TITLE

Occult Malignancy in Patients With Suspected Paraneoplastic Neurologic Syndromes: Value of Positron Emission Tomography in Diagnosis

AUTHOR(S)
Patel, Rajesh R.; Subramaniam, Rathan M.; Mandrekar, Jaywant N.; Hammack, Julrn E.; Lowe, Val J.; Jerr, James R.
PUB. DATE
August 2008
SOURCE
Mayo Clinic Proceedings;Aug2008, Vol. 83 Issue 8, p917
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
OBJECTIVE: To determine the value of positron emission tomography (PET) in diagnosing occult malignancies in patients with paraneoplastic neurologic syndromes (PNSs) at Mayo Clinic's site in Rochester, MN. PATIENTS AND METHODS: We retrospectivety reviewed the medical charts of all 107 patients who underwent PET from January 1, 2000, to July 31, 2006, for the indication of suspected PNS. Three patients did not meet inclusion criteria. PET results were considered positive if increased fiudeoxygiucose F 18 uptake indicated malignancy (24 patients). Resuits from computed tomography were interpreted as positive if any suspect lesion was consistent with malignancy (26 patients). RESULTS: One hundred four patients with PNS were identified from the PET centrai database; 73 patients had at ieast 1 positive resuit for paraneopiastic antibody, and 31 had antibody-negative PNS. Malignancy was confirmed páthologically in 10 patients, of whom 8 had positive PET results. There were 2 cases of confirmed malignancy (faliopian tube adenocarcinoma and spindie cell uterine carcinoma) for which PET resuits were negative. Two patients with positive PET results declined biopsy. Computed tomography was able to identify 3 of the 10 malignancies detected. Five cases of malignancy were detected only by PET. All patients with confirmed malignancy had positive results for at least 1 paraneoplastic antibody. One patient with positive resuits for PNS antibody and negative PET results was diagnosed as having small cell carcinoma on a follow-up PET scan after 27 months. PET had sensitivity, specificity, positive predictive value, and negative predictive value of 80%, 67%, 53%, and 88%, respectively. CONCLUSION: PET scan was shown to be more sensitive than computed tomography for detecting occult malignancy (confirmed by positive test results for autoantibody) among patients with suspected PNS. The greatest clinical utility of PET could be in its high negative predictive value.
ACCESSION #
33967215

 

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