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

Berends, A. M. A., Kerstens, M. N., Bolt, J. W., Links, T. P., Korpershoek, E., de Krijger, R. R., Walenkamp, A. M. E., Noordzij, W., van Etten, B., Kats-Ugurlu, G., Brouwers, A. & van der Horst-Schrivers, A. N. A., Aug-2018, In : European Journal of Endocrinology. 179, 2, p. 125-133 9 p.

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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

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DOI

Background/aim: PET with 6-[18F]fluor-L-3,4-dihydroxyphenylalanine (F-18-FDOPA) has been shown to be a useful imaging tool with a high sensitivity for the visualization of neuroendocrine tumors (NETs). F-18-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 F-18-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 F-18-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 F-18-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 F-18-FDOPA PET scans from 705 patients were evaluated. Focal or multiple F-18-FDOPA-avid lesions were described in 709 F-18-FDOPA PET scans (66%). Histology of these F-18-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 F-18-FDOPA does not always indicate the presence of a NET. The possibility of F-18-FDOPA uptake by tumor types other than NETs, although rare, should be considered.

Original languageEnglish
Pages (from-to)125-133
Number of pages9
JournalEuropean Journal of Endocrinology
Volume179
Issue number2
Early online date6-Jun-2018
Publication statusPublished - Aug-2018

    Keywords

  • ACID TRANSPORTER 1, POSITRON-EMISSION-TOMOGRAPHY, SQUAMOUS-CELL CARCINOMA, PROGNOSTIC-SIGNIFICANCE, DOPA DECARBOXYLASE, F-18-DOPA PET/CT, HIGH EXPRESSION, MESSENGER-RNA, IN-VITRO, LAT1

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