Editorial comment

摘要

This report from Burnette et al presents an interesting case in which a retroperitoneal metastasis from p-RMS was apparently missed using standard staging imaging. From their case, the authors make an argument for PET-CT as the first-line staging imaging modality in children with p-RMS to improve the sensitivity and specificity of the staging findings. However, this conflicts with their title, which includes the "as low as reasonably achievable" principle. Although PET-CT, on its own, confers less ionizing radiation exposure than the current recommended imaging study for staging,1 no data are available to support a paradigm of using PET-CT alone, forgoing the standard staging study using contrast-enhanced CT, in this setting. Therefore, the PET phase would be included with the current standard imaging protocol, adding to the overall radiation exposure. Although I agree that increasing the accuracy of staging in this population is an important goal, a broad recommendation to routinely include PET-CT would be overreaching, resulting in unnecessary radiation exposure to many patients. Rather, the objective should be to identify and use markers of aggressive tumor biology and then adjust the staging studies and therapy accordingly.