Procena vrednosti semikvantitativnog bodovnog sistema simpatičko-adrenalne scintigrafije u dece obolele od neuroblastoma

Abstract

Cilj: Neuroblastom je najčešći dečji tumor u čijoj se dijagnostici obavezno izvodi simpatičko-adrenalna scintigrafija pomoću metajodobenzilgvanidina. SIOPEN semi-kvantitativni bodovni sistem je jedan od bodovnih sistema kojim se procenjuje planarni mIBG scintigram, a koji se sastoji od dva segmenta mekotkivnog i osteomedularnog. Glavni ciljevi studije su : 1) procena oba „skora” (mekotkivnog i osteomedularnog) SIOPEN semikavantitativnog bodovnog sistema u odnosu na: a) klinički stadijum bolesti određen na osnovu INSS kriterijuma; b) histološki stadijum neuroblastoma određen pomoću INPC kriterijuma; c) „biološke markere“ neuroblastoma: urinarne nivoe VMA i HVA; nivo LDH; nivo NSE; nivo s-feritina; nalaz ćelija neuroblastoma u punktatu koštane srži; prisustvo umnoženosti MYCN onkogena; 2) procena međusobne povezanosti oba skora SIOPEN bodovnog sistema; 3) povazanosti skorova SIOPEN bodovnog sistema sa skorom „Kiri“ semikvantitativnog bodovnog sistema. Metodologija: Prospektivna kohortna studija sa ponovljenim merenjim, izvedena je na 143 planarna scintigrama u sedamdesetšestoro dece koja su u Centar za nuklearnu medicinu Kliničkog centra Srbije upućena sa sumnjom na neuroblastom ili sa postavljenom dijagnozom neuroblastoma u smislu postterapijskog praćenja. Deca su upućivana iz dva centra: Univerzitetske dečje bolnice i iz Instituta za zdravstvenu zaštitu majke i deteta Srbije ,,Dr Vukan Čupić’’ u Beogradu, gde im je postavljena dijagnoza i započeto lečenje, između januara 2007. i jula 2014. Za poređenje sa skorovima SIOPEN bodovnog sistema korišćeni su podaci iz istorija bolesti malih pacijenata. Istraživanje je odobreno od strane Etičkog komiteta Medicinskog fakulteta u Beogradu. Scintigrafija pomoću meta-jodobenzilgvanidina obeleženog sa J123 ili J131 učinjena je po preporukama vodiča za scintigrafiju pomoću mIBG kod dece, Evropske asocijacije za nuklearnu medicinu. Tako dobijeni planarni scintigrami su procenjivani po kriterijumima SIOPEN i „Kiri“ semikvantitativnog bodovnog sistema. SIOPEN sistem ima dva „skora“ mekotkivni i osteomedularni. Mekotkivni „skor“ se izračunava sabiranjem zona patološkog nakupljanja radiofarmaka u 6 anatomskih mekotkivnih regija bolesnika. Osteomedularni „skor“ se izračunava sabiranjem zona patološkog nakupljanja radiofarmaka u 12 anatomskih regija skeleta bolesnika. „Kiri“ skor se izračunava sabiranjem zona patološkog nakupljanja radiofarmaka u 10 anatomskih regija bolesnika...

Objective: Neuroblastoma is the most common malignancy in children. MIBG scintigraphy is a mandatory neuroblastoma diagnostic test, which is among others methods, semi-quantified by the SIOPEN method. SIOPEN semi-quantative method is defined by two separate scores: soft tissue score and skeletal (osteo-medullary) score. The main objectives of the study are the following: 1) comparison both of the scores of SIOPEN semi-quantitative method to: a) INSS clinical stage of neuroblastoma: b) INPC histology grade of the tumour; c) neuroblastoma biology markers (urinary catecholamine VMA and HVA; LDH, NSE, serum ferritin, presence of neuroblastoma cell line in bone marrow smears and amplified MYCN); 2) correlation of the two scores; 3) correlation both of the SIOPEN scores with “Curie” semi-quantative method score. Methodology: The cross-sectional study with repeated measurements of 143 planar scintigrams , which included 76 children, was performed at the Centre for Nuclear Medicine of Clinical centre of Serbia. In line with international agreement, patients were referred to the centre by paediatricians because of suspected or proven neuroblastoma. They were sent for an MIBG scan for initial diagnosis or for evaluation after treatment by physicians of two centres: Institute for Health Protection of Mother and Child of Serbia “Dr. Vukan Cupic” and University Children’s Hospital, both in Belgrade. Patients were sent between January 2007 and July 2014. I-123/131 MIBG scintigraphy was performed according to previously published guidelines; the images were acquired 24 h or 48 h after slow intravenous injection of no less than 80 MBq (I-123) or 35 MBq (I-131) in accordance with the EANM (European Association of Nuclear Medicine) dosage card. For every patient, the I-123 MIBG and I-131 MIBG scans were scored by the Curie and the SIOPEN methods. The SIOPEN method included both the skeletal (osteo-medullary) and the soft tissue score. The skeleton was divided into 12 anatomical body segments. The soft tissue was divided into 6 anatomical body segments. According to the Curie semi-quantitative scoring method, the skeleton was divided into nine areas, and a tenth sector counting any soft tissue involvement was added. Results: The skeletal SIOPEN scores were significantly higher in bone marrow positive children (Mann-Whitney U=77.9; p=0.009), in children with pathologically elevated urinary VMA levels (Mann-Whitney U=322; p=0.038) and in children in a more advanced clinical stage (Spearman r=0. 37, p= 0,003)...