Clinical value of somatostatin receptor imaging in patients with suspected head and neck paragangliomas

Abstract

Paragangliomas or glomus tumours of the head and neck region are rare somatostatin receptor-expressing neuroendocrine tumours. Precise preoperative diagnosis is of special importance in order to adequately weigh the potential benefit of the operation against the inherent risks of the procedure. In this study, the clinical value of somatostatin receptor imaging was assessed in 19 patients who underwent somatostatin receptor scintigraphy because of known or suspected paraganglioma of the head and neck region. The results were compared with the results of computed tomography and/or magnetic resonance imaging, histology and clinical follow-up. [(111)In-DTPA- D-Phe(1)]-octreotide scintigraphy was performed 4-6 and 24 h after i.v. injection of 140-220 MBq (111)In-octreotide. Whole-body and planar images as well as single-photon emission tomography images were acquired and lesions were graded according to qualitative tracer uptake. Somatostatin receptor imaging was positive in nine patients, identifying paragangliomas for the first time in three patients and recurrent disease in six patients. In one patient, a second, previously unknown paraganglioma site was identified. Negative results were obtained in ten patients. These patients included one suffering from chronic hyperplastic otitis externa, one with granuloma tissue and an organised haematoma, one with an acoustic neuroma, one with an asymmetric internal carotid artery, two with ectasia of the bulbus venae jugularis and one with a jugular vein thrombosis. In two patients with a strong family history of paraganglioma, individual involvement could be excluded. In only one patient did somatostatin receptor imaging and magnetic resonance imaging yield false negative results in respect of recurrent paraganglioma tissue. It is concluded that somatostatin receptor scintigraphy provides important information in patients with suspected paragangliomas of the head and neck region and has a strong impact on further therapeutic management.

Is There an Additional Value of Using Somatostatin Receptor Subtype 2a Immunohistochemistry Compared to Somatostatin Receptor Scintigraphy Uptake in Predicting Gastroenteropancreatic Neuroendocrine Tumor Response?

“…Potential sources for this false-positive uptake on SRS are: thyroid disease, breast disease, granulomatous lung disease, inflammatory diseases like respiratory infections, recent operation sites, lymphomas, meningiomas, paragangliomas, and accessory spleens [28,29,30,31,32]. None of these causes could explain SRS positivity in our 5 patients with negative tumoral sst 2a IHC.…”

Expression of somatostatin receptors, dopamine D2 receptors, noradrenaline transporters, and vesicular monoamine transporters in 52 pheochromocytomas and paragangliomas

“…As already mentioned for PGL, SRS with 111 In-pentreotide is a first-line detection tool with high sensitivity/specificity (Schmidt et al 2002, Duet et al 2003, Koopmans et al 2008. However, in PCC, its sensitivity is clearly lower than that of 18 F-DA PET and MIBG scintigraphy (Kwekkeboom et al 2010), can be applied to metastatic PCC/PGL with good efficacy in selected cases (van Essen et al 2006, Forrer et al 2008.…”

Familial Cervical Paragangliomas with Lymph Node Metastasis Expressing Somatostatin Receptor Type 2A

“…Following and treating these patients after surgery remains a problem. The tumor cells from the present cases strongly demonstrated immunoreactivity for sstr 2A, suggesting that octreotide scintigraphy is a very sensitive method for the detection of PGs of the head and neck [14]. There have been no previous reports on the immunohistochemical study of somatostatin receptor types for cervical PGs.…”