[(123)I]metaiodobenzylguanidine and [(111)In]octreotide uptake in begnign and malignant pheochromocytomas
Selecting the appropriate approach for resection and follow-up of pheochromocytomas (PCCs) is highly dependent upon reliable localization and exclusion of multifocal, bilateral, or metastatic disease. Metaiodobenzylguanidine (MIBG) scintigraphy was developed for functional localization of catecholamine-secreting tissues. Somatostatin receptor imaging (SRI) has a high sensitivity for localizing head and neck paragangliomas, but studies of intraabdominal PCCs are rare. In this study we review our experience of [(123)I]MIBG and SRI, performed since 1983 and 1989, respectively, in the work-up of primary and recurrent PCCs. Scintigraphic results were correlated with catecholamine secretion, size and site, malignancy, associated tumor syndromes, and morphological features. [(123)I]MIBG scans were performed in a total of 75 patients, in 70 cases before resection of primary PCCs and in 5 cases because of recurrent disease. Ninety-one PCCs were resected. The overall detection rates were 83.3% and 89.8% for PCCs larger than 1.0 cm. Multifocal disease was detected in 4 patients with [(123)I]MIBG. [(123)I]MIBG uptake correlated with greater size of PCC (r = 0.33; P = 0.008) and greater concentration of plasma epinephrine (r = 0.32; P = 0.006). [(123)I]MIBG-negative PCCs (n = 14) had significantly (P = 0.01) smaller diameters than [(123I)]MIBG-positive tumors. Furthermore, [(123)I]MIBG uptake was significantly higher in unilateral (P = 0.02), benign (P = 0.02), sporadic (P = 0.02), intraadrenal (P = 0.02), and capsular invasive (P = 0.03) PCCs than in bilateral, malignant, MEN2A/2B-related, extraadrenal, and noninvasive PCCs, respectively. The detection rate of SRI was only 25% (8 of 32) for primary benign PCCs. In 14 patients metastases occurred, which were effectively visualized with [(123)I]MIBG in 8 of 14 cases. SRI was able to detect metastases in 7 of 8 cases, including 3 [(123)I]MIBG-negative metastatic cases. In addition, [(123)I]MIBG and SRI detected 2 recurrences. In conclusion, [(123)I]MIBG uptake is correlated with the size, epinephrine production, and site of PCCs. Its role in bilateral and MEN2A/2B-related PCCs seems limited. In cases of recurrent elevation of catecholamines, localization of metastases and/or recurrence should be attempted with [(123)I]MIBG scintigraphy. In suspicious metastatic PCCs, SRI might be considered to supplement [(123)I]MIBG scintigraphy.
|Keywords||3-Iodobenzylguanidine/diagnostic use/*pharmacokinetics, Adolescent, Adrenal Gland Neoplasms/metabolism/mortality/pathology/*radionuclide imaging/surgery, Adult, Aged, Disease-Free Survival, Humans, Indium Radioisotopes/diagnostic use/*pharmacokinetics, Iodine Radioisotopes/diagnostic use/*pharmacokinetics, Middle aged, Multiple Endocrine Neoplasia Type 2a/radionuclide imaging, Multiple Endocrine Neoplasia Type 2b/radionuclide imaging, Neoplasm Metastasis, Octreotide/diagnostic use/*pharmacokinetics, Pheochromocytoma/metabolism/mortality/pathology/*radionuclide imaging/surgery, Radiopharmaceuticals/diagnostic use/*pharmacokinetics, Receptors, Somatostatin/analysis, Recurrence, Research Support, Non-U.S. Gov't, Retrospective Studies, Survival Rate, Tissue Distribution|
|Journal||Journal of Clinical Endocrinology and Metabolism|
van der Harst, E, Krenning, E.P, Kwekkeboom, D.J, Bosman, F.T.B, Bruining, H.A, Bonjer, H.J, … van den Meiracker, A.H. (2001). [(123)I]metaiodobenzylguanidine and [(111)In]octreotide uptake in begnign and malignant pheochromocytomas. Journal of Clinical Endocrinology and Metabolism. Retrieved from http://hdl.handle.net/1765/9575