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False-positive findings on 6-[18F]fluor-l-3,4-dihydroxyphenylalanine PET (18F-FDOPA-PET) performed for imaging of neuroendocrine tumors.

AbstractBACKGROUND/AIM:
PET with 6-[18F]fluor-l-3,4-dihydroxyphenylalanine (18F-FDOPA) has been shown to be a useful imaging tool with a high sensitivity for the visualization of neuroendocrine tumors (NETs). 18F-FDOPA uptake in tumors other than NETs has been suggested previously, but data on this phenomenon are limited. We therefore studied the non-physiological, false-positive uptake of 18F-FDOPA in a large population of patients with a NET or with a high clinical suspicion of harboring a NET.
PATIENTS AND METHODS:
Retrospective single-center study among adult patients in whom 18F-FDOPA PET scintigraphy was performed between January 2004 and December 2014. The original scan report was compared with the original pathology report corresponding with the 18F-FDOPA PET-positive lesion. In case this was inconsistent with the diagnosis of a NET, both the scan and the pathology slides were reassessed. Specimens of these non-NET tissues were immunohistochemically stained for AADC.
RESULTS:
1070 18F-FDOPA PET scans from 705 patients were evaluated. Focal or multiple 18F-FDOPA-avid lesions were described in 709 18F-FDOPA PET scans (66%). Histology of these 18F-FDOPA PET-positive lesions was present in 508 (72%) cases. In seven cases, the histopathology was not compatible with NET but showed squamous cell carcinoma of the cervix, multiple myeloma (two cases), hepatocellular carcinoma, Schwannoma, adrenocortical carcinoma and a skeletal myxoid chondrosarcoma, with positive immunohistochemical staining for AADC in 67%.
CONCLUSIONS:
Pathological uptake of 18F-FDOPA does not always indicate the presence of a NET. The possibility of 18F-FDOPA uptake by tumor types other than NETs, although rare, should be considered.
AuthorsAnnika M A Berends, Michiel N Kerstens, Janne W Bolt, Thera P Links, Esther Korpershoek, Ronald R de Krijger, Annemiek M E Walenkamp, Walter Noordzij, Boudewijn van Etten, Gursah Kats-Ugurlu, Adrienne H Brouwers, Anouk N A van der Horst-Schrivers
JournalEuropean journal of endocrinology (Eur J Endocrinol) Vol. 179 Issue 2 Pg. 125-133 (Aug 2018) ISSN: 1479-683X [Electronic] England
PMID29875288 (Publication Type: Journal Article)
Copyright© 2018 European Society of Endocrinology.
Chemical References
  • fluorodopa F 18
  • Dihydroxyphenylalanine
Topics
  • Adrenal Gland Neoplasms (diagnostic imaging, metabolism, pathology)
  • Adult
  • Aged
  • Dihydroxyphenylalanine (administration & dosage, analogs & derivatives, metabolism, pharmacokinetics)
  • False Positive Reactions
  • Female
  • Humans
  • Immunohistochemistry
  • Intestinal Neoplasms (diagnostic imaging, metabolism, pathology)
  • Male
  • Middle Aged
  • Neuroendocrine Tumors (diagnostic imaging, metabolism, pathology)
  • Pancreatic Neoplasms (diagnostic imaging, metabolism, pathology)
  • Paraganglioma (diagnostic imaging, metabolism, pathology)
  • Pheochromocytoma (diagnostic imaging, metabolism, pathology)
  • Positron-Emission Tomography
  • Radionuclide Imaging
  • Retrospective Studies
  • Stomach Neoplasms (diagnostic imaging, metabolism, pathology)
  • Tissue Distribution

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