Positron emission tomography-computed tomography in paraneoplastic neurologic disorders: Systematic analysis and review

Andrew McKeon, Metha Apiwattanakul, Daniel H. Lachance, Vanda A. Lennon, Jayawant N. Mandrekar, Bradley F. Boeve, Brian Mullan, Bahram Mokri, Jeffrey W. Britton, Daniel A. Drubach, Sean J. Pittock

Research output: Contribution to journalReview article

93 Scopus citations

Abstract

Objective: To evaluate the cancer detection rate of wholebody positron emission tomography-computed tomography (PET-CT) in a paraneoplastic neurologic context. Design: Retrospective medical record review. Setting: Mayo Clinic, Rochester, Minnesota. Patients: Fifty-six consecutive patients with clinically suspected paraneoplastic neurologic disorders who underwent PET-CT after negative standard evaluations, including CT. Main Outcome Measure: Rate of cancer detection. Results: Abnormalities suggestive of cancer were detected using PET-CTin 22 patients (39%); 10 patients (18%) had cancer confirmed histologically. Cancers detected (limited stage in 9 of 10 patients and extratruncal in 4) were as follows: 2 thyroid papillary cell carcinomas, 3 solitary lymph nodes with unknown primary (2 adenocarcinomas and 1 small cell carcinoma), 1 tonsil squamous cell carcinoma, 3 lung carcinomas (1 adenocarcinoma, 1 small cell, and 1 squamous cell), and 1 colon adenocarcinoma. Detection of a well-characterized neuronal nuclear or cytoplasmic paraneoplastic autoantibody was associated with a successful PET-CT-directed cancer search (P<.001). Detection of limited-stage cancer facilitated early initiation of oncologic treatments and immunotherapy; cancer remission was reported in 7 patients, and sustained improvements in neurologic symptoms were reported in 5 (median followup, 11 months; range, 2-48 months). Combined data from 2 previous studies using conventional PET alone (123 patients) revealed that 28% of patients had a PET abnormality suggestive of cancer and that12%had a cancer diagnosis. Conclusion: In a paraneoplastic neurologic context, PET-CT improves the detection of cancers when other screening test results are negative, particularly in the setting of seropositivity for a neuronal nuclear or cytoplasmic autoantibody marker of cancer.

Original languageEnglish (US)
Pages (from-to)322-329
Number of pages8
JournalArchives of neurology
Volume67
Issue number3
DOIs
StatePublished - Mar 1 2010

ASJC Scopus subject areas

  • Arts and Humanities (miscellaneous)
  • Clinical Neurology

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