Left supraclavicular MIBG uptake in children with neuroblastoma

Objectives MIBG uptake in the left supraclavicular (LSC) region is occasionally seen in metastatic neuroblastoma. This study evaluated the frequency of this finding, and the clinical and imaging characteristics of these patients (pts).

Methods MIBG studies of children with neuroblastoma from 2002-2011 along with clinical and correlative imaging data were reviewed. MIBG scans included whole body images, SPECT or SPECT/CT.

Results 571 studies of 123 children with neuroblastoma (median age 30 months) were evaluated. Primary tumors were abdominal in 104 pts, mediastinal in 14 and other sites in 5. 65 pts had high risk (HR) disease (stage 4 and stage 3 with N-Myc amplification). 33/123 pts died. The median follow up was 50 months. 8 patients had LSC focal uptake comprising 6% of all pts and 12% of the HR group. All 8 pts were stage 4 with primary abdominal tumors. LSC metastases were present at diagnosis in 7/8 pts and during relapse in 3. 6/8 HR pts (75%) with LSC disease died as opposed to 22/57 HR pts (38%) without LSC involvement. The difference approached statistical significance (p=0.059) LSC metastases were identified on planar MIBG images in 5/8 pts and on SPECT or SPECT CT in all. In 2 cases only SPECT/CT could distinguish LSC disease from adjacent skeletal disease. CT scans of 6 pts that included the LSC area showed soft tissue masses (2 prior and 4 after scintigraphy).

Conclusions Metastases to the LSC area from primary abdominal neuroblastoma are not rare in MIBG studies of HR pts. The phenomenon resembles metastatic spread to Virchow nodes from gastric cancer. The presence of LSC disease may have prognostic significance. Mortality was higher among HR pts with LSC disease than in those without. The difference didn’t reach statistical significance due to the small sample size. SPECT/CT is advised to clearly identify these metastases and to distinguish them from adjacent skeletal disease