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Indium-111-Pentetreotide Scintigraphy in Children with Neuroblast-Derived Tumors

Departments of Nuclear Medicine and Pediatrics, Institut Curie, Paris
Department of Nuclear Medicine, Institut Gustave Roussy, Villejuif, France

Correspondence: For correspondence or reprints contact: Luc Manil, MD, Nuclear Medicine, 6 Avenue des Tilleuls, F-9440 Bures-sur-Yvette, France.

ABSTRACT

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, but ¹¹¹In-pentetreotide is unlikely to replace 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.

Key Words: neuroblastoma • ganglioneuroblastoma • indium-111-pentetreotide • iodine-131-MIBG • pediatrics

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