Dr. Andrew McKeon discusses a new Mayo Clinic study on Paraneoplastic Neurologic Disorders with a MedPage Today reporter. The study appears online in early release for the Archives of Neurology.
ABSTRACT
Objective To evaluate the cancer detection rate of whole-body 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-CT in 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 follow-up, 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 that 12% 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.
AUTHORS
Andrew McKeon, MB, MRCPI; Metha Apiwattanakul, MD; Daniel H. Lachance, MD; Vanda A. Lennon, MD, PhD; Jayawant N. Mandrekar, PhD; Bradley F. Boeve, MD; Brian Mullan, MD; Bahram Mokri, MD; Jeffrey W. Britton, MD; Daniel A. Drubach, MD; Sean J. Pittock, MD all of Mayo Clinic.
