.

Stage 2B

In stage 2B neuroblastoma, the tumor has spread to nearby lymph nodes on the opposite side of the body from the primary tumor. Similar to stage 2A, the tumor can be completely removed through surgery. As stage 2A, the prognosis for stage 2B neuroblastoma depends on various factors, such as the patient's age and the tumor's specific characteristics.

Stage 3

Stage 3 neuroblastoma indicates that the tumor has extended beyond its original location and has infiltrated nearby structures or crossed the midline of the body. Complete surgical removal of the tumor may be challenging due to its size and involvement with surrounding tissues. The prognosis for stage 3 neuroblastoma depends on several factors, such as the age of the patient, the tumor's location and size, and whether it can be surgically resected.

Stage 4

Stage 4 neuroblastoma is characterized by the presence of distant metastases in organs such as the bones, bone marrow, liver, or other distant sites. The primary tumor may or may not be completely resectable. Stage 4 neuroblastoma has a higher risk and is associated with a more challenging prognosis, requiring a comprehensive and aggressive treatment approach.

Stage 4S

Stage 4S neuroblastoma primarily affects infants, and the tumor has spread to specific organs, such as the liver, skin, or bone marrow. Despite the presence of metastases, the overall prognosis for stage 4S neuroblastoma is generally favorable, especially in infants under the age of one year.

Relapsed Neuroblastoma

Relapsed neuroblastoma refers to the recurrence of the disease after initial treatment. It may occur locally at the site of the original tumor or in distant locations. The treatment approach for relapsed neuroblastoma depends on several factors, including the time of relapse, the extent of the recurrence, and the response to previous therapies.

At Sheba Medical Center, our team of specialists is highly experienced in staging neuroblastoma based on these classifications. Accurate staging is crucial for determining the most appropriate treatment plan and optimizing the chances of successful outcomes. Our multidisciplinary approach ensures that each patient receives personalized care and tailored treatments that address their neuroblastoma's specific stage and characteristics.

Neuroblastoma Risk Groups

In addition to staging, specialists will assign a risk group to the child based on various diagnostic factors: low-risk, intermediate-risk, or high-risk.

Low-Risk Neuroblastoma

Low-risk neuroblastoma refers to a subgroup of neuroblastoma with a favorable prognosis. Typically, it includes stage 1 or stage 2 neuroblastoma in infants younger than 12 months. These tumors are often small, well-defined, and localized. Low-risk neuroblastoma may exhibit favorable biological characteristics, such as low levels of certain genetic markers or favorable histology. Treatment approaches for low-risk neuroblastoma may involve observation, surgical resection, or minimal chemotherapy. The overall survival rate for low-risk neuroblastoma is high, with an increased likelihood of long-term remission and cure.

Intermediate-Risk Neuroblastoma

Intermediate-risk neuroblastoma encompasses a diverse group of tumors with intermediate characteristics between low-risk and high-risk neuroblastoma. It includes certain stage 2 or stage 3 tumors, as well as tumors with specific genetic or biological features. The prognosis for intermediate-risk neuroblastoma varies depending on factors such as age, tumor characteristics, and response to treatment. Treatment strategies may involve a combination of surgery, chemotherapy, radiation therapy, and other targeted therapies. Close monitoring and personalized treatment plans are tailored to achieve the best possible outcomes for patients with intermediate-risk neuroblastoma.

High-Risk Neuroblastoma

High-risk neuroblastoma represents the most aggressive and challenging form of the disease. It includes tumors with features such as stage 4 neuroblastoma, MYCN gene amplification, unfavorable histology, or other genetic abnormalities associated with aggressive behavior. High-risk neuroblastoma often requires intensive multimodal treatment approaches, including surgery, high-dose chemotherapy, radiation therapy, immunotherapy, and stem cell transplantation.

The prognosis for high-risk neuroblastoma depends on various factors, such as age, response to treatment, and specific genetic markers. Despite the challenges, advancements in treatment protocols and research have improved outcomes for some patients with high-risk neuroblastoma.

Diagnosing Neuroblastoma at Sheba

In conclusion, at Sheba Medical Center, we take a comprehensive and patient-centered approach to the diagnosis, staging and risk classification of neuroblastoma. Our team of highly skilled specialists, including oncologists, pediatric oncologists, radiation oncologists, pathologists, and other experts, work collaboratively to ensure accurate and precise assessments. From the initial diagnostic evaluation to the determination of the disease stage and risk group, our state-of-the-art facilities and advanced imaging techniques enable us to provide prompt and thorough results.

Sheba Medical Center provides innovative, personalized neuroblastoma treatment to patients from around the world to patients from around the world. We are the largest, most comprehensive hospital in the Middle East and dedicated to providing advanced and compassionate medicine for everyone. We welcome all cases, including the rarest and the most challenging.

Our medical teams collaborate to provide the best possible health outcomes. From your initial inquiry through the long-term follow-up care, we are here for you. If you or your loved one is facing a neuroblastoma diagnosis or seeking a second opinion, we encourage you to request a consultation with our experienced case managers at Sheba Medical Center.

Request a consultation

Sheba Medical Center provides innovative, personalized medical care to patients from around the world. We are the largest, most comprehensive hospital in the Middle East and dedicated to providing advanced and compassionate medicine for everyone. We welcome all cases, including the rarest and the most challenging. Our medical teams collaborate to provide the best possible health outcomes. From your initial inquiry through the long-term follow-up care, we are here for you.

Request a consultation and a Sheba Case Manager will contact you shortly: