Department of Cancer Imaging, KCL School of Biomedical Engineering and Imaging Sciences, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, UK.
Department of Nuclear Medicine, CHUV, Lausanne, Switzerland.
Clin Endocrinol (Oxf). 2021 Aug;95(2):315-322. doi: 10.1111/cen.14446. Epub 2021 May 30.
Head and neck paragangliomas (HNPGLs) are rare tumours with ~ 30% genetic mutations, mainly in succinate dehydrogenase (SDHx) genes. The utility of FDG PET-CT in HNPGLs is questioned by recent developments in novel radiotracers. We therefore performed a retrospective study in a single tertiary referral centre to address the utility of FDG PET/CT in HNPGLs.
Clinical data on genetic testing and follow-up were collected for patients who had FDG PET-CT scans from 2004 to 2016. Receiver operator characteristic (ROC) analysis was used to compare standardized uptake values (SUVs), metabolic tumour volume (MTV) and total lesion glycolysis (TLG) between lesions in patients who had a clinically related event: event (+) and those who did not: event (-). Similarly, we compared PET parameters between SDHx+ patients and a control group with low probability of mutation.
Of 153 HNPGL patients, 73 (29 SDHx+) with 93 FDG-positive lesions were identified: 53.8% of lesions were assessed in a pre-therapeutic setting. In comparison with a reference extracted from clinicoradiological database, FDG PET-CT showed good performance to detect HNPGLs (96.6% accuracy). In this study population, 16 disease progression, 1 recurrence and 1 death were recorded and event (+) patients had lesions with higher SUVmax (p = .03 and p = .02, respectively). Conversely, there were no differences in PET parameters between lesions in SDHx+ patients and controls with low probability of SDHx+ mutations.
FDG PET-CT has clinical utility in HNPGLs, mostly before local treatment. There were no significant differences in PET parameters between SDHx patients and a sporadic HNPGL population. However, regardless of SDHx mutation status, a high SUVmax was associated with more clinical events and prompts to a closer follow-up.
头颈部副神经节瘤（HNPGL）是一种罕见的肿瘤，约有 30%存在基因突变，主要发生在琥珀酸脱氢酶（SDHx）基因。由于新型放射性示踪剂的发展，FDG PET-CT 在 HNPGL 中的应用受到质疑。因此，我们在一个三级转诊中心进行了一项回顾性研究，以探讨 FDG PET/CT 在 HNPGL 中的应用价值。
收集了 2004 年至 2016 年间进行 FDG PET-CT 扫描的患者的遗传检测和随访临床数据。使用受试者工作特征（ROC）分析比较了有临床相关事件（事件+）和无临床相关事件（事件-）的患者病变之间的标准化摄取值（SUV）、代谢肿瘤体积（MTV）和总病灶糖酵解（TLG）。同样，我们比较了 SDHx+患者和低突变可能性的对照组之间的 PET 参数。
在 153 例 HNPGL 患者中，发现 73 例（29 例 SDHx+）有 93 个 FDG 阳性病变：53.8%的病变在治疗前进行了评估。与从临床放射数据库中提取的参考值相比，FDG PET-CT 对 HNPGL 的检测具有良好的性能（准确性为 96.6%）。在本研究人群中，记录了 16 例疾病进展、1 例复发和 1 例死亡，并且事件+患者的病变 SUVmax 更高（分别为 p=0.03 和 p=0.02）。相反，SDHx+患者和低 SDHx+突变可能性的对照组之间的 PET 参数没有差异。
FDG PET-CT 在 HNPGL 中有临床应用价值，主要是在局部治疗前。SDHx 患者与散发性 HNPGL 患者的 PET 参数无显著差异。然而，无论 SDHx 突变状态如何，高 SUVmax 与更多的临床事件相关，并提示需要更密切的随访。
