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Positron Emission Tomography– Computed Tomography in Paraneoplastic Neurologic DisordersSystematic Analysis and Review
Andrew McKeon, MB, MRCPI;
Metha Apiwattanakul, MD;
Daniel H. Lachance, MD;
Vanda A. Lennon, MD, PhD;
Jayawant N. Mandrekar, PhD;
Bradley F. Boeve, MD;
Brian Mullan, MD;
Bahram Mokri, MD;
Jeffrey W. Britton, MD;
Daniel A. Drubach, MD;
Sean J. Pittock, MD
Arch Neurol. 2010;67(3):(doi:10.1001/archneurol.2009.336).
Objective To evaluate the cancer detection rate of whole-body positron emission tomography–computed tomography (PET-CT) in a paraneoplastic neurologic context.
Design Retrospective medical record review.
Setting Mayo Clinic, Rochester, Minnesota.
Patients Fifty-six consecutive patients with clinically suspected paraneoplastic neurologic disorders who underwent PET-CT after negative standard evaluations, including CT.
Main Outcome Measure Rate of cancer detection.
Results Abnormalities suggestive of cancer were detected using PET-CT in 22 patients (39%); 10 patients (18%) had cancer confirmed histologically. Cancers detected (limited stage in 9 of 10 patients and extratruncal in 4) were as follows: 2 thyroid papillary cell carcinomas, 3 solitary lymph nodes with unknown primary (2 adenocarcinomas and 1 small cell carcinoma), 1 tonsil squamous cell carcinoma, 3 lung carcinomas (1 adenocarcinoma, 1 small cell, and 1 squamous cell), and 1 colon adenocarcinoma. Detection of a well-characterized neuronal nuclear or cytoplasmic paraneoplastic autoantibody was associated with a successful PET-CT–directed cancer search (P < .001). Detection of limited-stage cancer facilitated early initiation of oncologic treatments and immunotherapy; cancer remission was reported in 7 patients, and sustained improvements in neurologic symptoms were reported in 5 (median follow-up, 11 months; range, 2-48 months). Combined data from 2 previous studies using conventional PET alone (123 patients) revealed that 28% of patients had a PET abnormality suggestive of cancer and that 12% had a cancer diagnosis.
Conclusion In a paraneoplastic neurologic context, PET-CT improves the detection of cancers when other screening test results are negative, particularly in the setting of seropositivity for a neuronal nuclear or cytoplasmic autoantibody marker of cancer.
Author Affiliations: Departments of Neurology (Drs McKeon, Lachance, Lennon, Boeve, Mokri, Britton, Drubach, and Pittock), Laboratory Medicine and Pathology (Drs McKeon, Apiwattanakul, Lachance, Lennon, and Pittock), Immunology (Dr Lennon), Biostatistics (Dr Mandrekar), and Radiology (Dr Mullan), Mayo Clinic, Rochester, Minnesota.
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