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Tumor Size (cm)
Histologic Type (select all that apply)
Degree of Differentiation (neuroblastic component)
Mitotic-Karyorrhectic Index (neuroblastic component)
+ Treatment Effect
Primary Tumor Extent
International Neuroblastoma Pathology Classification
INRG staging system
INRG Staging System Explained
International Neuroblastoma Risk Group (INRG) Staging System (INRGSS)
Recently, a new clinical staging system, the INRGSS, has been proposed and increasingly
adopted.6 Unlike the INSS, which relies on postsurgical data, the INRGSS relies only
on pretreatment imaging, patient age, and clinical extent of disease. The INRGSS can
be summarized as localized disease (stage L1), regional disease (stage L2), metastatic
disease (stage L3), and “special stage” (stage MS, similar to the INSS stage 4S).
However, this schema relies heavily on image-defined risk factors* and may be
difficult for pathologists to implement.