From Adult Renal Masses to Pediatric Wilms Tumors: Evaluating Cross-Domain Generalization of Kidney Lesion Segmentation on MRI

Sarah de Boer; Myrthe A. D. Buser; Hartmut Häntze; Jawed Nawabi; Lisa C. Adams; Alida F. W. van der Steeg; Marry M. van den Heuvel-Eibrink; Annemieke S. Littooij; Keno K. Bressem; Mathias Prokop; Alessa Hering

arXiv · 2610.23568

From Adult Renal Masses to Pediatric Wilms Tumors: Evaluating Cross-Domain Generalization of Kidney Lesion Segmentation on MRI

Sarah de Boer·Myrthe A. D. Buser·Hartmut Häntze·Jawed Nawabi·Lisa C. Adams·Alida F. W. van der Steeg·Marry M. van den Heuvel-Eibrink·Annemieke S. Littooij·Keno K. Bressem·Mathias Prokop·Alessa Hering

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Abstract

Deep learning segmentation models for pediatric oncology are often trained on small, single-center cohorts, whereas much larger datasets exist for adult diseases, such as kidney cancer. Whether models trained on adult renal lesions generalize to pediatric Wilms tumors remains unclear. We trained a segmentation model on single-sequence T1- or T2-weighted adult kidney MRI and evaluated it on a held-out adult test set and a pediatric Wilms tumor cohort, where it was compared with a pediatric-specific nnU-Net. Segmentation performance was quantified using the Dice similarity coefficient (DSC) and 95th-percentile Hausdorff distance. On the adult test set, the model achieved a median DSC of 0.86 for renal lesions. On the pediatric cohort, the adult-trained model achieved a median DSC of 0.85 compared with 0.90 for the pediatric-specific model. Despite differences in age, anatomy, and tumor type, the adult-trained model showed promising performance on pediatric Wilms tumors, with only a modest difference in median DSC compared with the pediatric-specific model. However, non-inferiority could not be shown, highlighting the value of pediatric training data. In future work, a fine-tuning strategy could be explored.

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Sarah de Boer, Myrthe A. D. Buser, Hartmut Häntze, Jawed Nawabi, Lisa C. Adams, Alida F. W. van der Steeg, Marry M. van den Heuvel-Eibrink, Annemieke S. Littooij, Keno K. Bressem, Mathias Prokop, Alessa Hering. 2026-10-16. From Adult Renal Masses to Pediatric Wilms Tumors: Evaluating Cross-Domain Generalization of Kidney Lesion Segmentation on MRI. https://arxiv.org/abs/2610.23568

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