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Patel M, Jha A, Ling A, Chen CC, Millo C, Kuo MJM, Nazari MA, Talvacchio S, Charles K, Miettinen M, Del Rivero J, Chen AP, Nilubol N, Lin FI, Civelek AC, Taïeb D, Carrasquillo JA, Pacak K. Performances of Functional and Anatomic Imaging Modalities in Succinate Dehydrogenase A-Related Metastatic Pheochromocytoma and Paraganglioma. Cancers (Basel) 2022; 14:cancers14163886. [PMID: 36010880 PMCID: PMC9406057 DOI: 10.3390/cancers14163886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 07/27/2022] [Accepted: 08/06/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Pheochromocytoma and paraganglioma (PPGL) are rare neuroendocrine cancers which carry the risk of metastatic disease. Pathogenic variants in the succinate dehydrogenase subunit A gene (SDHA) have been shown to cause metastatic disease, occurring in various regions of the body. Imaging is an early and vital step in the diagnosis and clinical care of these patients. The study here identifies which imaging modality among positron emission tomography (PET), computed tomography (CT), and magnetic resonance imaging (MRI) performs better in localizing metastatic PPGL lesions related to SDHA. The study identified that 68Ga-DOTATATE PET/CT performed best at overall lesion detection; however, 18F-FDG PET/CT performed better in certain anatomic regions of the body. A combined approach with 68Ga-DOTATATE and 18F-FDG would optimize care and guide clinicians in selecting the appropriate interventions and therapies. Abstract The study identifies the importance of positron emission tomographic (PET) and anatomic imaging modalities and their individual performances in detecting succinate dehydrogenase A (SDHA)-related metastatic pheochromocytoma and paraganglioma (PPGL). The detection rates of PET modalities—68Ga-DOTATATE, 18F-FDG, and 18F-FDOPA—along with the combination of computed tomography (CT) and magnetic resonance imaging (MRI) are compared in a cohort of 11 patients with metastatic PPGL in the setting of a germline SDHA mutation. The imaging detection performances were evaluated at three levels: overall lesions, anatomic regions, and a patient-by-patient basis. 68Ga-DOTATATE PET demonstrated a lesion-based detection rate of 88.6% [95% confidence interval (CI), 84.3–92.5%], while 18F-FDG, 18F-FDOPA, and CT/MRI showed detection rates of 82.9% (CI, 78.0–87.1%), 39.8% (CI, 30.2–50.2%), and 58.2% (CI, 52.0–64.1%), respectively. The study found that 68Ga-DOTATATE best detects lesions in a subset of patients with SDHA-related metastatic PPGL. However, 18F-FDG did detect more lesions in the liver, mediastinum, and abdomen/pelvis anatomic regions, showing the importance of a combined approach using both PET modalities in evaluating SDHA-related PPGL.
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Affiliation(s)
- Mayank Patel
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20814, USA
| | - Abhishek Jha
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20814, USA
| | - Alexander Ling
- Radiology and Imaging Sciences, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20814, USA
| | - Clara C. Chen
- Nuclear Medicine Department, Radiology and Imaging Sciences, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20814, USA
| | - Corina Millo
- Positron Emission Tomography Department, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20814, USA
| | - Mickey J. M. Kuo
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20814, USA
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Matthew A. Nazari
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20814, USA
| | - Sara Talvacchio
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20814, USA
| | - Kailah Charles
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20814, USA
| | - Markku Miettinen
- Laboratory of Pathology, National Cancer Institute, NIH, Bethesda, MD 20814, USA
| | - Jaydira Del Rivero
- Developmental Therapeutics Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Alice P. Chen
- Early Clinical Trials Development Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Naris Nilubol
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Frank I. Lin
- Targeted Radionuclide Therapy Section, Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ali Cahid Civelek
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, MD 21287, USA
| | - David Taïeb
- Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, 13273 Marseille, France
| | - Jorge A. Carrasquillo
- Targeted Radionuclide Therapy Section, Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
- Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20814, USA
- Correspondence:
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Knighton RC, Troadec T, Mazan V, Le Saëc P, Marionneau-Lambot S, Le Bihan T, Saffon-Merceron N, Le Bris N, Chérel M, Faivre-Chauvet A, Elhabiri M, Charbonnière LJ, Tripier R. Cyclam-Based Chelators Bearing Phosphonated Pyridine Pendants for 64Cu-PET Imaging: Synthesis, Physicochemical Studies, Radiolabeling, and Bioimaging. Inorg Chem 2021; 60:2634-2648. [PMID: 33496592 DOI: 10.1021/acs.inorgchem.0c03492] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Herein we present the preparation of two novel cyclam-based macrocycles (te1pyp and cb-te1pyp), bearing phosphonate-appended pyridine side arms for the coordination of copper(II) ions in the context of 64Cu PET imaging. The two ligands have been prepared through conventional protection-alkylation sequences on cyclam, and their coordination properties have been thoroughly investigated. The corresponding copper complexes have been fully characterized in the solid state (X-ray diffraction analysis) and in solution (EPR and UV-vis spectroscopies). Potentiometric studies combined with spectrometry have also allowed us to determine their thermodynamic stability constants, confirming their high affinity for copper(II) cations. The kinetic inertness of the complexes has been verified by acid-assisted dissociation experiments, enabling their use in 64Cu-PET imaging in mice for the first time. Indeed, the two ligands could be quantitatively radiolabeled under mild conditions, and the resulting 64Cu complexes have demonstrated excellent stability in serum. PET imaging demonstrated a set of features emerging from the combination of picolinates and phosphonate units: high stability in vivo, fast clearance from the body via renal elimination, and most interestingly, very low fixation in the liver. This is in contrast with what was observed for monopicolinate cyclam (te1pa), which had a non-negligible accumulation in the liver, owing probably to its different charge and lipophilicity. These results thus pave the way for the use of such phosphonated pyridine chelators for in vivo 64Cu-PET imaging.
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Affiliation(s)
- Richard C Knighton
- Univ. Brest, UMR CNRS 6521, 6 Avenue Victor Le Gorgeu, 29200 Brest, France
| | - Thibault Troadec
- Univ. Brest, UMR CNRS 6521, 6 Avenue Victor Le Gorgeu, 29200 Brest, France
| | - Valérie Mazan
- Université de Strasbourg, CNRS, UMR 7042-LIMA, Equipe de Chimie Bioorganique et Médicinale, ECPM, 25 rue Becquerel, Strasbourg 67087, France
| | - Patricia Le Saëc
- Université de Nantes, CHRU de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers (CRCINA), Unité INSERM 1232-CNRS 6299, 8 quai Moncousu, BP 70721, 44007 Nantes Cedex, France
| | - Séverine Marionneau-Lambot
- Université de Nantes, CHRU de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers (CRCINA), Unité INSERM 1232-CNRS 6299, 8 quai Moncousu, BP 70721, 44007 Nantes Cedex, France
| | - Thomas Le Bihan
- Univ. Brest, UMR CNRS 6521, 6 Avenue Victor Le Gorgeu, 29200 Brest, France
| | | | - Nathalie Le Bris
- Univ. Brest, UMR CNRS 6521, 6 Avenue Victor Le Gorgeu, 29200 Brest, France
| | - Michel Chérel
- Université de Nantes, CHRU de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers (CRCINA), Unité INSERM 1232-CNRS 6299, 8 quai Moncousu, BP 70721, 44007 Nantes Cedex, France
| | - Alain Faivre-Chauvet
- Université de Nantes, CHRU de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers (CRCINA), Unité INSERM 1232-CNRS 6299, 8 quai Moncousu, BP 70721, 44007 Nantes Cedex, France
| | - Mourad Elhabiri
- Université de Strasbourg, CNRS, UMR 7042-LIMA, Equipe de Chimie Bioorganique et Médicinale, ECPM, 25 rue Becquerel, Strasbourg 67087, France
| | - Loïc J Charbonnière
- UMR 7178, Institut Pluridisciplinaire Hubert Curien, Université de Strasbourg, ECPM, , 25 rue Becquerel, 67087 Strasbourg Cedex 2, France
| | - Raphaël Tripier
- Univ. Brest, UMR CNRS 6521, 6 Avenue Victor Le Gorgeu, 29200 Brest, France
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Jaiswal SK, Sarathi V, Malhotra G, Hira P, Shah R, Patil VA, Dalvi A, Prakash G, Lila AR, Shah NS, Bandgar T. The utility of 68Ga-DOTATATE PET/CT in localizing primary/metastatic pheochromocytoma and paraganglioma in children and adolescents - a single-center experience. J Pediatr Endocrinol Metab 2021; 34:109-119. [PMID: 33180042 DOI: 10.1515/jpem-2020-0354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/15/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Pediatric pheochromocytoma and paraganglioma (PPGL) are rare tumors with limited data on the diagnostic performance of 68Ga-DOTA(0)-Tyr(3)-octreotate positron emission tomography-computed tomography (68Ga-DOTATATE PET/CT). We have described our experience of 68Ga-DOTATATE PET/CT in overall and von Hippel Lindau (VHL)-associated pediatric PPGL and compared its sensitivity with that of 131I-meta-iodobenzyl-guanidine (131I-MIBG), 18F-fluorodeoxyglucose PET/CT (18F-FDG PET/CT), and contrast-enhanced CT (CECT). METHODS Retrospective evaluation of consecutive PPGL patients (age: ≤20 years), who had undergone at least one functional imaging [131I-MIBG, 18F-FDG PET/CT, and/or 68Ga-DOTATATE PET/CT], was done. Composite of anatomical and all the performed functional imaging scans, image comparator (IC), was considered as the gold standard for sensitivity analysis. RESULTS In a cohort of 32 patients (16 males, age at diagnosis: 16.4 ± 2.68 years), lesion-wise sensitivity of 68Ga-DOTATATE PET/CT (95%) was higher than that of both 18F-FDG-PET/CT (80%, p=0.027) and 131I-MIBG (65%, p=0.0004) for overall lesions, than that of 18F-FDG-PET/CT (100 vs. 67%, p=0.017) for primary PPG, and than that of 131I-MIBG (93 vs. 42%, p=0.0001) for metastases. In the VHL (n=14), subgroup, 68Ga-DOTATATE PET/CT had higher lesion-wise sensitivity (100%) compared to 18F-FDG PET/CT (74%, p=0.045) and 131I-MIBG (64%, p=0.0145). CONCLUSIONS In our pediatric PPGL cohort, overall lesion-wise sensitivity of 68Ga-DOTATATE PET/CT was higher than that of 18F-FDG PET/CT and 131I-MIBG scintigraphy. Hence, we recommend 68Ga-DOTATATE PET/CT as the preferred modality in pediatric PPGL. 68Ga-DOTATATE PET/CT may evolve as a preferred imaging modality for disease surveillance in VHL.
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Affiliation(s)
- Sanjeet Kumar Jaiswal
- Department of Endocrinology, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Vijaya Sarathi
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Center, Bengaluru, Karnataka, India
| | - Gaurav Malhotra
- Department of Nuclear Medicine, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
| | - Priya Hira
- Department of Radiology, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Ravikumar Shah
- Department of Endocrinology, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Virendra A Patil
- Department of Endocrinology, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Abhay Dalvi
- Department of General Surgery, Seth G.S. Medical College & KEM Hospital, Mumbai, India
| | - Gagan Prakash
- Department of Uro-Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Anurag R Lila
- Department of Endocrinology, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Nalini S Shah
- Department of Endocrinology, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Tushar Bandgar
- Department of Endocrinology, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
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Cheruku RR, Cacaccio J, Durrani FA, Tabaczynski WA, Watson R, Marko A, Kumar R, El-Khouly MES, Missert JR, Yao R, Sajjad M, Chandra D, Guru K, Pandey RK. Epidermal Growth Factor Receptor-Targeted Multifunctional Photosensitizers for Bladder Cancer Imaging and Photodynamic Therapy. J Med Chem 2019; 62:2598-2617. [PMID: 30776232 PMCID: PMC10029094 DOI: 10.1021/acs.jmedchem.8b01927] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The in vitro and in vivo anticancer activity of iodinated photosensitizers (PSs) with and without an erlotinib moiety was investigated in UMUC3 [epidermal growth factor (EGFR)-positive] and T24 (EGFR-low) cell lines and tumored mice. Both the erlotinib-conjugated PSs 3 and 5 showed EGFR target specificity, but the position-3 erlotinib-PS conjugate 3 demonstrated lower photodynamic therapy efficacy than the corresponding non-erlotinib analogue 1, whereas the conjugate 5 containing an erlotinib moiety at position-17 of the PS showed higher tumor uptake and long-term tumor cure (severe combined immunodeficient mice bearing UMUC3 tumors). PS-erlotinib conjugates in the absence of light were ineffective in vitro and in vivo, but robust apoptotic and necrotic cell death was observed in bladder cancer cells after exposing them to a laser light at 665 nm. In contrast to 18F-fluorodeoxyglucose, a positron emission tomography agent, the position-17 erlotinib conjugate (124I-analogue 6) showed enhanced UMUC3 tumor contrast even at a low imaging dose of 15 μCi/mouse.
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Affiliation(s)
- Ravindra R. Cheruku
- Photodynamic Therapy Center, Cell Stress Biology, Roswell
Park Comprehensive Cancer Center, Buffalo, NY, 14263
| | - Joseph Cacaccio
- Photodynamic Therapy Center, Cell Stress Biology, Roswell
Park Comprehensive Cancer Center, Buffalo, NY, 14263
| | - Farukh A. Durrani
- Photodynamic Therapy Center, Cell Stress Biology, Roswell
Park Comprehensive Cancer Center, Buffalo, NY, 14263
- Photolitec, LLC, 73 High Street, Buffalo, NY 14226
| | - Walter A. Tabaczynski
- Photodynamic Therapy Center, Cell Stress Biology, Roswell
Park Comprehensive Cancer Center, Buffalo, NY, 14263
| | - Ramona Watson
- Photodynamic Therapy Center, Cell Stress Biology, Roswell
Park Comprehensive Cancer Center, Buffalo, NY, 14263
| | - Aimee Marko
- Photolitec, LLC, 73 High Street, Buffalo, NY 14226
| | - Rahul Kumar
- Department of Pharmacology, Roswell Park Comprehensive
Cancer Center, Buffalo, NY, 14263
| | | | - Joseph R. Missert
- Photodynamic Therapy Center, Cell Stress Biology, Roswell
Park Comprehensive Cancer Center, Buffalo, NY, 14263
| | - Rutao Yao
- Department of Nuclear Medicine, SUNY, Buffalo, NY
14221
| | | | - Dhyan Chandra
- Department of Pharmacology, Roswell Park Comprehensive
Cancer Center, Buffalo, NY, 14263
| | - Khurshid Guru
- Department of Urology, Roswell Park Comprehensive Cancer
Center, Buffalo, NY, 14263
| | - Ravindra K Pandey
- Photodynamic Therapy Center, Cell Stress Biology, Roswell
Park Comprehensive Cancer Center, Buffalo, NY, 14263
- Corresponding author: Professor Ravindra K Pandey,
Ph.D., , Phone:
716-845-3203
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Zhang J, Zuo CJ, Jia NY, Wang JH, Hu SP, Yu ZF, Zheng Y, Zhang AY, Feng XY. Cross-modality PET/CT and contrast-enhanced CT imaging for pancreatic cancer. World J Gastroenterol 2015; 21:2988-2996. [PMID: 25780297 PMCID: PMC4356919 DOI: 10.3748/wjg.v21.i10.2988] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 09/25/2014] [Accepted: 11/19/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the diagnostic value of the cross-modality fusion images provided by positron emission tomography/computed tomography (PET/CT) and contrast-enhanced CT (CECT) for pancreatic cancer (PC).
METHODS: Data from 70 patients with pancreatic lesions who underwent CECT and PET/CT examinations at our hospital from August 2010 to October 2012 were analyzed. PET/CECT for the cross-modality image fusion was obtained using TureD software. The diagnostic efficiencies of PET/CT, CECT and PET/CECT were calculated and compared with each other using a χ2 test. P < 0.05 was considered to indicate statistical significance.
RESULTS: Of the total 70 patients, 50 had PC and 20 had benign lesions. The differences in the sensitivity, negative predictive value (NPV), and accuracy between CECT and PET/CECT in detecting PC were statistically significant (P < 0.05 for each). In 15 of the 31 patients with PC who underwent a surgical operation, peripancreatic vessel invasion was verified. The differences in the sensitivity, positive predictive value, NPV, and accuracy of CECT vs PET/CT and PET/CECT vs PET/CT in diagnosing peripancreatic vessel invasion were statistically significant (P < 0.05 for each). In 19 of the 31 patients with PC who underwent a surgical operation, regional lymph node metastasis was verified by postsurgical histology. There was no statistically significant difference among the three methods in detecting regional lymph node metastasis (P > 0.05 for each). In 17 of the 50 patients with PC confirmed by histology or clinical follow-up, distant metastasis was confirmed. The differences in the sensitivity and NPV between CECT and PET/CECT in detecting distant metastasis were statistically significant (P < 0.05 for each).
CONCLUSION: Cross-modality image fusion of PET/CT and CECT is a convenient and effective method that can be used to diagnose and stage PC, compensating for the defects of PET/CT and CECT when they are conducted individually.
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Sharkey RM, Karacay H, McBride WJ, Rossi EA, Chang CH, Goldenberg DM. Bispecific antibody pretargeting of radionuclides for immuno single-photon emission computed tomography and immuno positron emission tomography molecular imaging: an update. Clin Cancer Res 2007; 13:5577s-5585s. [PMID: 17875792 DOI: 10.1158/1078-0432.ccr-07-1087] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Molecular imaging is intended to localize disease based on distinct molecular/functional characteristics. Much of today's interest in molecular imaging is attributed to the increased acceptance and role of 18F-flurodeoxyglucose (18F-FDG) imaging in a variety of tumors. The clinical acceptance of 18F-FDG has stimulated research for other positron emission tomography (PET) agents with improved specificity to aid in tumor detection and assessment. In this regard, a number of highly specific antibodies have been described for different cancers. Although scintigraphic imaging with antibodies in the past was helpful in patient management, most antibody-based imaging products have not been able to compete successfully with the sensitivity afforded by 18F-FDG-PET, especially when used in combination with computed tomography. Recently, however, significant advances have been made in reengineering antibodies to improve their targeting properties. Herein, we describe progress being made in using a bispecific antibody pretargeting method for immuno-single-photon emission computed tomography and immunoPET applications, as contrasted to directly radiolabeled antibodies. This approach not only significantly enhances tumor/nontumor ratios but also provides high signal intensity in the tumor, making it possible to visualize micrometastases of colonic cancer as small as 0.1 to 0.2 mm in diameter using an anti-carcinoembryonic antigen bispecific antibody, whereas FDG failed to localize these lesions in a nude mouse model. Early detection of micrometastatic non-Hodgkin's lymphoma is also possible using an anti-CD20-based bispecific antibody pretargeting procedure. Thus, this bispecific antibody pretargeting procedure may contribute to tumor detection and could also contribute to the detection of other diseases having distinct antigen targets and suitably specific antibodies.
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Affiliation(s)
- Robert M Sharkey
- Garden State Cancer Center, Center for Molecular Medicine and Immunology, Belleville, New Jersey, USA.
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Timmers HJLM, Kozupa A, Chen CC, Carrasquillo JA, Ling A, Eisenhofer G, Adams KT, Solis D, Lenders JWM, Pacak K. Superiority of fluorodeoxyglucose positron emission tomography to other functional imaging techniques in the evaluation of metastatic SDHB-associated pheochromocytoma and paraganglioma. J Clin Oncol 2007; 25:2262-9. [PMID: 17538171 DOI: 10.1200/jco.2006.09.6297] [Citation(s) in RCA: 264] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Germline mutations of the gene encoding subunit B of the mitochondrial enzyme succinate dehydrogenase (SDHB) predispose to malignant paraganglioma (PGL). Timely and accurate localization of these aggressive tumors is critical for guiding optimal treatment. Our aim is to evaluate the performance of functional imaging modalities in the detection of metastatic lesions of SDHB-associated PGL. PATIENTS AND METHODS Sensitivities for the detection of metastases were compared between [18F]fluorodopamine ([18F]FDA) and [18F]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET), iodine-123- (123I) and iodine-131 (131I) -metaiodobenzylguanidine (MIBG), 111In-pentetreotide, and Tc-99m-methylene diphosphonate bone scintigraphy in 30 patients with SDHB-associated PGL. Computed tomography (CT) and magnetic resonance imaging (MRI) served as standards of reference. RESULTS Twenty-nine of 30 patients had metastatic lesions. In two patients, obvious metastatic lesions on functional imaging were missed by CT and MRI. Sensitivity according to patient/body region was 80%/65% for 123I-MIBG and 88%/70% for [18F]FDA-PET. False-negative results on 123I-MIBG scintigraphy and/or [18F]FDA-PET were not predicted by genotype or biochemical phenotype. [18F]FDG-PET yielded a by patient/by body region sensitivity of 100%/97%. At least 90% of regions that were false negative on 123I-MIBG scintigraphy or [18F]FDA-PET were detected by [18F]FDG-PET. In two patients, 111In-pentetreotide scintigraphy detected liver lesions that were negative on other functional imaging modalities. Sensitivities were similar before and after chemotherapy or 131I-MIBG treatment, except for a trend toward lower post- (60%/41%) versus pretreatment (80%/65%) sensitivity of 123I-MIBG scintigraphy. CONCLUSION With a sensitivity approaching 100%, [18F]FDG-PET is the preferred functional imaging modality for staging and treatment monitoring of SDHB-related metastatic PGL.
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Affiliation(s)
- Henri J L M Timmers
- Reproductive Biology and Medicine Branch, National Institutes of Child Health and Human Development, Bethesda MD 20892-1109, USA.
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