To our knowledge, data are lacking on the role of 18F-FDG PET/CT in the localization and prediction of neuroendocrine tumors, in particular the pheochromocytoma/paraganglioma (PCC/PGL) group.
Purpose
To evaluate the role of 18F-FDG PET/CT in localizing and predicting the malignant potential of PCC/PGL.
Material and Methods
Twenty-three consecutive patients with a history of PCC/PGL, presenting with symptoms related to catecholamine excess, underwent 18F-FDG PET/CT. Final confirmation of the diagnosis was made using the composite references. PET/CT findings were analyzed on a per-lesion basis and a per-patient basis. Tumor SUVmax was analyzed to predict the dichotomization of patient endpoints for the local disease and metastatic groups.
Results
We investigated 23 patients (10 men, 13 women) with a mean age of 46.43 ± 3.70 years. Serum catecholamine levels were elevated in 82.60% of these patients. There were 136 sites (mean SUVmax: 16.39 ± 3.47) of validated disease recurrence. The overall sensitivities for diagnostic CT, FDG PET, and FDG PET/CT were 86.02%, 87.50%, and 98.59%, respectively. Based on the composite references, 39.10% of patients had local disease. There were significant differences in the SUVmax distribution between the local disease and metastatic groups; a significant correlation was noted when a SUVmax cut-off was set at 9.2 (P < 0.05).
Conclusion
In recurrent PCC/PGL, diagnostic 18F-FDG PET/CT is a superior tool in the localization of recurrent tumors. Tumor SUVmax is a potentially useful predictor of malignant tumor potential.
YoungWFJr. Paragangliomas: Clinical overview. Ann N Y Acad Sci2006; 1073: 21–29.
3.
DeLellisRALloydRVHeitzPU. World Health Organization Classification of Tumors: Pathology and Genetics of Tumors of Endocrine Organs. 2004; Vol. 8. 3rd edn. Lyon: IARC Press.
4.
PacakKEisenhoferGAhlmanH. Pheochromocytoma: recommendations for clinical practice from the First International Symposium 2005. Nat Clin Pract Endocrinol Metab2007; 3: 92–102.
5.
HeaneyCMullanBYoungW. 18F FDG PET/CT imaging of primary extradrenal paragangliomas. J Nucl Med Meeting Abstracts2006; 1;47: 442–442.
6.
AmarLServaisAGimenez-RoqueploAP. Year of diagnosis, features at presentation, and risk of recurrence in patients with pheochromocytoma or secreting paraganglioma. J Clin Endocrinol Metab2005; 90: 2110–2116.
7.
TaiebDTessonnierLSebagF. The role of 18F-FDOPA and 18F-FDG-PET in the management of malignant and multifocal phaeochromocytomas. Clin Endocrinol (Oxf)2008; 69: 580–586.
8.
PacakKEisenhoferGGoldsteinDS. Functional imaging of endocrine tumors: role of positron emission tomography. Endocr Rev2004; 25: 568–580.
9.
Fathinul FikriASAbdul JalilNNorhafizahM. 18(F) FDG-PET/CT is a useful molecular marker in evaluating thymoma aggressiveness. Eur J Radiol Extra2011; 78: e89–e92.
10.
TimmersHJCarrasquilloJAWhatleyM. Usefulness of standardized uptake values for distinguishing adrenal glands with pheochromocytoma from normal adrenal glands by use of 6-18F-fluorodopamine PET. J Nucl Med2007; 48: 1940–1944.
11.
YonMSKyungSLByungTK. 18F-FDG PET/CT of thymic epithelial tumors: usefulness for distinguishing and staging tumor subgroups. J Nucl Med2006; 47: 1628–1634.
12.
GabbertHWagnerRMollR. Tumor dedifferentiation: an important step in tumor invasion. Clin Exp Metastasis1985; 3: 257–292.
13.
KayaniIBomanjiJBGrovesA. Functional imaging of neuroendocrine tumors with combined PET/CT using 68Ga-DOTATATE (DOTA-DPhe1,Tyr3-octreotate) and 18FFDG. Cancer2008; 112: 2447–2455.
14.
HenriJLTimmersMKozupaA. Superiority of fluorodeoxyglucose positron emission tomography to other functional imaging techniques in the evaluation of metastatic SDHB-associated pheochromocytoma and paraganglioma. J Clin Oncol2010; 25: 2262–2269.
15.
MamedeMCarrasquilloJAChenCC. Discordant localization of 2-(18F)-fluoro-2-deoxy-D-glucose in 6-(18F)-fluorodopamine- and (123I)-metaiodobenzylguanidine-negative metastatic pheochromocytoma sites. Nucl Med Commun2006; 27: 31–36.
16.
HicksRJ. Use of molecular targeted agents for the diagnosis, staging and therapy of neuroendocrine malignancy. Cancer Imaging2010; 10: S83–S91.
17.
ShapiroBGrossMDShulkinB. Radioisotope diagnosis and therapy of malignant pheochromocytoma. Trends Endocrinol Metab2001; 12: 469–475.
18.
OJHYooIRKimSH. Clinical significance of small pulmonary nodules with little or no 18F-FDG uptake on PET/CT images of patients with nonthoracic malignancies. J Nucl Med2007; 48: 15–21.
19.
SchwartzaLHBogaertsbJFordcR. Evaluation of lymph nodes with RECIST 1.1. European Journal of Cancer2009; 45: 261–267.
20.
KroissAPutzerDUprimnyC. Functional imaging in phaeochromocytoma and neuroblastoma with Ga-DOTA-Tyr-octreotide positron emission tomography and I-metaiodobenzylguanidine. Eur J Nucl Med Mol Imaging2011; 38: 865–873.
21.
TimmersHJChenCCCarrasquilloJA. Comparison of 18F-fluoro-L-DOPA, 18F-fluoro-deoxyglucose, and 18F-fluorodopamine PET and 123I-MIBG scintigraphy in the localization of pheochromocytoma and paraganglioma. J Clin Endocrinol Metab2009; 94: 4757–4767.
22.
Fathinul FikriASMasiyatiJHemlataKG. A rare primary malignant vaginal melanoma detected by 18 (F)-FDG PET/CT imaging. Biomed Imaging Interv J2012; 8: e27–e27.
23.
FathinulFNordinAJLauWFE. 18(F) FDG-PET/CT is a useful molecular marker in evaluating tumor aggressiveness; a revised understanding of an in- vivo FDGPET imaging that alludes the alteration of cancer biology. Cell Biochemistry and Biophysics2013; 6: 37–43.
24.
BrouwersFMEisenhoferGTaoJJ. High frequency of SDHB germline mutations in patients with malignant catecholamine-producing paragangliomas: implications for genetic testing. J Clin Endocrinol Metab2006; 91: 4505–4509.
25.
O'RiordainDSYoungWFJrGrantCS. Clinical spectrum and outcome of functional extraadrenal paraganglioma. World J Surg1996; 20: 916–921.
26.
NiklausGSChristianTKlausS. Hodgkin disease: diagnostic value of FDG PET/CT after first-line therapy- is biopsy of FDG-avid lesions still needed?Radiology2007; 244: 257–262.
27.
ChristopherCRTimothyAStevenL. 18F-FDG PET scanning correlates with tissue markers of poor prognosis and predicts mortality for patients after liver resection for colorectal metastases. J Nucl Med2007; 48: 771–775.
28.
ReimerSEAdlerLPBloomAD. Prospective evaluation of PET FDG in FNA indeterminate thyroid nodules (abstract). J Nucl Med1998; 39: 123–123.
29.
BrennerWEaryJFHwangW. Risk assessment in liposarcoma patients based on FDG PET imaging. Eur J Nucl Med Molec Imaging2006; 33: 1290–1295.
30.
SongB-IHongCLeeH. Prognostic value of primary tumor uptake on F-18 FDG PET/CT in patients with invasive ductal breast cancer. Nucl Med Mol Imaging2011; 45: 117–122.
31.
FathinulFLauWFE. A subcentimetre single pulmonary nodule (SPN); Potentials of FDG-PET interpretative pitfalls in patients with a known extrapulmonary malignancy. Biomed Imaging Interv J2009; 6: 34–34.
32.
ShionoSAbikoMSatoT. Positron emission tomography/computed tomography and lymphovascular invasion predict recurrence in stage I lung cancers. J Thorac Oncol2011; 6: 43–47.
33.
BinderupTKniggeULoftA. 18F-Fluorodeoxyglucose positron emission tomography predicts survival of patients with neuroendocrine tumors. Clin Cancer Res2010; 16: 978–985.
34.
HoegerleSNitzscheEAltehoeferC. Pheochromocytomas: detection with 18F DOPA whole body PET-initial results. Radiology2002; 222: 507–512.
35.
LumachiFTregnaghiAZucchettaP. Sensitivity and positive predictive value of CT, MRI and 123I-MIBG scintigraphy in localising pheochromocytomas: A prospective study. Nuclear Medicine Communications2006; 27: 583–587.
