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Functional characterization of nonmetastatic paraganglioma and pheochromocytoma by 18 F‐ FDOPA PET : focus on missed lesions

2012; Wiley; Volume: 79; Issue: 2 Linguagem: Inglês

10.1111/cen.12126

1365-2265

S. Gabriel, Elise M. Blanchet, F. Sébag, Clara C. Chen, Nicolas Fakhry, Arnaud Devèze, Anne Barlier, Isabelle Morange, Karel Pacák, David Taïeb,

Cancer, Hypoxia, and Metabolism

Summary Aims and methods To evaluate the clinical value of 18 F ‐fluorodihydroxyphenylalanine ( 18 F ‐ FDOPA ) PET in relation to tumour localization and the patient's genetic status in a large series of pheochromocytoma/paraganglioma ( PHEO / PGL ) patients and to discuss in detail false‐negative results. A retrospective study of PGL patients who were investigated with 18 F ‐ FDOPA PET or PET / CT imaging in two academic endocrine tumour centres was conducted ( L a T imone U niversity H ospital, M arseilles, F rance and N ational I nstitutes of H ealth ( NIH ), B ethesda, MD , USA ). Results One hundred sixteen patients (39·7% harbouring germline mutations in known disease susceptibility genes) were evaluated for a total of 195 PHEO / PGL foci. 18 F ‐ FDOPA PET correctly detected 179 lesions (91·8%) in 107 patients (92·2%). Lesion‐based sensitivities for parasympathetic PGL s (head, neck, or anterior/middle thoracic ones), PHEO s, and extra‐adrenal sympathetic (abdominal or posterior thoracic) PGL s were 98·2% [96·5% for Timone and 100% for NIH ], 93·9% [93·8 and 93·9%] and 70·3% [47·1 and 90%] respectively ( P < 0·001). Sympathetic (adrenal and extra‐adrenal) SDH x‐related PGL s were at a higher risk for negative 18 F‐ FDOPA PET than non‐ SDH x‐related PGL s (14/24 vs 0/62, respectively, P < 0·001). In contrast, the risk of negative 18 F‐ FDOPA PET was lower for parasympathetic PGL s regardless of the genetic background (1/90 in SDH x vs 1/19 in non‐ SDH x tumours, P = 0·32). 18 F‐ FDOPA PET failed to detect two head and neck PGL s ( HNPGL ), likely due to their small size, whereas most missed sympathetic PGL were larger and may have exhibited a specific 18 F‐ FDOPA ‐negative imaging phenotype. 18 F‐ FDG PET detected all the missed sympathetic lesions. Conclusions 18 F‐ FDOPA PET appears to be a very sensitive functional imaging tool for HNPGL regardless of the genetic status of the tumours. Patients with false‐negative tumours on 18 F‐ FDOPA PET should be tested for SDH x mutations.