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Indium-111-pentetreotide scintigraphy in children with neuroblast-derived tumors
L Manil1, V Edeline, J Lumbroso
1Department of Nuclear Medicine, Institut Curie, Paris, France.
Insights
111In-pentetreotide imaging shows promise for detecting neuroblast-derived tumors, sometimes identifying MIBG-negative sites. This somatostatin analog may offer new insights into tumor biology and prognosis in children.
Area of Science:
- Nuclear Medicine
- Pediatric Oncology
- Radiopharmaceutical Imaging
Background:
- Sympathetic embryonic cell-derived tumors, such as neuroblastomas, are a significant concern in pediatric oncology.
- Accurate tumor detection and characterization are crucial for effective treatment planning and prognosis.
Purpose of the Study:
- To evaluate the efficacy of the somatostatin analog 111In-pentetreotide in imaging children with sympathetic embryonic cell-derived tumors.
- To compare the diagnostic performance of 111In-pentetreotide with 123I-metaiodobenzylguanidine (MIBG).
Main Methods:
- Eleven children with sympathetic embryonic cell-derived tumors (neuroblastomas, ganglioneuroblastomas, ganglioneuroma) underwent imaging.
- Patients received 111In-pentetreotide and 123I-metaiodobenzylguanidine (MIBG) at specified doses and time points.
- Imaging results were analyzed for primary tumor detection and bone marrow metastasis identification.
Main Results:
- 111In-pentetreotide detected primary tumors in most cases, while the benign ganglioneuroma was not localized.
- Bone marrow metastasis detection was superior with 111In-pentetreotide in some patients, comparable or slightly better with MIBG in others.
- Higher 111In-pentetreotide uptake was observed in undifferentiated neuroblastomas, correlating with elevated urinary catecholamines and aneuploid tumors.
Conclusions:
- 111In-pentetreotide uptake patterns differed from MIBG, revealing MIBG-negative tumor sites in neuroblastoma patients.
- This somatostatin analog may provide complementary information regarding tumor biology and prognosis.
- Further studies are needed to define the clinical significance of 111In-pentetreotide findings in neuroblast-derived tumors.
Unlabelled:
The somatostatin analog 111In-pentetreotide was evaluated in 11 children with sympathetic embryonic cell-derived tumors.
Methods:
Six neuroblastomas, four ganglioneuroblastomas and one ganglioneuroma (benign) were imaged 4 and 24 hr after injection of 111In-pentetreotide (5 MBq/kg) and 24 hr after administration of 123I-metaiodobenzylguanidine (MIBG) (3.7 MBq/kg).
Results:
Primary tumor was detected with both tracers in four of the five patients studied before surgery (one Stage III neuroblastoma, one Stage IV neuroblastoma, one Stage IVs neuroblastoma, one ganglioneuroblastoma), but the ganglioneuroma was not localized. Detection of bone marrow metastases was clearly better with 111In-pentetreotide in two patients, similar or slightly better with MIBG in six and (true) negative with both procedures in three. The positivity rate of 111In-pentetreotide for imaging of metastases was higher in undifferentiated malignant tumors (six neuroblastomas: two very positive, three positive, one true-negative) than in histologically well-differentiated tumors (four ganglioneuroblastomas: three weakly positive, one true-negative). All patients with positive 111In-pentetreotide imaging results had elevated urinary catecholamine levels, and the two most 111In-pentetreotide-positive metastases were found in neuroblastomas from children with an aneuploid primary tumor. The 111In-pentetreotide and MIBG results were only partly correlated with bone marrow status, as assessed by immunocytological and histological studies at the time of scanning.
Conclusion:
Abnormalities detected in 111In-pentetreotide uptake were slightly different from those seen with MIBG as a first-line routine method in neuroblast-derived tumors. However, some MIBG as a first-line routine method in neuroblast-derived tumors. However, some MIBG-negative tumor sites were detected by 111In-pentetreotide in patients with neuroblastomas. Thus, 111In-pentetreotide could provide novel information on the biology and prognosis of tumors whose clinical significance remains to be defined.