Pediatric Radiology

, Volume 48, Issue 5, pp 648–657 | Cite as

Importance of whole-body imaging with complete coverage of hands and feet in alveolar rhabdomyosarcoma staging

  • Monika Scheer
  • Tobias Dantonello
  • Peter Brossart
  • Dagmar Dilloo
  • Lothar Schweigerer
  • Simone Feuchtgruber
  • Monika Sparber-Sauer
  • Christian Vokuhl
  • Stefan S. Bielack
  • Thomas Klingebiel
  • Ewa Koscielniak
  • Thekla von Kalle
  • on behalf of the Cooperative Weichteilsarkom Studiengruppe (CWS)
Original Article



Alveolar rhabdomyosarcoma commonly arises in the extremities and is characterized by aggressive biology and high frequency of metastases. Whole-body imaging is increasingly employed in pediatric oncology but not recommended as standard in the staging of soft-tissue sarcomas.


After observing patients with a large symptomatic alveolar rhabdomyosarcoma lesion and a smaller silent lesion in the more distal part of an extremity we sought to estimate the frequency of this constellation.

Materials and Methods

We retrospectively evaluated the data of prospectively registered paediatric patients (age <21 years) with alveolar rhabdomyosarcoma in the SoTiSaR (Soft Tissue Sarcoma Registry) of the Cooperative Weichteilsarkom Studiengruppe (CWS) 09/2011–04/2015 with regard to whole-body imaging.


Seventy-five patients were eligible. Images of 57 patients had been submitted for reference consultation, including 80 whole-body examinations in 36 patients. Among them were 5 patients (14%, 95% confidence interval 3–25%) who had been diagnosed because of a symptomatic lesion while an additional silent lesion in the distal part of an extremity had remained unnoticed and had only been detected by later whole-body imaging. It is noteworthy that in 42 (53%) of all 80 whole-body examinations, the hands and feet had been only partially covered or completely excluded.


In alveolar rhabdomyosarcoma silent lesions can be overlooked when the distal parts of the limbs are not thoroughly examined and not completely covered by imaging. Missing them influences treatment decisions and prognosis. Our results should be considered when evaluating the potential role of whole-body imaging in rhabdomyosarcoma.


Adolescent Alveolar rhabdomyosarcoma Child Extremity tumors Metastases Silent lesions Soft-tissue sarcoma Staging examinations Whole-body imaging 



We are indebted to the personnel of all participating institutions and thank all patients, parents and guardians for their willingness to participate in the CWS-trials.

The study was supported by the German Childhood Cancer Foundation, Bonn; German Cancer Aid, Bonn; Federal Ministry of Research and Technology, Bonn, and the Förderkreis Krebskranke Kinder e.V., Stuttgart, Germany.

Compliance with Ethical Standards

Conflicts of Interest



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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Monika Scheer
    • 1
  • Tobias Dantonello
    • 1
  • Peter Brossart
    • 2
  • Dagmar Dilloo
    • 3
  • Lothar Schweigerer
    • 4
  • Simone Feuchtgruber
    • 1
  • Monika Sparber-Sauer
    • 1
  • Christian Vokuhl
    • 5
  • Stefan S. Bielack
    • 1
    • 6
  • Thomas Klingebiel
    • 7
  • Ewa Koscielniak
    • 1
    • 8
  • Thekla von Kalle
    • 9
    • 10
  • on behalf of the Cooperative Weichteilsarkom Studiengruppe (CWS)
  1. 1.Stuttgart Cancer Center, Peadiatric 5 (Oncology, Hematology, Immunology)Klinikum Stuttgart-OlgahospitalStuttgartGermany
  2. 2.Department of OncologyUniversity Hospital BonnBonnGermany
  3. 3.Department of Paediatric OncologyUniversity Hospital BonnBonnGermany
  4. 4.Department of Paediatric OncologyHelios KlinikumBerlinGermany
  5. 5.Kiel Peadiatric Tumour Registry, Department of Pediatric PathologyUniversity Hospital KielKielGermany
  6. 6.Department of Paediatric Hematology and OncologyUniversity Children’s HospitalMuensterGermany
  7. 7.Department of Paediatric OncologyUniversity of Frankfurt (Main)FrankfurtGermany
  8. 8.Department of Paediatric OncologyUniversity of TuebingenTuebingenGermany
  9. 9.Institute of Paediatric RadiologyKlinikum Stuttgart-OlgahospitalStuttgartGermany
  10. 10.Department of Radiology, Diagnostic and Interventional RadiologyUniversity of TuebingenTuebingenGermany

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