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

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.(ABSTRACT TRUNCATED AT 250 WORDS)

Integrated Imaging Using MRI and 123| Metaiodobenzylguanidine Scintigraphy to Improve Sensitivity and Specificity in the Diagnosis of Pediatric Neuroblastoma

“…2). These findings are concordant with published studies showing the difficulties in differentiating liver metastases from physiologic uptake in the liver [20,21] and a general false-negative rate of 8-10% on MIBG scintigraphy [12,22].…”

Undeserved bad press for bone scans: reply

“…As we noted in our paper [2], the conclusion that m I B G scan is superior to 99mTc-MDP bone scan in detecting small foci of bone metastases and/or bone marrow involvement is not confined to our group but rather is shared by other groups [5][6][7][8][9]. It is true that 10% of neuroblastomas fail to accumulate m I B G [9] while MDP bone scan clearly demonstrates the involved bony sites and this may cause an underestimation of tumour dissemination [4,6,10].…”

“…This ~ts because of the non-specificity of 99mTc-MDP while 123I-mIBG shows highly specific bony uptake without any false-positive results [2][3][4]. This ~ts because of the non-specificity of 99mTc-MDP while 123I-mIBG shows highly specific bony uptake without any false-positive results [2][3][4].…”

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Undeserved bad press for bone scans: reply

Dear Sir

We are really astonished by the style of Dr. Gordon's letter [1], which exposes us to what we consider to be unjustifiable criticism. Our paper [2] was not intended to -nor does it -place bone scans in an unfavourable light; it simply concludes that in certain situations more information is provided by the m I B G scan.1. In Dr. Gordon's letter the meaning of the sentence 'q23I-MIBG is able to detect early tumoral diposits [sic] ... before 99mTc-MDP bone scans" is distorted by the omission signalled by dots.

…”

“…In Dr. Gordon's letter the meaning of the sentence 'q23I-MIBG is able to detect early tumoral diposits [sic] ... before 99mTc-MDP bone scans" is distorted by the omission signalled by dots. This ~ts because of the non-specificity of 99mTc-MDP while 123I-mIBG shows highly specific bony uptake without any false-positive results [2][3][4].As we noted in our paper [2], the conclusion that m I B G scan is superior to 99mTc-MDP bone scan in detecting small foci of bone metastases and/or bone marrow involvement is not confined to our group but rather is shared by other groups [5][6][7][8][9]. Our conclusion is based on the following results as reported in our article: a) Thirty-eight mIBG scans showed no visualization of the skeleton: the matching 99mTc-MDP bone scans were also normal.…”