Role of radio-iodinated meta-iodo benzyl guanidine in assessment of children with neuroblastoma at NEMROCK.

BACKGROUND

For more than ten years. MIBG has been successfully used in diagnosis and staging of children with neuroblastoma.

AIM OF THE STUDY: Identify the role of 131I MIBG in the assessment of neuroblastoma and correlate its findings with other non-invasive tests.

PATIENTS AND

METHODS

Twenty eight patients with neuroblastoma attending the Pediatric Oncology Unit, Kasr El-Aini Center of Radiation Oncology and Nuclear Medicine (NEMROCK), Cairo University, over a period of 5 years (2002-2006) were assessed by MIBG scanning. The age of patients ranged from 40 days to 12 years with a mean of 4.7 years +/- 1.1. They were 16 boys and 12 girls with a M:F ratio of 1:3, none was stage I and II, 7 patients (25%) were stage III and 21 patients (75%) were stage IV (Evan's staging system). Clinically, 24 patients (85.7%) presented with an abdominal mass, and 3 patients (10.7%) with a mediastinal mass. Metastases were present in the bone marrow in 11 children (39.3%), lymph nodes in 5 (17.9%), CNS in 4 (14.3%), liver in 2 (7.1%), soft tissues in 3 (10.7%), lungs and pleura in 1 (3.6%), brain in 1 (3.6%), and testis in 1 patient (3.8%).

RESULTS

131I MIBG could accurately diagnose local and distant neuroblastoma lesions in 23 patients with a sensitivity of 82.2%. High levels of VMA correlated with no cardiac uptake in the first 24 hours in 7/8 patients with a sensitivity of 87.5%. On the other hand, low VMA levels were associated with cardiac uptake of (131)I MIBG in 3/4 patients with a specificity of 75%, a PPV of 88% and NPV of 86.7%. (131)I MIBG scintigraphy and bone marrow aspiration agreed on detecting neuroblastoma lesions in 24 /28 patients (85.7%) p<0.01, with a sensitivity of 59.5%, specificity of 96.6%. PPV of 89.3%, and NPV of 83.2%.

CONCLUSION

(131)I MIBG scintigraphy, in a dose of 2 mci can be used with 87.5% accuracy in the diagnosis and follow-up of Children with neuroblastoma.