Abstract
In staging neuroblastomas, the demonstration of tumoural invasion of the bone marrow is an important criterion with regard to the therapeutic prospects and the prognosis. Iliac crest aspiration sampling has been used routinely for the detection of bone marrow metastases in neuroblastoma. However, due to the limited character of the sampling, it sometimes leads to false-negative results. Another procedure which is used to determine the extent of neuroblastoma is metaiodobenzylguanidine (mIBG) scintigraphy. In order to establish the respective merits of both diagnostic techniques retrospectively, 148 iodine-123 mIBG scans of 26 children with neuroblastoma have been re-evaluated and compared with the results of routine bone marrow samples obtained within a 4-week period before or after scanning. Three types of mIBG uptake in the bone/bone marrow could be differentiated: (1) no visualization of the skeleton; (2) diffuse uptake in the skeleton with or without focally increased uptake, which indicates massive, diffuse bone marrow invasion by the tumour; and (3) focal tracer accumulation in one or several bones. No tracer uptake was observed in the skeleton in 91 scans. In 89 of the 91 the bone marrow biopsy was negative. Twenty-four scans showed diffuse skeletal uptake with or without foci. The bone marrow biopsies were negative for eight of those 24 scans. Hyperactive foci in one or more bones without diffuse tracer accumulation in the skeleton were detected in 33 scans. In only 7 of these 33 scans did bone marrow biopsy specimens from the iliac MDP crest contain neuroblastoma cells. Available technetium-99m methylene diphosphonate (MDP) whole-body scintigrams were also compared with the corresponding mIBG scans. Thirty-eight mIBG scans showed no visualization of the skeleton; 99mTc-MDP scintigrams were also normal. Seven patients with diffuse mIBG uptake in the skeleton appeared as normal on the 99mTc-MDP scans. Among 27 cases showing focal mIBG uptake in the skeleton with or without diffuse uptake, only I8 demonstrated a hot spot on the bone scintigram. The results of our study indicate that for the assessment of bone marrow infiltration by neuroblastoma, 1231-mIBG scintigraphy is more sensitive than the conventional cytological examination of bone marrow smears routinely obtained from the iliac crest, has a very high sensitivity in excluding bone marrow invasion, has a high specificity for detecting bone marrow invasion, appears to be able to detect early tumoural deposits in the bone marrow before osseous invasion occurs as shown on the MDP scans and is superior to 99mTc-MDP bone scan in detecting bone/bone marrow metastases of neuroblastoma. In patients with a positive mIBG scan in the skeleton, bone marrow biopsy will not yield additional information.
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Behrman RE, Vaughan VC, Nelson WE. Nelson textbook of pediatrics. Philadelphia: Saunders; 1987: 1093–1095
Sisson JC, Wieland DM, Sherman P, Mangner TJ, Tobes MC, Jacques S Jr. Metaiodobenzylguanidine as an index of the adrenergic nervous system integrity and function. J Nucl Med 1987;28: 1620–1624
Smets LA, Loesberg C, Janssen M, Ebtisam A, Metwally EA, Huiskamp R. Active uptake and extravesicular storage of m-iodobenzyl-guanidine in human neuroblastoma SK-N-SH cells. Cancer Res 1989;49: 2941–2944
Glowniak JV, Kilty JE, Amara SG, Hoffman BJ, Turner FE. Evaluation of metaiodobenzylguanidine uptake by the norepinephrine, dopamine and serotonin transporters. J Nucl Med 1993;34: 1140–1146
Geatti O, Shapiro B, Sisson JC, Hutchinson RJ, Malette S, Eyre P, Beierwaltes WH. Iodine-131 metaiodobenzylguanidine for the locating of neuroblastoma: preliminary experiences in ten cases. J Nucl Med 1985; 26: 736–742
Hoefnagel CA, Voûte PA, de Kraker J, Marcuse HR. Total body scintigraphy with 131 I-meta-iodobenzylguanidine for detection of neuroblastoma. Diagn Imag Clin Med 1985;54: 21–27
Hausegger KA, Fueger GF, Ebner F, Urban Ch. Indikationen zur mIBG-Szintigraphie in der Neuroblastomdiagnostik. Nuklearmedizin 1989;28:34–40
Lumbroso JD, Guermazi F, Hartmann O, Coornaert S, Rabarison Y, Leclère JG, Counaet D, Bayle C, Caillaud JM, Lemerle J, Parmentier C. Meta-iodobenzylguanidine (mIBG) scan in neuroblastoma: sensitivity and specificity a review of 115 scans. Prog Clin Biol Res 1988;271: 689–705
Bostrom B, Nesbit ME, Brunning RD. The value of bone marrow trephine biopsy in the diagnosis of metastatic neuroblastoma. Am J Pediatr Hematol Oncol 1985;7: 303–305
Franklin IM, Pritchard J. Detection of bone marrow invasion by neuroblastoma is improved by sampling at two sites with both aspirates and trephine biopsies. J Clin Pathol 1983;36: 1215–1218
Widding A, Stilbo L, Hansen SW, Hansen HH, Rossing N. Scintigraphy with nanocolloid Tc 99m in patients with small cell lung cancer, with special reference to bone marrow and hepatic metastases. Eur J Nucl Med 1990;16: 717–719
Perrin-Resche I, Bizais Y, Buhe T, Fiche M. How does iliac crest bone marrow biopsy compare with imaging in the detection of bone metastases in small cell lung cancer? Eur J Nucl Med 1993;20: 420–425
Jonas M, Sciuk J, Dreyling M. 99m Tc-MAk-Knochenmarkszintigraphie und sondengezielte Punktion bei aplastischer Anämie. Nucl Med 1992;31: 202–204
Berthold F, Schneider A, Schumacher R, Bosslet K. Detection of minimal disease in bone marrow of neuroblastoma patients by immunoflorescence. Pediatr Hematol Oncol 1989;6: 73–83
Beck D, Maritazo, Gross N, Favrot M, Vultier N, Bailly C, Villa I, Gentilhomme O, Philip T. Immunocytochemical detection of neuroblastoma cells infiltrating clinical bone marrow samples. Eur J Pediatr 1988;147: 609–612
Moss TJ, Reynolds CP, Sather HN, Romansky SG, Hammond GD, Seeger RC. Prognostic value of immunocytologic detection of bone marrow metastases in neuroblastoma. N Engl J Med 1991;324: 219–226
Favrot MC, Frappaz D, Maritaz O, Philip I, Fontaniere B, Gentilhomme O, Bailly C, Zucker JM, Gentet JC, Kemshead J, Philip T. Histological, cytological and immunological analyses are complemetary for the detection of neuroblastoma cells in bone marrow. Br J Cancer 1986;54: 637–641
Combaret V, Favrot MC, Kremens B, Philip I, Bailly C, Fontaniere B, Gentilhomme O, Chauvin F, Zucker JM, Bernard JL, Philip T. Immunological detection of neuroblastoma cells in bone marrow harvested for autologous transplanation. Br J Cancer 1989;59: 844–847
Crary GS, Singleton TP, Neglia JP, Swanson PE, Strickler JG. Detection of metastatic neuroblastoma in bone marrow biopsy specimens with an antibody to neuron specific enolase. Mod Pathol 1992;5: 308–311
Boman F, Chastagner P, Floquet J, Sommelet D, Aymard B, Palau R, Kleinclaus I. Diagnostic histologique et immunohistochimique des métastases ostéomédullaires des neuroblastomes. Bull Cancer 1991;78: 943–951
Feine U, Mueller-Schauenburg W Treuner J, Klingebiel Th. mIBG labeled with 123I/131I, in neuroblastoma diagnosis and follow-up treatment with a review of the diagnostic results of the international workshop of pediatric oncology held in Rome, September 1986. Med Pediatr Oncol 1987;15: 181–187
Benz-Bohm G, Gross-Fengels W Widemann B, Linden A. Knochenmarkmetastasierung bei Neuroblastom: MRT im Vergleich zur Knochenmarkzytologie und mIBG-Szintigraphie. ROFO 1990;152:523–527
Bourliere Najean B, Siles S, Panuel M, Cammileri S, Faure F, Devred P, Kaphan G. Value of MRI and mIBG-I 123 scintigraphy in the diagnosis of spinal bone marrow involvement in neuroblastoma in children. Pediatr Radiol 1992;22: 443–446
Kretschmer A, Dewes W Graf N, Hau U, Kubale R, Kramann B, Sitzmann CF. MR-Tomographie der Unterschenkel bei Kindern mit Erkrankungen des hämatopoetischen Systems. Nucl Med 1992;31: 186–191
Algra PR, Postma T, van Groeningen CJ, van der Valk P, Bloem JL, Valk J. MR imaging of skeletal metastases from medulloblastoma. Skeletal Radiol 1992;21: 425–430
Layer G, Jarosch K. Magnetresonanztomographie des Knochenmarks zum Nachweis von Metastasen solider Tumoren. Radiologe 1992;32: 502–508
Shulkin BL, Wieland DM, Baro ME, Mitchell DS, Ungar DR, Dole MG, Hagen CA, Koeppe RA, Hutchinson RJ. PET studies of neuroblastoma with carbon 11-hydroxyephedrine. J Nucl Med 1993; 34: 220P
Jacobs A, Delree M, Desprechins B, Otten J, Ferster A, Jonckheer MH, Mertens J, Ham HR, Piepsz A. Consolidating the role of I-mIBG scintigraphy in childhood neuroblastoma: five years of clinical experience. Pediatr Radiol 1990;20: 157–159
Shulkin BL, Shapiro B, Hutchinson RJ, Sisson JC, Mallette S, Mudgett EE. Comparison of bone and 131 I-mIBG scanning for the detection of skeletal and extraskeletal neuroblastoma. Eur J Nucl Med 1991;18: 553
Bomanji J, Conry BG, Britton KE, Reznek RH. Imaging neural crest tumours with 123 I-metaiodobenzylguanidine and X-ray computed tomography: a comparative study. Clinic Radiol 1988;39: 502–506
Mueller-Gaertner HW Erttmann R, Helmke K. Metaiodobenzylguanidine scintigraphy in neuroblastoma: a comparison with conventional X-ray and ultrasound. Pediatr Hematol Oncol 1986;3: 97–109
Bouvier JF, Philp T, Chauvot P, Brunat Mentigny M, Ducrettet F, Maïassi N, Lahnèche BE. Pitfalls and solutions in neuroblastoma diagnosis using radioiodine mIBG: our experience about 50 cases. Prog Clin Biol Res 1988;271: 707–720
Shulkin BL, Shen SW, Sisson JC, Shapiro B. Iodine-131 mIBG scintigraphy of the extremities in metastatic pheochromocytoma and neuroblastoma. J Nucl Med 1987;28: 315–318
Hibi S, Todo S, Imashuku S, Miyazaki T. 131 I-metaiodobenzylguanidine scintigraphy in patients with neuroblastoma. Pediatr Radiol 1987;17: 308–313
Adolph J, Kimmig B. Diagnostik und Therapie neuroektodermaler Tumoren. Radiologe 1989;29: 32–42
Shulkin B, Shapiro B. Editorial. J Nucl Med 1993;34: 865
Gordon I, Peters AM, Gutman A, Morony S, Dicks-Mireaux C, Pritchard J. Skeletal assessment in neuroblastoma — the pitfalls of iodine- 123-mIBG scans. J Nucl Med 1990;31: 129–134
Heyman S, Evans EA, D'Angio GJ. I-131 metaiodobenzylguanidine: diagnostic use in neuroblastoma patients in relapse. Med Pediatr Oncol 1988;16: 337–340
Sautter-Bihl ML, Bihl H, Heinze HG. Stellenwert der 99m Tc-MDP-Skelettszintigraphie beim Neuroblastom. Ist eine Neubewertung nötig? Nuklearmedizin 1991;30: 7–12
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Osmanagaoglu, K., Lippens, M., Benoit, Y. et al. A comparison of iodine-123 meta-iodobenzylguanidine scintigraphy and single bone marrow aspiration biopsy in the diagnosis and follow-up of 26 children with neuroblastoma. Eur J Nucl Med 20, 1154–1160 (1993). https://doi.org/10.1007/BF00171013
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DOI: https://doi.org/10.1007/BF00171013