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Utility of 18F-FDG-PET/CT in patients suspected of paraneoplastic neurological syndrome: importance of risk classification

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Abstract

Purpose

To assess the diagnostic impact of 18F-FDG-PET/CT in patients suspected of paraneoplastic neurological syndrome (PNS) based on our own pre-test risk classification (PRC).

Methods

A multicenter retrospective longitudinal study was conducted from 2006 to 2014. We designed a seven-point scoring system using the clinical syndrome characteristics [classical (CS) and non-classical syndromes (NCS)] and its location (central, peripheral, in the neuromuscular junction or combined), onconeural antibodies and tumor markers. Patients were classified as low (score 0–2), intermediate (3–4) and high (5–7) pre-test risk of PNS. FDG-PET/CT was classified as negative or positive. Final diagnosis according Graus’ criteria (definite, possible or no PNS) was established. Relations between clinical and metabolic variables with the final diagnosis were studied.

Results

73 patients were included, with a follow-up time of 33 months. Eleven (15 %) patients were finally diagnosed with neoplasm (8 invasive cancers). Ultimately, 13 (18 %) and 24 (33 %) subjects were diagnosed as definite or possible PNS. All the patients with final diagnosis of neoplasm had a CS (p = 0.005). PET/CT was helpful to diagnose 6/8 (75 %) invasive cancers. PET/CT findings were associated with the final diagnosis of neoplasm (p = 0.003) and the diagnosis of PNS attending to Graus’ criteria (p = 0.019). PRC showed significant association with the final diagnosis of neoplasm and PET/CT results. A majority of patients (10/11) diagnosed of neoplasm had intermediate/high-risk.

Conclusions

Our PRC seems to be a valid tool to select candidates for PET/CT imaging in this setting. PET/CT detected malignancy in a significant proportion of patients with invasive cancer.

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Authors and Affiliations

  1. Nuclear Medicine Department, University General Hospital, C/Obispo Rafael Torija s/n, 13005, Ciudad Real, Spain

    F. J. Pena Pardo, A. M. García Vicente & A. Soriano Castrejón

  2. Mathematics Department, Castilla La Mancha University, Ciudad Real, Spain

    M. Amo-Salas & J. F. López-Fidalgo

  3. Neurology Department, Virgen de la Salud Hospital, Toledo, Spain

    J. A. Garrido Robles

  4. Internal Medicine Department, University Hospital, Albacete, Spain

    J. Á. de Ayala Fernández

  5. Neurology Department, Mancha Centro Hospital, Alcázar de San Juan, Ciudad Real, Spain

    P. del Saz Saucedo

  6. Neurology Department, Puertollano Hospital, Ciudad Real, Spain

    M. Muñoz Pasadas

Authors
  1. F. J. Pena Pardo
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  2. A. M. García Vicente
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  3. M. Amo-Salas
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  4. J. F. López-Fidalgo
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  5. J. A. Garrido Robles
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  6. J. Á. de Ayala Fernández
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  7. P. del Saz Saucedo
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  8. M. Muñoz Pasadas
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  9. A. Soriano Castrejón
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Corresponding author

Correspondence to F. J. Pena Pardo.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Informed consent was obtained from all individual participants included in the study.

Research involving human participants and/or animals. Ethical approval

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Pena Pardo, F.J., García Vicente, A.M., Amo-Salas, M. et al. Utility of 18F-FDG-PET/CT in patients suspected of paraneoplastic neurological syndrome: importance of risk classification. Clin Transl Oncol 19, 111–118 (2017). https://doi.org/10.1007/s12094-016-1511-3

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  • DOI: https://doi.org/10.1007/s12094-016-1511-3

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