ORIGINAL ARTICLE   

The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2020 March;64(1):131-8

DOI: 10.23736/S1824-4785.18.03031-5

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Prognostic impact of postoperative 123I-metaiodobenzylguanidine scintigraphy: added value of SPECT/CT and semiquantification of the uptake at the surgical site

Mathieu GAUTHÉ ^{1, 2} ✉, Matthieu BRETON ¹, Nina JEHANNO ¹, Cécile CELLIER ³, Jean MICHON ⁴, Sabine SARNACKI ⁵, Gudrun SCHLEIERMACHER ³, Myriam WARTSKI ¹

¹ Unit of Nuclear Medicine, Curie Institute, Paris, France; ² Unit of Nuclear Medicine, Tenon Hospital, AP-HP, Paris, France; ³ Unit of Radiology, Curie Institute, Paris, France; ⁴ Unit of Pediatrics, Curie Institute, Paris, France; ⁵ Unit of Pediatric Surgery, Necker Hospital, Paris, France

BACKGROUND: The aim of this study was to assess the prognostic value of postoperative 123I-MIBG scintigraphy, including systematic SPECT/CT and semiquantification of the uptake at the surgical site, in a prospective series of NB patients.
METHODS: Patients operated for neuroblastoma and who had benefited from postoperative 123I-MIBG scintigraphy were prospectively and consecutively included. Completeness of surgery was assessed on operative report. One month postoperative 123I-MIBG scintigraphy included planar acquisition and SPECT/CT. Semi-quantification of the 123I-MIBG SPECT/CT uptake at the surgical site was performed and ratios to reference (liver and mediastinum) areas were calculated.
RESULTS: Thirty patients were included between August 2012 and July 2015. Median follow-up was 36 months (range 10-98). Surgery was considered as complete in 23 patients and incomplete in 7 patients. Eight patients (26.7%) presented progressive disease (1 progression and 7 recurrences). Seven patients died (23.3%), all from NB. Six (20%) patients had positive 123I-MIBG scintigraphy (3 on planar acquisitions and 6 on SPECT/CT) and 24 patients had negative 123I-MIBG scintigraphy. Five of the 6 patients (83%) with positive 123I-MIBG scintigraphy presented progressive disease. Ratio of the uptake at the surgical site to mediastinum was strongly and independently correlated with disease-free interval and overall survival (P=0.02 and 0.01 respectively). The amplified MYCN status was also confirmed as correlated with poorer outcomes.
CONCLUSIONS: Postoperative 123I-MIBG scintigraphy including SPECT/CT and semiquantification of the uptake at the surgical site appeared to be a valuable prognostic tool in neuroblastoma.

KEY WORDS: Neuroblastoma; Pediatrics; Survival