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The Journal of Clinical Endocrinology & Metabolism Vol. 86, No. 2 685-693
Copyright © 2001 by The Endocrine Society

Original Studies

[123I]Metaiodobenzylguanidine and [111In]Octreotide Uptake in Benign and Malignant Pheochromocytomas1

Erwin van der Harst, Wouter W. de Herder, Hajo A. Bruining, H. Jaap Bonjer, Ronald R. de Krijger, Steven W. J. Lamberts, Anton H. van de Meiracker, Frans Boomsma, Theo Stijnen, Eric P. Krenning, Fred T. Bosman and Dik J. Kwekkeboom

Departments of Surgery (E.v.d.H., H.A.B., H.J.B.), Internal Medicine III (W.W.d.H., S.W.J.L., A.H.v.d.M., F.B., E.P.K.), Pathology (R.R.d.K.), Biostatistics (T.S.), and Nuclear Medicine (E.P.K., D.J.K.), Erasmus University Hospital, 3000 CA Rotterdam, The Netherlands; and Department of Pathology, University Hospital of Lausanne (F.T.B.), Lausanne, Switzerland

Address all correspondence and requests for reprints to: Erwin van der Harst, M.D., Department of Surgery, Erasmus University Hospital, Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. E-mail: evanderharst{at}hotmail.com

Selecting the appropriate approach for resection and follow-up of pheochromocytomas (PCCs) is highly dependent upon reliable localization and exclusion of multifocal, bilateral, or metastatic disease. Metaiodobenzylguanidine (MIBG) scintigraphy was developed for functional localization of catecholamine-secreting tissues. Somatostatin receptor imaging (SRI) has a high sensitivity for localizing head and neck paragangliomas, but studies of intraabdominal PCCs are rare. In this study we review our experience of [123I]MIBG and SRI, performed since 1983 and 1989, respectively, in the work-up of primary and recurrent PCCs. Scintigraphic results were correlated with catecholamine secretion, size and site, malignancy, associated tumor syndromes, and morphological features.

[123I]MIBG scans were performed in a total of 75 patients, in 70 cases before resection of primary PCCs and in 5 cases because of recurrent disease. Ninety-one PCCs were resected. The overall detection rates were 83.3% and 89.8% for PCCs larger than 1.0 cm. Multifocal disease was detected in 4 patients with [123I]MIBG. [123I]MIBG uptake correlated with greater size of PCC (r = 0.33; P = 0.008) and greater concentration of plasma epinephrine (r = 0.32; P = 0.006). [123I]MIBG-negative PCCs (n = 14) had significantly (P = 0.01) smaller diameters than [123I]MIBG-positive tumors. Furthermore, [123I]MIBG uptake was significantly higher in unilateral (P = 0.02), benign (P = 0.02), sporadic (P = 0.02), intraadrenal (P = 0.02), and capsular invasive (P = 0.03) PCCs than in bilateral, malignant, MEN2A/2B-related, extraadrenal, and noninvasive PCCs, respectively. The detection rate of SRI was only 25% (8 of 32) for primary benign PCCs. In 14 patients metastases occurred, which were effectively visualized with [123I]MIBG in 8 of 14 cases. SRI was able to detect metastases in 7 of 8 cases, including 3 [123I]MIBG-negative metastatic cases. In addition, [123I]MIBG and SRI detected 2 recurrences.

In conclusion, [123I]MIBG uptake is correlated with the size, epinephrine production, and site of PCCs. Its role in bilateral and MEN2A/2B-related PCCs seems limited. In cases of recurrent elevation of catecholamines, localization of metastases and/or recurrence should be attempted with [123I]MIBG scintigraphy. In suspicious metastatic PCCs, SRI might be considered to supplement [123I]MIBG scintigraphy.




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