Impact of I-123-MIBG Scintigraphy on Clinical Decision-Making in Pheochromocytoma and Paraganglioma

Rao, Dipti; van Berkel, Anouk; Piscaer, Ianthe; Young, William F.; Gruber, Lucinda; Deutschbein, Timo; Fassnacht, Martin; Beuschlein, Felix; Spyroglou, Ariadni; Prejbisz, Aleksander; Hanus, Katarzyna; Eisenhofer, Graeme; Manelli, Massimo; Canu, Letizia; Lenders, Jacques W. M.; Bancos, Irina und Timmers, Henri J. L. M. (2019): Impact of I-123-MIBG Scintigraphy on Clinical Decision-Making in Pheochromocytoma and Paraganglioma. In: Journal of Clinical Endocrinology & Metabolism, Bd. 104, Nr. 9: S. 3812-3820

Abstract

Context: Cross-sectional imaging with CT or MRI is regarded as a first-choice modality for tumor localization in patients with pheochromocytoma and paraganglioma (PPGL). I-123-labeled metaiodobenzylguanidine (I-123-MIBG) is widely used for functional imaging but the added diagnostic value is controversial. Objective: To establish the virtual impact of adding I-123-MIBG scintigraphy to CT or MRI on diagnosis and treatment of PPGL. Design: International multicenter retrospective study. Intervention: None. Patients: Two hundred thirty-six unilateral adrenal, 18 bilateral adrenal, 48 unifocal extra-adrenal, 12 multifocal, and 26 metastatic PPGL. Main Outcome Measures: Patients underwent both anatomical imaging (CT and/or MRI) and I-123-MIBG scintigraphy. Local imaging reports were analyzed centrally by two independent observers who were blinded to the diagnosis. Imaging-based diagnoses determined by CT/MRI only, I-123-MIBG only, and CT/MRI combined with I-123-MIBG scintigraphy were compared with the correct diagnoses. Results: The rates of correct imaging-based diagnoses determined by CT/MRI only versus CT/MRI plus I-123-MIBG scintigraphy were similar: 89.4 versus 88.8%, respectively (P = 0.50). Adding I-123-MIBG scintigraphy to CT/MRI resulted in a correct change in the imaging-based diagnosis and ensuing virtual treatment in four cases (1.2%: two metastatic instead of nonmetastatic, one multifocal instead of single, one unilateral instead of bilateral adrenal) at the cost of an incorrect change in seven cases (2.1 %: four metastatic instead of nonmetastatic, two multifocal instead of unifocal and one bilateral instead of unilateral adrenal). Conclusions: For the initial localization of PPGL, the addition of I-123-MIBG scintigraphy to CT/MRI rarely improves the diagnostic accuracy at the cost of incorrect interpretation in others, even when I-123-MIBG scintigraphy is restricted to patients who are at risk for metastatic disease. In this setting, the impact of I-123-MIBG scintigraphy on clinical decision-making appears very limited.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0021-972X
• Sprache: Englisch