Extending positron emission tomography scan utility to high-risk neuroblastoma: Fluorine-18 fluorodeoxyglucose positron emission tomography as sole imaging modality in follow-up of patients

Purpose: Although positron emission tomography (PET) with fluorine-18 fluor odeoxyglucose (F-18-FDG) has a major impact on the treatment of adult cance r, the reported experience with extracranial tumors of childhood is limited . We describe a role for PET in patients with neuroblastoma (NB). patients and Methods: In 51 patients with high-risk NE, 92 PET scans were p art of a staging evaluation that included iodine-123 or iodine-131 metaiodo benzylguanidine (MIBG) scan, bone scan, computed tomography (and/or magneti c resonance imaging), urine catecholamine measurements, and bone marrow (BM ) examinations. The minimum number of tests sufficient to detect Nh wets de termined. Results: Of 40 patients who were not in complete remission, only 1 (2.5%) h ad NE that would have been missed had a staging evaluation been limited to PET and BM studies, and 13 (32.5%) had NE detected by PET but nor by BM and urine tests. PET wets equal or superior to MIBG scans for identifying NE i n soft tissue and extracranial skeletal structures, for revealing small les ions, and for delineating the extent and localizing sites of disease. In 36 evaluations of 22 patients with NE in soft tissue, PET failed to identify only two long-standing MIBG-negative abdominal masses. PET and MIBG scans s howed more skeletal lesions than bone scans, but the normally high physiolo gic brain uptake of FDG blocked PET visualization of cranial vault lesions. Similar to MIBG, FDG skeletal uptake was diffusely increased with extensiv e or progressing BM disease but faint or absent with minimal or nonprogress ing BM disease. Conclusion: In the absence or after resolution of cranial vault lesions, an d once the primary tumor is resected, PET and BM tests suffice for monitori ng NE patients at high risk for progressive disease in soft tissue and bone /BM. (C) 2001 by American Society of Clinical Oncology.