CION Ameerpet
Pediatric Oncology · Cancer Types & Subtypes
How neuroblastoma is diagnosed — MIBG, catecholamines & beyond
Medically reviewed by Dr. Naresh Gundu, Medical Oncology · Last reviewed June 2026
If your child has been told they may have neuroblastoma, the next step is a careful sequence of tests — urine catecholamines, imaging including an MIBG scan, biopsy, and bone marrow sampling. Each test answers a different question. Our paediatric oncology team walks with you through every one of them, with 45-minute consultations and a dedicated tumour board for every child's case.
- Coordinated diagnosis — all tests ordered and reviewed by the same paediatric oncology team
- MIBG & catecholamines testing — specialist nuclear medicine and urine testing available across our network
- Tumour board for every child — surgical, medical, and radiation oncologists review each case together
- Free first consultation — bring your child's existing reports; we will give you a clear, honest picture
17+
Cancer Specialists
on Panel
on Panel
96.9%
Breast Cancer
Survival Rate*
Survival Rate*
15,000+
Patients
Treated
Treated
4.8★
Google Rating
(800+ reviews)
(800+ reviews)
Understanding neuroblastoma
What is neuroblastoma — and why does the neuroblastoma diagnosis process involve so many tests?
Neuroblastoma is a cancer that forms from immature nerve cells — called neuroblasts — that are part of the sympathetic nervous system. Most neuroblastomas start in the adrenal glands, the small organs that sit on top of each kidney. Because the sympathetic nervous system runs from the brain down through the chest and abdomen, tumours can also appear in the neck, chest, or pelvis.
Neuroblastoma is the most common solid tumour outside the brain in children under five years old. It can behave very differently from one child to another: some tumours are slow-growing and localised, while others spread quickly to bone, bone marrow, or the liver before they are found. This wide range of behaviour is exactly why the diagnostic process is thorough — the tests are not just confirming cancer is present, they are building a precise picture of that particular child's tumour so the treatment plan can be as well-matched as possible.
If you are reading this page, you are probably waiting for test results or trying to understand what a doctor has told you. That uncertainty is one of the hardest parts. We want this page to answer your questions clearly, without jargon and without false reassurance — so that when you next speak to your oncologist, you feel equipped to ask the right questions.
At CION, every child's case is reviewed by a multidisciplinary tumour board that includes medical, surgical, and radiation oncologists. No single doctor decides alone. We walk this journey with you — from the first suspicious finding through to a clear diagnosis and an evidence-based treatment plan.
The diagnostic process
How neuroblastoma is diagnosed — the process, step by step
Neuroblastoma diagnosis unfolds in a defined sequence. Understanding each step helps you know what to expect and what each result means for the next decision.
1
Clinical examination and initial suspicion
A paediatrician or general doctor notices something that does not fit a common illness — a firm lump in the abdomen, unexplained weight loss, pallor, bone pain, or swelling around the eyes (a sign that can occur when neuroblastoma spreads). The child is referred promptly to a paediatric oncologist. At this stage, no cancer diagnosis is confirmed — only a concern that warrants specialist evaluation.
2
Blood tests and urine catecholamines
The oncologist orders a full blood count, kidney and liver function tests, LDH (lactate dehydrogenase), and ferritin — elevated LDH and ferritin are associated with more aggressive neuroblastoma. Critically, a urine sample is collected to measure VMA (vanillylmandelic acid) and HVA (homovanillic acid), the breakdown products of catecholamines. Elevated urinary catecholamines in a child with an abdominal mass are a strong pointer toward neuroblastoma and help rule out other causes of a lump.
3
Imaging: ultrasound, CT, and MRI
An ultrasound is usually the first imaging step because it is quick, does not use radiation, and can confirm that a mass is solid. A CT scan or MRI then gives a detailed picture of the tumour's size, its relationship to nearby blood vessels, and whether it has crossed the midline of the body or involved nearby lymph nodes. This information is used for the INRG pre-surgical staging (L1 or L2) and for planning whether surgery is safe upfront. MRI is often preferred for tumours near the spine to avoid radiation in young children.
4
MIBG scan — mapping the full extent of disease
The MIBG (meta-iodobenzylguanidine) scan is a nuclear medicine study specific to neuroblastoma. A small amount of radioactively labelled MIBG is injected and taken up selectively by neuroblastoma cells throughout the body. Images are taken 24–48 hours later using a gamma camera. The MIBG scan shows not just the primary tumour but any deposits that have spread to bones, lymph nodes, or other organs — information that CT and MRI cannot reliably provide on their own. Before the injection, the child receives iodine drops to protect the thyroid gland. The scan itself is painless and the child simply needs to lie still, which may require sedation in very young children.
5
Biopsy — confirming the diagnosis and tumour biology
A sample of the tumour is obtained by image-guided core needle biopsy or a small surgical procedure. The pathologist examines the cells under a microscope (histopathology) and sends the sample for molecular testing. The most important molecular finding is whether the MYCN gene is amplified — this single result has a major effect on risk classification and treatment intensity. Other markers evaluated include chromosome 1p and 11q status. The biopsy result, not the imaging, is the definitive confirmation of neuroblastoma.
6
Bone marrow assessment
Neuroblastoma commonly spreads to the bone marrow. To check for this, samples are taken from two separate sites — typically the back of each hip bone (posterior iliac crests). This is done under general anaesthesia so that your child is fully asleep and comfortable. The samples are examined by a pathologist and assessed for the presence of neuroblastoma cells. Bone marrow involvement determines whether the disease is Stage M (spread) or confined (Stage L1/L2), which is central to the risk group assignment.
7
Risk group assignment and tumour board review
Once all results are available, the oncology team brings everything together: imaging stage, age at diagnosis, histopathology, MYCN status, and other molecular markers. Each child is placed into a risk group — low, intermediate, or high — that determines the treatment approach. At CION, every neuroblastoma case is reviewed at a multidisciplinary tumour board before any treatment decision is made. You will receive a clear, unhurried explanation of your child's risk group and what the treatment plan involves, with full transparency on timelines and what to expect at each stage.
12+ Centres in Hyderabad · Pick yours
CION cancer care is closer than you think.
We're never more than 30 minutes away. Same panel of specialists at every centre. Same tumour board reviews. Same NCCN protocols. Pick the closest one and call directly — or let us pick for you.
CION Ameerpet
CION Kukatpally
CION L.B. Nagar
CION Tolichowki
CION Masab Tank
CION Banjara Hills
CION Kompally
CION Balanagar
CION Siddipet
CION Sangareddy
Not sure which centre fits best? Tell us where you are — we'll suggest the closest one with the right specialists.
Help me pick the right centre
Beyond Hyderabad
35+ centres across Telangana & Andhra Pradesh
Travelling for treatment? We may have a centre right where you are.
Telangana
Andhra Pradesh
Don't see your city? Call 18002028726 — we'll find your nearest CION partner centre.
Meet the Specialists
17+ senior cancer specialists. One panel for your case.
Trained at AIIMS, Tata Memorial, and leading international centres. Combined 150+ years of experience. Every complex case is reviewed by 3+ of them — together.
Medical Oncologist
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
Surgical Oncologist
Surgical Oncologist
Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
Surgical Oncologist
Radiation Oncologist
Radiation Oncologist
Radiation Oncologist
Hematologist
Interventional Radiologist
Dr. Mohammed Imran
Surgical Oncologist
Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
Surgical Oncologist
Want a specific doctor for your case? Mention them when booking.
Book Free ConsultationBook an appointment with our specialist
Share your name and number — we'll call you back within 30 minutes to schedule your consultation.
Understanding the tests is just the first step — let us help you navigate what comes next
Every child with neuroblastoma deserves a coordinated team that reads every report together and explains the plan clearly. We walk this journey with you.
Key diagnostic tests explained
What each test in the neuroblastoma diagnosis tells doctors
Each investigation in the workup answers a specific question. Here is what each one is looking for — and why it matters for your child's treatment plan.
Urinary catecholamines (VMA & HVA)
What it shows: Whether neuroblastoma cells are releasing abnormal amounts of catecholamine breakdown products into urine. Why it matters: A clearly elevated VMA or HVA alongside a mass is a strong pointer toward neuroblastoma. These levels are also tracked during and after treatment to see whether the tumour is responding.
MIBG scan (nuclear medicine imaging)
What it shows: The exact location of neuroblastoma cells anywhere in the body — primary tumour and any metastatic deposits — using the tumour's natural ability to take up the MIBG tracer. Why it matters: An MIBG scan is the most sensitive way to determine whether the disease has spread beyond the original site, which directly determines the stage and the treatment intensity.
CT scan and MRI
What they show: Detailed anatomy of the primary tumour — its size, its relationship to blood vessels and nearby structures, and whether it crosses the midline. Why they matter: These images determine whether the tumour can be safely removed with surgery upfront, or whether treatment to shrink it is needed first. MRI is also used to check for spinal involvement, which is a surgical emergency if present.
Tumour biopsy and molecular testing
What it shows: The definitive diagnosis and, crucially, the tumour's biology — including MYCN amplification status and chromosomal changes that predict how aggressive the cancer is likely to be. Why it matters: Biopsy is the only test that confirms neuroblastoma with certainty and provides the molecular information that determines whether a child is in a low, intermediate, or high-risk group. Treatment intensity is set by this result.
Bone marrow aspiration and trephine biopsy
What it shows: Whether neuroblastoma cells have spread into the bone marrow — one of the most common sites of spread in high-risk disease. Samples are taken from two hip-bone sites to increase accuracy. Why it matters: Bone marrow involvement confirms Stage M disease and shifts the child into a high-risk category, requiring more intensive treatment. It is performed under anaesthesia so the child feels nothing during the procedure.
Blood markers: LDH and ferritin
What they show: LDH (lactate dehydrogenase) and ferritin are non-specific markers of cell turnover and tumour burden. Significantly elevated levels at diagnosis are associated with more active disease and are incorporated into risk stratification tools alongside staging and molecular results. Why they matter: These routine blood tests are quick to obtain and give the team an early signal of disease activity before imaging and biopsy results are available. They are also monitored during treatment to track response.
Your child may not need every test listed above. The specific combination depends on clinical findings, age, and what each investigation shows. Your oncologist will tell you exactly which tests are needed and why.
Read our detailed guide to the MIBG scan for neuroblastoma →
You deserve the best care for your child
A coordinated team. A clear plan. No rushed decisions.
We know the waiting is the hardest part. Our team will walk with you through every result, every test, and every decision — so you are never navigating this alone.
Real Stories. Real Voices.
15,000+ patients chose CION. Hear from them directly.
These aren't paid endorsements or written reviews. These are video testimonials from real patients and families — recorded on their own phones, in their own words. Pick any one. Watch it. Then decide.
4.8★800+ Google reviews
50+video testimonials
15,000+patients treated
Read all 800+ reviews on Google
Start Your Story. Book Free Consultation.
Common questions
Your questions about neuroblastoma diagnosis — answered
What is neuroblastoma and how is it different from other childhood cancers?
Neuroblastoma is a cancer that develops from immature nerve cells — called neuroblasts — found in the adrenal glands and the sympathetic nervous system. The adrenal glands sit on top of the kidneys, which is why many neuroblastoma tumours are first felt as a lump in the abdomen. Unlike blood cancers such as leukaemia, neuroblastoma forms a solid tumour that can be seen on imaging. It is one of the most common solid tumours in young children, and it tends to produce hormones called catecholamines — this chemical signature is very helpful for diagnosis. The behaviour of neuroblastoma varies widely: some tumours in very young infants may even shrink on their own, while others are aggressive and require intensive treatment. A full diagnostic workup is essential to understand how each child's tumour will behave.
What is a catecholamines test for neuroblastoma and how is it done?
Catecholamines are a family of hormones — including adrenaline, noradrenaline, and their breakdown products — that the sympathetic nervous system naturally produces. Neuroblastoma cells, because they arise from nerve tissue, typically continue to produce these chemicals in large amounts. The catecholamines neuroblastoma test measures the breakdown products of these hormones — primarily VMA (vanillylmandelic acid) and HVA (homovanillic acid) — in a child's urine sample collected over 24 hours, or sometimes in a single spot urine sample. Elevated VMA and HVA levels are a strong indicator of neuroblastoma and help doctors both diagnose the tumour and track whether treatment is working. The test is non-invasive and painless — it simply involves collecting urine at home or in the hospital over a set period.
What is an MIBG scan and why is it used for neuroblastoma?
MIBG stands for meta-iodobenzylguanidine — a substance that neuroblastoma cells absorb because they behave like nerve cells. A small amount of radioactively labelled MIBG is injected into the bloodstream. The substance travels to wherever neuroblastoma cells are present — not just the primary tumour but also any deposits that have spread elsewhere in the body. A special gamma camera then detects the radioactive signal and maps exactly where the tumour is. This is why an MIBG scan is central to neuroblastoma diagnosis: it shows the full extent of the disease in a way that CT or MRI alone cannot. MIBG is used both to confirm the diagnosis and to check how much of the body is affected, which directly guides treatment planning.
Does my child need a biopsy to confirm neuroblastoma?
Yes, in almost all cases a tissue biopsy is required to confirm neuroblastoma. Imaging and urine tests can strongly suggest the diagnosis, but a biopsy gives the pathologist a sample of the actual tumour cells. The pathologist examines the cells under a microscope and, crucially, sends the sample for molecular and genetic testing. These tests look for specific changes — such as a gene amplification called MYCN — that affect the tumour's behaviour and guide how intensively it should be treated. The biopsy may be performed with a needle (image-guided core needle biopsy) or through a small surgical incision, depending on where the tumour is. The result is not just about confirming cancer — it shapes the entire treatment plan.
What does neuroblastoma staging mean and how does it affect treatment?
Staging tells doctors how far the neuroblastoma has spread from where it started. The system most commonly used today is the International Neuroblastoma Risk Group Staging System (INRGSS). Stage L1 means the tumour is localised and does not involve any major structures nearby. Stage L2 means the tumour is localised but has features that make surgery more complex. Stage M means the cancer has spread to distant parts of the body such as the bone marrow, bones, or liver. Stage Ms is a special category for infants with limited spread that often resolves on its own. Beyond staging, doctors also look at a child's age and the tumour's biology — including MYCN status — to place each child into a risk group (low, intermediate, or high), which determines the treatment intensity. Your oncology team will explain what your child's risk group means for the path ahead.
How long does it take to get a neuroblastoma diagnosis?
Reaching a complete neuroblastoma diagnosis typically takes one to three weeks from the time the first specialist is seen, though it can feel much longer when you are waiting. The process involves several steps that must happen in sequence: initial blood and urine tests, imaging scans (ultrasound, CT, MRI, MIBG), a biopsy, bone marrow sampling, and waiting for pathology and molecular test results. Each step provides a piece of the picture, and some results — particularly molecular genetic testing — take several days to return. The team will share findings with you as they come in rather than waiting for everything to be complete. If you feel the process is moving slowly or you would like a second opinion while results are pending, asking your care team or requesting a tumour board review is entirely reasonable.
Pediatric Cancer A–Z
Explore All Pediatric Cancer Topics
Browse our complete library of parent-facing guides, grouped by topic — from warning signs and cancer types to diagnosis, treatment, side-effect care, survivorship and family support.