Metastatic neuroblastoma in children older than one year: Prognostic significance of the initial metaiodobenzylguanidine scan and proposal for a scoring system

Suc, Agnès; Lumbroso, J.; Rubie, H; Hattchouel, Jean-Marc; Boneu, A; Rodary, C; Robert, Alain; Hartmann, Olivier

doi:10.1002/(sici)1097-0142(19960215)77:4<805::aid-cncr29>3.0.co;2-3

Cited by 72 publications

(29 citation statements)

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“…It is used in the diagnosis, staging, and reassessment of patients with neuroblastoma, and has been shown to be highly sensitive and specific in this condition. 4 Meanwhile, MRI is extremely sensitive in detecting abnormalities of bone marrow. Bone marrow involvement (with or without bony involvement) is seen as areas of decreased signal intensity on T 1 -weighted images because of the replacement of the fat tissue normally seen with high signal intensity by tumor cells.…”

Section: Discussionmentioning

confidence: 99%

Use of Real-Time Magnetic Resonance Guidance to Assist Bone Biopsy in Pediatric Malignancy

et al. 2002

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ABSTRACT. Magnetic resonance (MR) imaging (MRI)has the advantage of demonstrating lesions not visualized by other radiologic modalities. We present a case involving pediatric malignancy where MR-guided bone biopsy confirmed correct histologic diagnosis and was used to plan additional treatment. A 2-year, 9-month-old boy had a history of spontaneous regression of stage 4S neuroblastoma. 123 I-metaiodobenzylguanidine scintigraphy showed a hot spot at his right lower leg; however, neither plain radiograph 99m Tc diphosphonate bone scan was positive. Only MRI depicted a lesion at the distal third of his right tibia, and a subsequent MR-guided bone biopsy was diagnostic of bone marrow metastasis. After 6 courses of intensive chemotherapy, he has been in complete remission. MR-guided biopsy technique is likely to be particularly useful for the resection of invisible metastatic lesions, especially those that are only visible using MRI. Pediatrics 2002;109(1). URL: http:// www.pediatrics.org/cgi/content/full/109/1/e18; magnetic resonance imaging, biopsy, neoplasm.ABBREVIATIONS. MR, magnetic resonance; MRI, magnetic resonance imaging; VMA, vanillylmandelic acid; HVA, homovanillic acid; MIBG, metaiodobenzylguanidine. M agnetic resonance (MR) imaging (MRI) has the advantage of demonstrating lesions not visualized on computed tomography or other conventional imaging methods. 1 Moreover, it is extremely sensitive in detecting abnormalities of bone marrow. 2 When an abnormality can be seen on MRI only, or can be seen significantly better on MR images, MR-guided interventional surgery may be required for diagnosis and therapy. In this report, we present a case of pediatric malignancy where bone biopsy under real-time MR guidance was diagnostic of metastasis. CASE REPORTA 2-year, 9-month-old boy had a history of spontaneous regression of stage 4S neuroblastoma. He was found to have bilateral adrenal tumors and multiple liver masses on the abdominal ultrasound at his regular 1-month-old infant health checkup. Blood neuron specific enolase was high (72 ng/mL), and urinary vanillylmandelic acid (VMA) and homovanillic acid (HVA) were elevated, 435 mg/g creatinine, 153 mg/g creatinine, respectively. Bone marrow aspiration did not show pathology. The diagnosis of stage 4S neuroblastoma was confirmed by a biopsy of skin metastasis. N-myc was not amplified, with a weak Trk-A expression. There was no 1p deletion. With all these favorable biological features except for a diploid DNA content, a wait-and-see strategy was initiated. By the age of 1 year 4 months, spontaneous regression of all the tumor was detected by graphic studies including ultrasound, computed tomography scan, MRI, and 123 I-MIBG (metaiodobenzylguanidine) scan. Although decreasing, urinary VMA and HVA excretions remained in higher levels, 26 mg/g creatinine and 56 mg/g creatinine, respectively. Now, at the age of 2 years and 9 months, a repeat MIBG scan showed a hot spot at his lower extremity (Fig 1). Neither plain radiographs nor 99m Tc diphosphate bone scan showed an...

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Section: Discussionmentioning

confidence: 99%

Use of Real-Time Magnetic Resonance Guidance to Assist Bone Biopsy in Pediatric Malignancy

et al. 2002

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“…To evaluate the prognostic effect of tumour burden at diagnosis and to be able to quantify response and define a partial response (50% reduction of all disease sites) by mIBG scan, semiquantitative scoring systems have been developed (Ady et al, 1995;Suc et al, 1996;Perel et al, 1999;Frappaz et al, 2000;Matthay et al, 2003b;Katzenstein et al, 2004;Messina et al, 2006;Lewington et al, 2009). This improves the concordance between readers, and enables one to differentiate a simple improvement with the disappearance of a lesion, or decreased intensity of lesions that can be subjective, from a significant response that would qualify as PR.…”

Section: Semi-quantitative Mibg Scoringmentioning

confidence: 99%

“…Previous studies have indicated that a positive mIBG scan after induction chemotherapy or just before myeloablative therapy may be a prognostic marker for a high likelihood of relapse (Ladenstein et al, 1998;Perel et al, 1999;Schmidt et al, 2008). Several publications have reported the use of semi-quantitative scoring systems to increase the precision and inter-observer reliability of this test, with success in correlating the results of mIBG scans with early response and event-free survival in some, but not all, reports (Ady et al, 1995;Suc et al, 1996;Frappaz et al, 2000;Hero et al, 2001;Matthay et al, 2003b;Katzenstein et al, 2004). As treatment of stage 4 neuroblastoma continues to be a challenge, with a high rate of relapse in bone and bone marrow, it is essential to have a quantitative and reliable measure of response in bone metastases to test the activity of new therapies for this disease (Messina et al, 2006).…”

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confidence: 99%

“…Metaiodobenzylguanidine score at diagnosis may be prognostic, as higher scores, indicating a high body burden of tumour, have been associated with a poorer outcome in some studies. For example, Suc et al (1996) have shown that an initial semi-quantitative score of 44 was independently associated with failure to achieve complete remission after induction chemotherapy, although most other studies showed only a trend or no significance to the initial mIBG score (Perel et al, 1999;Matthay et al, 2003b;Katzenstein et al, 2004;Yanik et al, 2010). Ongoing prospective studies of large numbers of uniformly treated patients in North America and Europe will further elucidate the prognostic significance of the initial mIBG score.…”

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confidence: 99%

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Criteria for evaluation of disease extent by 123I-metaiodobenzylguanidine scans in neuroblastoma: a report for the International Neuroblastoma Risk Group (INRG) Task Force

et al. 2010

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BACKGROUND: Neuroblastoma is an embryonic tumour of the sympathetic nervous system, metastatic in half of the patients at diagnosis, with a high preponderance of osteomedullary disease, making accurate evaluation of metastatic sites and response to therapy challenging. Metaiodobenzylguanidine (mIBG), taken into cells via the norepinephrine transporter, provides a sensitive and specific method of assessing tumour in both soft tissue and bone sites. The goal of this report was to develop consensus guidelines for the use of mIBG scans in staging, response assessment and surveillance in neuroblastoma. METHODS: The International Neuroblastoma Risk Group (INRG) Task Force, including a multidisciplinary group in paediatric oncology of North and South America, Europe, Oceania and Asia, formed a subcommittee on metastatic disease evaluation, including expert nuclear medicine physicians and oncologists, who developed these guidelines based on their experience and the medical literature, with approval by the larger INRG Task Force. RESULTS: Guidelines for patient preparation, radiotracer administration, techniques of scanning including timing, energy, specific views, and use of single photon emission computed tomography are included. Optimal timing of scans in relation to therapy and for surveillance is reviewed. Validated semi-quantitative scoring methods in current use are reviewed, with recommendations for use in prognosis and response evaluation. CONCLUSIONS: Metaiodobenzylguanidine scans are the most sensitive and specific method of staging and response evaluation in neuroblastoma, particularly when used with a semi-quantitative scoring method. Use of the optimal techniques for mIBG in staging and response, including a semi-quantitative score, is essential for evaluation of the efficacy of new therapy.

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“…In order to evaluate the prognostic effects and quantify efficacy of therapy, a number of semi-quantitative scores have emerged [14][15][16][17][18][19] and have been shown to be essential for the evaluation and quantification of response to the treatment [12,20,21].…”

Section: Introductionmentioning

confidence: 99%

Recognition of Abnormal Uptake through 123I-mIBG Scintigraphy Entropy for Paediatric Neuroblastoma Identification

Martínez-Díaz

Ruiz

et al. 2016

Entropy

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Whole-body 123 I-Metaiodobenzylguanidine (mIBG) scintigraphy is used as primary image modality to visualize neuroblastoma tumours and metastases because it is the most sensitive and specific radioactive tracer in staging the disease and evaluating the response to treatment. However, especially in paediatric neuroblastoma, information from mIBG scans is difficult to extract because of acquisition difficulties that produce low definition images, with poor contours, resolution and contrast. These problems limit physician assessment. Current oncological guidelines are based on qualitative observer-dependant analysis. This makes comparing results taken at different moments of therapy, or in different institutions, difficult. In this paper, we present a computerized method that processes an image and calculates a quantitative measurement considered as its entropy, suitable for the identification of abnormal uptake regions, for which there is enough suspicion that they may be a tumour or metastatic site. This measurement can also be compared with future scintigraphies of the same patient. Over 46 scintigraphies of 22 anonymous patients were tested; the procedure identified 96.7% of regions of abnormal uptake and it showed a low overall false negative rate of 3.3%. This method provides assistance to physicians in diagnosing tumours and also allows the monitoring of patients' evolution.

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Metastatic neuroblastoma in children older than one year: Prognostic significance of the initial metaiodobenzylguanidine scan and proposal for a scoring system

Abstract: The initial mIBG scan is of prognostic significance to predict response to chemotherapy for metastatic neuroblastoma in children older than 1 year of age. A prospective study comparing this initial mIBG score with other recently established prognostic factors is warranted.

Cited by 72 publications

References 25 publications

Use of Real-Time Magnetic Resonance Guidance to Assist Bone Biopsy in Pediatric Malignancy

Use of Real-Time Magnetic Resonance Guidance to Assist Bone Biopsy in Pediatric Malignancy

Criteria for evaluation of disease extent by 123I-metaiodobenzylguanidine scans in neuroblastoma: a report for the International Neuroblastoma Risk Group (INRG) Task Force

Recognition of Abnormal Uptake through 123I-mIBG Scintigraphy Entropy for Paediatric Neuroblastoma Identification

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