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Sachpekidis C, Sidiropoulou P, Hassel JC, Drakoulis N, Dimitrakopoulou-Strauss A. Positron Emission Tomography in Merkel Cell Carcinoma. Cancers (Basel) 2020; 12:E2897. [PMID: 33050255 PMCID: PMC7601068 DOI: 10.3390/cancers12102897] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/23/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare neuroendocrine skin malignancy usually arising as a nonspecific nodule on sun-exposed areas of the head and neck. Given the poor prognosis of this aggressive tumor, assessment of disease burden in pre- and post-treatment care may ensure an optimal management with significant implications for patient surveillance and prognosis. Although imaging has established its role in locally advanced or distant metastatic MCC, a standard imaging algorithm is yet to be determined and respective recommendations are mainly based on melanoma. Positron emission tomography/computed tomography (PET/CT) is increasingly evolving as a valuable imaging tool in metastatic or unresectable MCC, mostly utilizing the glucose analogue 18F-fluorodeoxyglucose (18F-FDG) as a radiotracer. Despite being inferior in detecting the disease in its early stages compared to the "gold standard" of sentinel lymph node biopsy, recent evidence suggests an important role for 18F-FDG PET/CT in the routine workup of localized MCC. Moreover, 68Ga-labeled somatostatin analogues have been employed as PET tracers in the field of MCC with promising, yet comparable to 18F-FDG, results. This article provides a structured literature review of the most important studies investigating the role of PET or PET/CT in the clinical practice of MCC.
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Affiliation(s)
- Christos Sachpekidis
- German Cancer Research Center, Clinical Cooperation Unit Nuclear Medicine, 69120 Heidelberg, Germany;
| | - Polytimi Sidiropoulou
- 1st Department of Dermatology-Venereology, Faculty of Medicine, National and Kapodistrian University of Athens, “A. Sygros” Hospital for Cutaneous & Venereal Diseases, GR-16121 Athens, Greece;
| | - Jessica C. Hassel
- Department of Dermatology and National Center for Tumor Diseases, University Hospital Heidelberg, 69120 Heidelberg, Germany;
| | - Nikolaos Drakoulis
- Research Group of Clinical Pharmacology and Pharmacogenomics, Faculty of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, GR-15771 Athens, Greece;
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Duncan JR, Carr D, Kaffenberger BH. The utility of positron emission tomography with and without computed tomography in patients with nonmelanoma skin cancer. J Am Acad Dermatol 2016; 75:186-96. [PMID: 26992283 DOI: 10.1016/j.jaad.2016.01.045] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 01/16/2016] [Accepted: 01/20/2016] [Indexed: 10/22/2022]
Abstract
Combined positron emission tomography (PET) and computed tomography (CT) scans are widely used in the staging and monitoring of most malignancies. The differential for PET-positive cutaneous lesions includes primary skin cancers, infections, cutaneous metastases from distant malignancies, and benign neoplasms. In dermatology, PET/CT scans have been most widely studied in patients with melanoma and Merkel cell carcinoma. The role of PET/CT scans in the management of other cutaneous malignancies is less clear, but it has shown great promise in the management of patients with squamous cell carcinoma and cutaneous lymphoma. This review seeks to address the usefulness of PET/CT scans in nonmelanoma skin cancer and to provide guidance regarding the management of patients with incidental PET-positive nodules. Currently, there is limited experience with PET/CT scans for staging and monitoring of non-head and neck metastatic basal cell and squamous cell carcinomas, and results show limited sensitivity and specificity. We also address the evidence for management of an incidental PET-positive cutaneous nodule and recommend obtaining a biopsy specimen in patients with a known noncutaneous malignancy, a history of primary skin cancer, or a high risk of either cutaneous or noncutaneous malignancy.
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Affiliation(s)
| | - David Carr
- Division of Dermatology, Wexner Medical Center at Ohio State University, Ghanna, Ohio
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Paun DL, Vija L, Stan E, Banica A, Bobeica E, Terzea D, Poiana C, Badiu C, Paun S. Cushing syndrome secondary to ectopic adrenocorticotropic hormone secretion from a Meckel diverticulum neuroendocrine tumor: case report. BMC Endocr Disord 2015; 15:72. [PMID: 26610855 PMCID: PMC4661995 DOI: 10.1186/s12902-015-0070-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 11/17/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Ectopic production of adrenocorticotropic hormone (ACTH) by neuroendocrine tumours (NET) is a rare condition, occult presentations often hampering the diagnosis. Although NET are relatively frequent in the ileon and Meckel diverticulum, we describe the first Cushing's syndrome due to ectopic adrenocorticotropic syndrome (CS-EAS) arising from a Meckel diverticulum. CASE PRESENTATION A 44-year-old man was admitted with recent onset of diabetes, myopathy, edema and hypokalemic metabolic alkalosis consistent with Cushing's syndrome. Both basal and dynamic laboratory evaluation suggested CS-EAS. Laboratory testing also showed high serum levels of chromogranin A (CgA) and urinary 5-hydroxyindoleacetic acid (5HIAA). Pituitary and neck/thorax/abdomen/pelvis imaging proved to be normal, while somatostatin analogue ((99m)Tc-HYNIC-TOC) scintigraphy revealed increased focalized ileum uptake on the right iliac fossa. Pre-operative ketoconazole and sandostatin treatment controlled the hypercortisolism within a month. Pathological analysis of the resected submucosal 1.8 cm tumour of the Meckel diverticulum and a metastatic local lymph node confirmed a well differentiated neuroendocrine tumour (grade I), whereas immunohistochemistry was positive for ACTH, chromogranin A and synaptophysin. Post-operative clinical and biochemical resolution of Cushing's syndrome was followed by normalization of both CgA and 5HIAA, which were maintained at the 6 month follow-up. CONCLUSION The identification, characterization and follow-up of this rare cause of ectopic ACTH secretion is important in order to assess the long-term prognostic and management.
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Affiliation(s)
- Diana Loreta Paun
- "C.I. Parhon" National Institute of Endocrinology, 34-36, Aviatorilor Boulevard, sector 1, 011863, Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Lavinia Vija
- "C.I. Parhon" National Institute of Endocrinology, 34-36, Aviatorilor Boulevard, sector 1, 011863, Bucharest, Romania.
| | - Emilia Stan
- Braila Department Hospital, Braila, Bucharest, Romania
| | - Alexandra Banica
- "C.I. Parhon" National Institute of Endocrinology, 34-36, Aviatorilor Boulevard, sector 1, 011863, Bucharest, Romania
| | - Elena Bobeica
- "C.I. Parhon" National Institute of Endocrinology, 34-36, Aviatorilor Boulevard, sector 1, 011863, Bucharest, Romania
| | - Dana Terzea
- "C.I. Parhon" National Institute of Endocrinology, 34-36, Aviatorilor Boulevard, sector 1, 011863, Bucharest, Romania
| | - Catalina Poiana
- "C.I. Parhon" National Institute of Endocrinology, 34-36, Aviatorilor Boulevard, sector 1, 011863, Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Corin Badiu
- "C.I. Parhon" National Institute of Endocrinology, 34-36, Aviatorilor Boulevard, sector 1, 011863, Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Sorin Paun
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- General Surgery Department, Bucharest Emergency Hospital, Bucharest, Romania
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Prieto I, Pérez de la Fuente T, Medina S, Castelo B, Sobrino B, Fortes JR, Esteban D, Cassinello F, Jover R, Rodríguez N. Merkel cell carcinoma: An algorithm for multidisciplinary management and decision-making. Crit Rev Oncol Hematol 2015; 98:170-9. [PMID: 26597015 DOI: 10.1016/j.critrevonc.2015.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 09/04/2015] [Accepted: 10/20/2015] [Indexed: 12/17/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine tumor of the skin. Therapeutic approach is often unclear, and considerable controversy exists regarding MCC pathogenesis and optimal management. Due to its rising incidence and poor prognosis, it is imperative to establish the optimal therapy for both the tumor and the lymph node basin, and for treatment to include sentinel node biopsy. Sentinel node biopsy is currently the most consistent predictor of survival for MCC patients, although there are conflicting views and a lack of awareness regarding node management. Tumor and node management involve different specialists, and their respective decisions and interventions are interrelated. No effective systemic treatment has been made available to date, and therefore patients continue to experience distant failure, often without local failure. This review aims to improve multidisciplinary decision-making by presenting scientific evidence of the contributions of each team member implicated in MCC management. Following this review of previously published research, the authors conclude that multidisciplinary team management is beneficial for care, and propose a multidisciplinary decision algorithm for managing this tumor.
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Affiliation(s)
- Isabel Prieto
- Radiation Oncology, Fundación Jiménez Díaz, Avd. Reyes Católicos 2, 28040 Madrid, Spain.
| | | | - Susana Medina
- Dermathology Department, Príncipe de Asturias University Hospital, Carretera de AlcaláMeco s/n, 28805 Alcalá de Henares, Madrid, Spain.
| | - Beatriz Castelo
- Medical Oncologist, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain.
| | - Beatriz Sobrino
- Radiology, Fundación Jiménez Díaz, Avd. Reyes Católicos 2, 28040 Madrid, Spain.
| | - Jose R Fortes
- Pathology, Fundación Jiménez Díaz, Avd. Reyes Católicos 2, 28040 Madrid, Spain.
| | - David Esteban
- Radiation Oncology, Fundación Jiménez Díaz, Avd. Reyes Católicos 2, 28040 Madrid, Spain.
| | - Fernando Cassinello
- Anesthesiology, Fundación Jiménez Díaz, Avd. Reyes Católicos 2, 28040 Madrid, Spain.
| | - Raquel Jover
- Nuclear Medicine, Hospital Rey Juan Carlos, Calle Gladiolo, s/n, 28933 Móstoles, Madrid, Spain.
| | - Nuria Rodríguez
- Medical Oncologist, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain.
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Grandhaye M, Teixeira PG, Henrot P, Morel O, Sirveaux F, Verhaeghe JL, Blum A. Focus on Merkel cell carcinoma: diagnosis and staging. Skeletal Radiol 2015; 44:777-86. [PMID: 25631356 DOI: 10.1007/s00256-015-2104-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 01/02/2015] [Accepted: 01/12/2015] [Indexed: 02/02/2023]
Abstract
Merkel cell carcinoma is a rare lymphophilic skin tumor of neuroendocrine origin with the potential for rapid progression. Small, localized lesions are diagnosed and treated clinically, but advanced tumors often undergo imaging evaluation. Due to its rarity, radiologists are unaware of evocative imaging features and usually do not consider Merkel cell carcinoma in the differential diagnosis of soft tissue tumors. Appropriate staging is important to determine appropriate treatment and has an impact on patient prognosis. Multimodality imaging is usually needed, and there is no consensus on the optimal imaging strategy. The purpose of this article is to review various aspects of Merkel cell carcinoma imaging and look in detail at how optimal multimodality staging should be carried out.
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Affiliation(s)
- Marion Grandhaye
- Imagerie Guilloz CHU de Nancy Hôpital Central, 29 Avenue de Lattre de Tassigny, 54000, Nancy, France,
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Beylergil V, Carrasquillo JA. Molecular imaging and therapy of merkel cell carcinoma. Cancers (Basel) 2014; 6:1020-30. [PMID: 24784954 PMCID: PMC4074814 DOI: 10.3390/cancers6021020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/08/2014] [Accepted: 04/14/2014] [Indexed: 11/16/2022] Open
Abstract
Several molecular imaging modalities have been evaluated in the management of Merkel cell carcinoma (MCC), a rare and aggressive tumor with a high tendency to metastasize. Continuous progress in the field of molecular imaging might improve management in these patients. The authors review the current modalities and their impact on MCC in this brief review article.
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Affiliation(s)
- Volkan Beylergil
- Molecular and Imaging Therapy Service, Department of Radiology Box 77, Memorial Sloan-Kettering Cancer Center 1275 York Ave, New York, NY 10065, USA; E-mail:
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-212-639-5313; Fax: +1-212-639-8045
| | - Jorge A. Carrasquillo
- Molecular and Imaging Therapy Service, Department of Radiology Box 77, Memorial Sloan-Kettering Cancer Center 1275 York Ave, New York, NY 10065, USA; E-mail:
- Department of Radiology, Weill Cornell Medical Center, New York, NY 10065, USA
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Ibrahim SF, Ahronowitz I, McCalmont TH, Pampaloni MH, Ryan JL, Yu SS. 18F-Fluorodeoxyglucose Positron Emission Tomography–Computed Tomography Imaging in the Management of Merkel Cell Carcinoma: A Single-Institution Retrospective Study. Dermatol Surg 2013; 39:1323-33. [DOI: 10.1111/dsu.12246] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Abstract
Merkel cell carcinoma (MCC) is a rare, clinically aggressive cutaneous neuroendocrine neoplasm with a high mortality rate. Though the etiology is not precisely known, Merkel cell polyomavirus DNA has been found recently in a large percentage of MCC tumors. Other suggested risk factors include sun exposure, immunosuppression, and a history of prior malignancy. Work up of patients with MCC most notably includes nodal staging via clinical examination or sentinel lymph node biopsy. The prognosis for most patients with MCC is poor, and the rarity of MCC precludes the prospective, randomized clinical trials necessary to elucidate optimum treatment protocols. Most published data support the use of a multimodality approach centered around surgical excision with negative margins, sentinel lymph node biopsy to establish the presence or absence of nodal metastases, adjuvant radiothearpy to decrease the risk of recurrence, and systemic chemotherapy in the case of widespread disease.
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Tirumani SH, Shinagare AB, Sakellis C, Saboo SS, Jagannathan JP, Krajewski KM, Ramaiya NH. Merkel Cell Carcinoma: A Primer for the Radiologist. AJR Am J Roentgenol 2013; 200:1186-1196. [DOI: 10.2214/ajr.12.9884] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Sree Harsha Tirumani
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave, Boston, MA 02215
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Atul B. Shinagare
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Christopher Sakellis
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave, Boston, MA 02215
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sachin S. Saboo
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jyothi P. Jagannathan
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave, Boston, MA 02215
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Katherine M. Krajewski
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave, Boston, MA 02215
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Nikhil H. Ramaiya
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave, Boston, MA 02215
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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10
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Hawryluk EB, O'Regan KN, Sheehy N, Guo Y, Dorosario A, Sakellis CG, Jacene HA, Wang LC. Positron emission tomography/computed tomography imaging in Merkel cell carcinoma: A study of 270 scans in 97 patients at the Dana-Farber/Brigham and Women's Cancer Center. J Am Acad Dermatol 2013; 68:592-599. [DOI: 10.1016/j.jaad.2012.08.042] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 07/03/2012] [Accepted: 08/06/2012] [Indexed: 11/26/2022]
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Balogova S, Talbot JN, Nataf V, Michaud L, Huchet V, Kerrou K, Montravers F. 18F-fluorodihydroxyphenylalanine vs other radiopharmaceuticals for imaging neuroendocrine tumours according to their type. Eur J Nucl Med Mol Imaging 2013; 40:943-66. [PMID: 23417499 PMCID: PMC3644207 DOI: 10.1007/s00259-013-2342-x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 01/04/2013] [Indexed: 01/01/2023]
Abstract
6-Fluoro-(18F)-L-3,4-dihydroxyphenylalanine (FDOPA) is an amino acid analogue for positron emission tomography (PET) imaging which has been registered since 2006 in several European Union (EU) countries and by several pharmaceutical firms. Neuroendocrine tumour (NET) imaging is part of its registered indications. NET functional imaging is a very competitive niche, competitors of FDOPA being two well-established radiopharmaceuticals for scintigraphy, 123I-metaiodobenzylguanidine (MIBG) and 111In-pentetreotide, and even more radiopharmaceuticals for PET, including fluorodeoxyglucose (FDG) and somatostatin analogues. Nevertheless, there is no universal single photon emission computed tomography (SPECT) or PET tracer for NET imaging, at least for the moment. FDOPA, as the other PET tracers, is superior in diagnostic performance in a limited number of precise NET types which are currently medullary thyroid cancer, catecholamine-producing tumours with a low aggressiveness and well-differentiated carcinoid tumours of the midgut, and in cases of congenital hyperinsulinism. This article reports on diagnostic performance and impact on management of FDOPA according to the NET type, emphasising the results of comparative studies with other radiopharmaceuticals. By pooling the results of the published studies with a defined standard of truth, patient-based sensitivity to detect recurrent medullary thyroid cancer was 70 % [95 % confidence interval (CI) 62.1–77.6] for FDOPA vs 44 % (95 % CI 35–53.4) for FDG; patient-based sensitivity to detect phaeochromocytoma/paraganglioma was 94 % (95 % CI 91.4–97.1) for FDOPA vs 69 % (95 % CI 60.2–77.1) for 123I-MIBG; and patient-based sensitivity to detect midgut NET was 89 % (95 % CI 80.3–95.3) for FDOPA vs 80 % (95 % CI 69.2–88.4) for somatostatin receptor scintigraphy with a larger gap in lesion-based sensitivity (97 vs 49 %). Previously unpublished FDOPA results from our team are reported in some rare NET, such as small cell prostate cancer, or in emerging indications, such as metastatic NET of unknown primary (CUP-NET) or adrenocorticotropic hormone (ACTH) ectopic production. An evidence-based strategy in NET functional imaging is as yet affected by a low number of comparative studies. Then the suggested diagnostic trees, being a consequence of the analysis of present data, could be modified, for some indications, by a wider experience mainly involving face-to-face studies comparing FDOPA and 68Ga-labelled peptides.
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Affiliation(s)
- Sona Balogova
- Department of Nuclear Medicine, Comenius University & St. Elisabeth Institute, Bratislava, Slovakia.
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12
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Imaging in patients with merkel cell carcinoma. J Skin Cancer 2013; 2013:973123. [PMID: 23476783 PMCID: PMC3580906 DOI: 10.1155/2013/973123] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 01/04/2013] [Indexed: 12/03/2022] Open
Abstract
Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine tumor of the skin with a mortality rate of approximately 25% (Peloschek et al., 2010). Accurate assessment of nodal involvement in patients with MCC predicts significantly overall outcome (Smith et al., 2012 and Ortin-Perez et al., 2007). Due to the rarity of this highly aggressive disease, only a few imaging reports on MCC were published, and subsequently still to date no accepted imaging algorithm for MCC is available. For primary staging of MCC, general recommendations have included ultrasonography, chest X-ray CT, and MRI, but recent articles show that the use of sentinel node and FDG-PET/PET-CT is gaining more and more importance.
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Colgan MB, Tarantola TI, Weaver AL, Wiseman GA, Roenigk RK, Brewer JD, Otley CC. The predictive value of imaging studies in evaluating regional lymph node involvement in Merkel cell carcinoma. J Am Acad Dermatol 2012; 67:1250-6. [PMID: 22552001 DOI: 10.1016/j.jaad.2012.03.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 03/16/2012] [Accepted: 03/27/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare cutaneous neuroendocrine malignancy with high potential for nodal or distant metastatic spread. Little information exists on sensitivity and specificity of various imaging techniques when compared with the gold standard of histopathologic evaluation of the lymph node basin. OBJECTIVE We sought to further understand the value of various imaging modalities in the staging and initial workup of patients with MCC. METHODS Of 240 patients with primary MCC evaluated between 1981 and 2008, 99 had diagnostic imaging at initial presentation with biopsy-proven cutaneous MCC and had histopathologic nodal evaluation within 4 weeks of the initial scan. We conducted a retrospective chart review of these identified patients. RESULTS Computed tomography (n = 69) demonstrated a sensitivity of 47%, specificity of 97%, positive predictive value of 94%, and negative predictive value of 68% in detecting nodal basin involvement. Fluorine-18-fluorodeoxyglucose positron emission tomography scan (n = 33) demonstrated a sensitivity of 83%, specificity of 95%, positive predictive value of 91%, and negative predictive value of 91% in detecting nodal basin involvement. Magnetic resonance imaging (n = 10) demonstrated a sensitivity of 0%, specificity of 86%, positive predictive value of 0%, and negative predictive value of 67% in detecting nodal basin involvement. LIMITATIONS This was a retrospective study with small sample size. CONCLUSION Use of fluorine-18-fluorodeoxyglucose positron emission tomography in the evaluation of a regional lymph node basin in primary MCC is significantly more sensitive and equally specific when compared with traditional computed tomography. Both fluorine-18-fluorodeoxyglucose positron emission tomography and computed tomography are more sensitive than clinical examination alone.
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Affiliation(s)
- Michael B Colgan
- Division of Dermatologic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA
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Abstract
Neuroendocrine tumors (NET) are a heterogeneous group of tumors that arise from neuroendocrine cells. These tumors may arise from various organs, including lung, thymus, thyroid, stomach, duodenum, small bowel, large bowel, appendix, pancreas, adrenal, and skin. Most are well differentiated and have the ability to produce biogenic amines and various hormones. NET usually occur sporadically but they also be associated with various familial syndromes. For the vast majority of NET, surgical resection is the treatment of choice whenever feasible. Localization of NET prior to surgery and for staging and follow-up relies on both anatomic and functional imaging modalities. In fact, the unique secretory characteristics of these tumors lend themselves to imaging by molecular imaging modalities, which can target specific metabolic pathways or receptors. Neuroendocrine cells have a variety of such target receptors and pathways for which radiopharmaceuticals have been developed, including [(123)I/(131)I]-metaiodobenzylguanidine (MIBG), [(111)In]pentetreotide, [(68)Ga] somatostatin analogs, [(18)F] fluorodeoxyglucose (FDG), [(11)C/(18)F] dihydroxyphenylalanine (DOPA), [(11)C] 5-hydroxytryptophan (5-HTP) (99m)Tc pentavalent dimercaptosuccinic acid ([(99m)Tc] (V) DMSA, and [(18)F] fluorodopamine (FDA). Here, we review the molecular imaging approaches for NET using various radiopharmaceuticals.
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Affiliation(s)
- Jorge A Carrasquillo
- Nuclear Medicine Service, Radiology Department Memorial Sloan-Kettering, New York, NY, USA.
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Concannon R, Larcos GS, Veness M. The impact of (18)F-FDG PET-CT scanning for staging and management of Merkel cell carcinoma: results from Westmead Hospital, Sydney, Australia. J Am Acad Dermatol 2010; 62:76-84. [PMID: 20082888 DOI: 10.1016/j.jaad.2009.06.021] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Revised: 05/05/2009] [Accepted: 06/01/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is a rare cutaneous malignancy with high mortality. Positron emission tomography (PET) using (18)F-fluorodeoxyglucose (FDG) has been shown to be valuable in the management of many types of cancer, and the purpose of this work was to determine its utility for patients with MCC. OBJECTIVE We sought to evaluate the impact of (18)F-FDG PET with simultaneous computed tomography (PET-CT) on the staging and management of patients with MCC. METHODS We reviewed the medical records of 18 patients with MCC who underwent 21 PET-CT scans at our institution from 2006 to 2008. The impact of PET-CT on staging and management plans were evaluated. RESULTS There were 12 men and 6 women with median age of 79 years (range, 54 to 85 years). All proven sites of MCC greater than 5 mm were positive on PET-CT with average maximum standardized uptake values (SUV max) of 4 in primary lesions, 5.6 in nodal disease and 11.5 in distant metastases. PET-CT contributed to altered staging in 7 patients (33%) and a change in management in 9 patients (43%). Two patients were found to have a second primary malignancy, but this did not alter management. LIMITATIONS This was a retrospective review. Most patients had stage II or III disease, suggesting some potential referral bias. CONCLUSIONS (18)F-FDG PET-CT had a high impact in the management of MCC patients in our series and this investigation merits further assessment.
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Affiliation(s)
- Rebecca Concannon
- Department of Nuclear Medicine & Ultrasound, Westmead Hospital, Westmead, Sydney, Australia
| | - George S Larcos
- Department of Nuclear Medicine & Ultrasound, Westmead Hospital, Westmead, Sydney, Australia; Centre for Biomedical Imaging, Research & Development, Westmead Hospital, Westmead, Sydney, Australia; University of Sydney, Sydney, Australia
| | - Michael Veness
- Department of Radiation Oncology, Westmead Hospital, Westmead, Sydney, Australia; University of Sydney, Sydney, Australia.
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Peloschek P, Novotny C, Mueller-Mang C, Weber M, Sailer J, Dawid M, Czerny C, Dudczak R, Kletter K, Becherer A. Diagnostic imaging in Merkel cell carcinoma: lessons to learn from 16 cases with correlation of sonography, CT, MRI and PET. Eur J Radiol 2008; 73:317-23. [PMID: 19108971 DOI: 10.1016/j.ejrad.2008.10.032] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Revised: 10/26/2008] [Accepted: 10/27/2008] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The authors report imaging findings in a series of 16 patients with MCC, a rare tumour which is often managed primarily by a dermatologist. To our knowledge, no equivalent series of MCC has been described in the nuclear medicine literature. MATERIAL AND METHODS In this IRB-approved retrospective noncomparative case series 16 patients with biopsy-proven Merkel cell carcinoma were included between January 1999 and October 2007. Twenty-nine whole body PET scans (18F-FDG n=24, 18F-FDOPA n=5) in 16 patients were retrospectively reviewed with regard to tracer uptake in six anatomical sites per patient. For 127/144 of FDG-PET evaluated regions and 68/144 of regions depicted by conventional imaging methods, a valid standard of reference could be obtained. A combined standard of reference was applied, which consisted of histopathology (lymphadenectomy or biopsy) or clinical or radiological follow-up for at least 12 months. RESULTS the mean FDG uptake over the clinicopatholigical verified FDG avid areas was 4.7 SUV (1.5-9.9 SUV). The region based assessment of diagnostic value, in consideration of the standard of reference, resulted in a sensitivity of 85.7% and a specificity of 96.2% of FDG-PET (n=127) and in a combined sensitivity of 95.5% and a specificity of 89.1% for morphological imaging methods (n=68). Differences between methods did not reach statistical significance (p=1.00, p=0.18). CONCLUSIONS FDG-PET is a highly useful whole body staging method of comparable value compared to conventional imaging methods with restricted field of view. The lessons learned from case series are discussed.
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Jager PL, Chirakal R, Marriott CJ, Brouwers AH, Koopmans KP, Gulenchyn KY. 6-L-18F-fluorodihydroxyphenylalanine PET in neuroendocrine tumors: basic aspects and emerging clinical applications. J Nucl Med 2008; 49:573-86. [PMID: 18344441 DOI: 10.2967/jnumed.107.045708] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In recent years, 6-l-18F-fluorodihydroxyphenylalanine (18F-DOPA) PET has emerged as a new diagnostic tool for the imaging of neuroendocrine tumors. This application is based on the unique property of neuroendocrine tumors to produce and secrete various substances, a process that requires the uptake of metabolic precursors, which leads to the uptake of 18F-DOPA. This nonsystematic review first describes basic aspects of 18F-DOPA imaging, including radiosynthesis, factors involved in tracer uptake, and various aspects of metabolism and imaging. Subsequently, this review provides an overview of current clinical applications in neuroendocrine tumors, including carcinoid tumors, pancreatic islet cell tumors, pheochromocytoma, paraganglioma, medullary thyroid cancer, hyperinsulinism, and various other clinical entities. The application of PET/CT in carcinoid tumors has unsurpassed sensitivity. In medullary thyroid cancer, pheochromocytoma, and hyperinsulinism, results are also excellent and contribute significantly to clinical management. In the remaining conditions, the initial experience with 18F-DOPA PET indicates that it seems to be less valuable, but further study is required.
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Affiliation(s)
- Pieter L Jager
- Department of Nuclear Medicine, Hamilton Health Sciences/McMaster University, Hamilton, Ontario, Canada.
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Abstract
Merkel cell carcinoma (MCC) is a rare and extremely aggressive skin cancer that arises from primary neural cells. It presents most commonly in the elderly and immunocompromised patients. Pathologically, MCC should be distinguished from extrapulmonary small cell lung cancer or metastatic small cell lung cancer or a small cell variant of melanoma. The prognosis is based largely on the stage of disease at the time of presentation. Therapeutic options for MCC include wide resection with or without adjuvant radiotherapy or chemotherapy. Novel therapies based on the understanding of the molecular aspects of MCC are currently being explored.
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Affiliation(s)
- Vy Dinh
- Department of Internal Medicine, University of Miami School of Medicine, Miami, FL 33136, USA
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Iagaru A, Quon A, McDougall IR, Gambhir SS. Merkel Cell Carcinoma: Is there a Role for 2-Deoxy-2-[F-18]fluoro-d-glucose-Positron Emission Tomography/Computed Tomography? Mol Imaging Biol 2006; 8:212-7. [PMID: 16724293 DOI: 10.1007/s11307-006-0047-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE 2-Deoxy-2-[F-18]fluoro-D-glucose (FDG)-positron emission tomography (PET)/computed tomography (CT) is becoming widely available as a powerful imaging modality, combining the ability to detect active metabolic processes and their morphologic features in a single study. The role of FDG-PET/CT is proven in lymphoma, melanoma, colorectal carcinoma, and other cancers. However, there are rare malignancies such as Merkel cell carcinoma that can potentially be evaluated with PET/CT. We were therefore prompted to review our experience with FDG-PET/CT in the management of patients with Merkel cell carcinoma. PROCEDURES This is a retrospective case series of six patients with Merkel cell carcinoma, 58-81 years old (average 69 +/- 8.3), who had whole-body PET/CT at our institution from January 1st, 2003 to August 31st, 2005. Two patients were women and four were men. Reinterpretation of the imaging studies for accuracy and data analysis from medical records were performed. RESULTS Twelve examinations were acquired for the six patients (one patient had six PET/CT, one patient had two PET/CT, and four patients had one PET/CT). The injected FDG doses ranged 381.1-669.7 MBq (average 573.5 +/- 70.3). Four patients had the PET/CT as part of initial staging, and two patients had the exam for restaging (after surgery and XRT). A total of six Merkel lesions (pancreas, adrenal, lip, submandibular lymph nodes, cervical lymph nodes, and parapharyngeal soft tissue) were identified in three patients and confirmed on histopathological examination. The FDG uptake in these areas was intense, with maximum standardized uptake value (SUVmax) values of 5-14 (average 10.4 +/- 3.8). In one patient, the PET/CT scan identified abnormal focal distal sigmoid uptake that was biopsied and diagnosed as adenocarcinoma. Two patients had negative scans and had no clinical evidence of disease on follow-up office visits (up to one year after PET/CT). CONCLUSIONS This case series suggests that FDG-PET/CT may have a promising role in the management of patients with Merkel cell carcinoma.
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Affiliation(s)
- A Iagaru
- Division of Nuclear Medicine, Department of Radiology, Stanford University Medical Center, 300 Pasteur Drive, H-0101, Stanford, CA 94305, USA
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