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Small adrenal masses found in infants under six months could safely be watched rather than operated on: nearly half shrank or disappeared and the rest were removed later without any child dying of neuroblastoma.
Children's Oncology Group prospective study of 87 infants under six months with small (under 3.1 cm solid or 5 cm cystic) adrenal masses managed by observation with serial ultrasound and urinary catecholamines, with surgery for growth or progression.
Eighty-one percent avoided surgery; among those observed, 45 percent had complete or partial spontaneous resolution, and three-year event-free and overall survival were 97.7 and 100 percent.
Observation without biopsy is standard for small adrenal masses in young infants, sparing them surgery for tumours that often regress.