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Technetium-99m depreotide imaging by single photon emission tomography/low resolution computed tomography in malignant lymphomas: comparison with gallium-67 citrate

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Abstract

Objective

Previous studies have demonstrated the feasibility of targeting lymphoma lesions with somatostatin receptor binding agents, mainly with In-111-pentetreotide. In the present work another somatostatin analog, Tc-99m depreotide, is investigated.

Methods

One-hundred and six patients, 47 with Hodgkin’s (HL) and 59 with various types of non-Hodgkin’s lymphoma (NHL), were imaged with both Tc-99m depreotide and Ga-67 citrate. Planar whole-body and single photon emission tomography/low resolution computerized tomography (SPECT/CT) images were obtained. A total of 142 examinations were undertaken at different phases of the disease. Depreotide and gallium findings were compared visually and semi-quantitatively, with reference to the results of conventional work-up and the patients’ follow-up data.

Results

In most HL, intermediate- and low-grade B-cell, as well as in T-cell NHL, depreotide depicted more lesions than Ga-67 and/or exhibited higher tumor uptake. The opposite was true in aggressive B-cell NHL. However, there were notable exceptions in all lymphoma subtypes. During initial staging, 93.3% of affected lymph nodes above the diaphragm, 100% of inguinal nodes and all cases with splenic infiltration were detected by depreotide. On the basis of depreotide findings, 32% of patients with early-stage HL were upstaged. However, advanced HL and NHL cases were frequently downstaged, due to low sensitivity for abdominal lymph node (22.7%), liver (45.5%) and bone marrow involvement (36.4%). Post-therapy, depreotide detected 94.7% of cases with refractory disease or recurrence. Its overall specificity was moderate (57.1%). Rebound thymic hyperplasia, various inflammatory processes and sites of unspecific uptake were the commonest causes of false positive findings. The combination of depreotide and gallium enhanced sensitivity (100%), while various false positive results of either agent could be avoided.

Conclusion

Except perhaps for early-stage HL, Tc-99m depreotide as a stand-alone imaging modality has limited value for the initial staging of lymphomas. Post-therapy, however, depreotide scintigraphy seems useful in the evaluation of certain anatomic areas, particularly in non-aggressive lymphoma types. The combination with Ga-67 potentially enhances sensitivity and specificity. If fluorodeoxyglucose positron emission tomography is not available or in case of certain indolent lymphoma types, Tc-99m depreotide may have a role as an adjunct to conventional imaging procedures.

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References

  1. Vinnicombe SJ, Reznek RH. Computerised tomography in the staging of Hodgkin’s disease and non-Hodgkin’s lymphoma. Eur J Nucl Med Mol Imaging. 2003;30(Suppl 1):S42–55.

    Article  PubMed  Google Scholar 

  2. Even-Sapir E, Israel O. Gallium-67 scintigraphy: a cornerstone in functional imaging of lymphoma. Eur J Nucl Med Mol Imaging. 2003;30(Suppl 1):S65–81.

    Article  CAS  PubMed  Google Scholar 

  3. Palumbo B, Sivolella S, Palumbo I, Liberati AM, Palumbo R. 67 Ga-SPECT/CT with a hybrid system in the clinical management of lymphoma. Eur J Nucl Med Mol Imaging. 2005;32:1011–7.

    Article  PubMed  Google Scholar 

  4. Kostakoglu L, Goldsmith SJ. Positron emission tomography in lymphoma: comparison with computed tomography and gallium-67 single photon emission computed tomography. Clin Lymphoma. 2000;1:67–74.

    Article  CAS  PubMed  Google Scholar 

  5. Barrington SF, O’Doherty MJ. Limitations of PET for imaging lymphoma. Eur J Nucl Med Mol Imaging. 2003;30(Suppl 1):S117–27.

    Article  PubMed  Google Scholar 

  6. Ferone D, Semino C, Boschetti M, Cascini GL, Minuto F, Lastoria S. Initial staging of lymphoma with octreotide and other receptor imaging agents. Semin Nucl Med. 2005;35:176–85.

    Article  PubMed  Google Scholar 

  7. Leners N, Jamar F, Fiasse R, Ferrant A, Pauwels S. Indium- 111-Pentetreotide Uptake in Endocrine Tumors and Lymphoma. J Nucl Med. 1996;37:916–22.

    CAS  PubMed  Google Scholar 

  8. Sarda L, Duet M, Zini JM, Berolatti B, Benelhadj S, Tobelem G, et al. Indium-111 pentetreotide scintigraphy in malignant lymphomas. Eur J Nucl Med. 1995;22:1105–9.

    Article  CAS  PubMed  Google Scholar 

  9. Lipp RW, Silly H, Ranner G, Dobnig H, Passath A, Leb G, et al. Radiolabeled octreotide for the demonstration of somatostatin receptors in malignant lymphoma and lymphadenopathy. J Nucl Med. 1995;36:13–8.

    CAS  PubMed  Google Scholar 

  10. Ivancević V, Wörmann B, Nauck C, Sandrock D, Munz DL, Hiddemann W, et al. Somatostatin receptor scintigraphy in the staging of lymphomas. Leuk Lymphoma. 1997;26:107–14.

    Article  PubMed  Google Scholar 

  11. Lugtenburg PJ, Löwenberg B, Valkema R, Oei HY, Lamberts SW, Eijkemans MJ, et al. Somatostatin receptor scintigraphy in the initial staging of low-grade non-Hodgkin’s lymphomas. J Nucl Med. 2001;42:222–9.

    CAS  PubMed  Google Scholar 

  12. Bares R, Galonska P, Dempke W, Handt S, Büll U, Osieka R. Somatostatin receptor scintigraphy in malignant lymphoma: first results and comparison with glucose metabolism measured by positron-emission tomography. Horm Metab Res Suppl. 1993;27:56–8.

    CAS  PubMed  Google Scholar 

  13. Virgolini I, Leimer M, Handmaker H, Lastoria S, Bischof C, Muto P, et al. Somatostatin receptor subtype specificity and in vivo binding of a novel tumor tracer, 99mTc-P829. Cancer Res. 1998;58:1850–9.

    CAS  PubMed  Google Scholar 

  14. Raderer M, Valencak J, Pfeffel F, Drach J, Pangerl T, Kurtaran A, et al. Somatostatin receptor expression in primary gastric versus nongastric extranodal B-cell lymphoma of mucosa-associated lymphoid tissue type. J Natl Cancer Inst. 1999;91:716–8.

    Article  CAS  PubMed  Google Scholar 

  15. Dalm VASH, Hofland LJ, Mooy CM, Waaijers MA, van Koetsveld PM, Langerak AW, et al. Somatostatin receptors in malignant lymphomas: targets for radiotherapy? J Nucl Med. 2004;45:8–16.

    CAS  PubMed  Google Scholar 

  16. Cholewinski W, Kowalczyk JR, Stefaniak B, Stefaniak J, Poniatowicz-Frasunek E, Tarkowska A. Diagnosis and staging of children’s lymphoma using the technetium-labelled somatostatin analogue, 99mTc-depreotide. Eur J Nucl Med Mol Imaging. 2004;31:820–4.

    Article  CAS  PubMed  Google Scholar 

  17. Bushnell DL, Menda Y, Madsen MT, Link BK, Kahn D, Truhlar SM, et al. 99mTc-depreotide tumour uptake in patients with non-Hodgkin’s lymphoma. Nucl Med Commun. 2004;25:839–43.

    Article  CAS  PubMed  Google Scholar 

  18. Montilla-Soler JL, Rexroad JT, Bridwell RS. Tc-99m depreotide scintigraphy of low-grade non-Hodgkin’s lymphoma. Clin Nucl Med. 2003;28:503–5.

    Article  PubMed  Google Scholar 

  19. Danielsson R, Bååth M, Kölbeck K-G, Klominek J, Svensson L. Accumulation of Tc-99m depreotide (NeoSpect) in axillary sweat glands. Clin Nucl Med. 2003;28:789–90.

    Article  PubMed  Google Scholar 

  20. Lugtenburg PJ, Krenning EP, Valkema R, Oei HY, Lamberts SW, Eijkemans MJ, et al. Somatostatin receptor scintigraphy useful in stage I-II Hodgkin’s disease: more extended disease identified. Br J Haematol. 2001;112:936–44.

    Article  CAS  PubMed  Google Scholar 

  21. Lastoria S, Palmieri G, Muto P, Lombardi G. Functional imaging of thymic disorders. Ann Med. 1999;31(Suppl 2):63–9.

    PubMed  Google Scholar 

  22. Reubi JC, Waser B, van Hagen M, Lamberts SWJ. In vitro and in vivo detection of somatostatin receptors in human malignant lymphomas. Int J Cancer. 1992;50:895–900.

    Article  CAS  PubMed  Google Scholar 

  23. Karam M, Novak L, Cyriac J, Ali A, Nazeer T, Nugent F. Role of fluorine-18 fluoro-deoxyglucose positron emission tomography scan in the evaluation and follow-up of patients with low-grade lymphomas. Cancer. 2006;107:175–83.

    Article  PubMed  Google Scholar 

  24. Weiler-Sagie M, Bushelev O, Epelbaum R, Dann EJ, Haim N, Avivi I, et al. (18)F-FDG avidity in lymphoma readdressed: a study of 766 patients. J Nucl Med. 2010;51:25–30.

    Article  PubMed  Google Scholar 

  25. Raderer M, Traub T, Formanek M, Virgolini I, Osterreicher C, Fiebiger W, et al. Somatostatin-receptor scintigraphy for staging and follow-up of patients with extraintestinal marginal zone B-cell lymphoma of the mucosa associated lymphoid tissue (MALT)-type. Br J Cancer. 2001;85:1462–6.

    Article  CAS  PubMed  Google Scholar 

  26. Landgren O, Tilly H. Epidemiology, pathology and treatment of non-follicular indolent lymphomas. Leuk Lymphoma. 2008;49(Suppl 1):35–42.

    Article  PubMed  Google Scholar 

  27. Mazloom A, Medeiros LJ, McLaughlin PW, Reed V, Cabanillas FF, Fayad LE, et al. Marginal zone lymphomas: factors that affect the final outcome. Cancer 2010 [Epub ahead of print].

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Acknowledgments

The authors acknowledge P. Barla, MD and A. Paschali, MD (residents in the department of Nuclear Medicine of the University Hospital of Patras), for their assistance in the performance of the scintigraphic studies, as well as in collecting, processing and organizing data.

Conflict of interest

The authors declare no financial conflict of interest in this work.

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Authors and Affiliations

  1. Department of Nuclear Medicine, University of Patras Medical School, University Hospital of Patras, Rion, 26500, Patras, Greece

    Dimitris J. Apostolopoulos, Nikolaos I. Papandrianos, Tryfon Spyridonidis, Sotiria Alexiou, Christos Savvopoulos & Pavlos J. Vassilakos

  2. Department of Haematology, University Hospital of Patras, Patras, Greece

    Argiris Symeonidis & Panagiota Matsouka

  3. Department of Radiology, University Hospital of Patras, Patras, Greece

    Petros Zampakis

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  1. Dimitris J. Apostolopoulos
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  2. Nikolaos I. Papandrianos
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Correspondence to Dimitris J. Apostolopoulos.

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Apostolopoulos, D.J., Papandrianos, N.I., Symeonidis, A. et al. Technetium-99m depreotide imaging by single photon emission tomography/low resolution computed tomography in malignant lymphomas: comparison with gallium-67 citrate. Ann Nucl Med 24, 639–647 (2010). https://doi.org/10.1007/s12149-010-0405-7

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  • DOI: https://doi.org/10.1007/s12149-010-0405-7

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