The diagnostic approach includes obtaining a thorough history for key diagnostic symptoms such as a painless, unilateral upper abdominal/flank mass, and for presence of a positive family history (although rare) and any congenital anomalies or associated congenital syndromes. Abdominal ultrasound is the initial test of choice to establish the diagnosis, and CT or MRI of abdomen and pelvis are useful to stage the tumour and plan further therapy. Definitive diagnosis of suspected Wilms' tumour is made by surgical resection (nephrectomy) or open biopsy (if tumour is unresectable). Metastatic disease should be ruled out on CXR and abdominal/pelvis CT or MRI.
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