Use of positron emission tomography for staging, preoperative response assessment and posttherapeutic evaluation in children with Wilms tumour.
OBJECTIVE
To evaluate FDG-PET for staging, grading, preoperative response assessment and posttherapeutic evaluation in children with Wilms tumour (WT).


METHODS
In this study, 23 FDG-PET examinations in 12 paediatric patients (female, n = 5; male, n = 7; age, 1-19 years) with WT (primary, n = 9; relapsed, n = 3) were analysed. All patients were examined with conventional imaging methods (CIM) according to the SIOP2001/GPOH trial protocol. Additionally, FDG-PET/PET-CT was performed for staging (n = 12), preoperative response assessment (n = 6) and posttherapeutic evaluation (n = 5). Imaging results of FDG-PET and CIM were analysed regarding the accuracy in tumour visualisation, impact on therapeutic management and preoperative response assessment, with clinical follow-up and histopathology as the standard of reference.


RESULTS
FDG-PET and CIM showed concordant results for staging of primary WT, whereas FDG-PET was superior in 1/3 cases with recurrent WT. Concerning histological differentiation, one case with anaplastic WT had an standard uptake value (SUV) of 12.3, which was remarkably higher than the average SUV in the eight cases with intermediate risk histology. No parameter analysed for PET or CIM was reliably predictive for histological regression or clinical outcome. After completion of therapy, FDG-PET was superior to CIM in 2/5 cases in detecting residual disease with therapeutic relevance.


CONCLUSIONS
FDG-PET does not provide additional information to the traditional imaging work-up for staging WT patients, preoperative response assessment and clinical outcome. FDG-PET was advantageous in ruling out residual disease after completion of first line treatment and in pretherapeutic staging of relapse patients. Furthermore, there seems to be a good correlation of initial SUV and histological differentiation.
Misch
Daniel
D
Klinik für Strahlenheilkunde, Bereiche Nuklearmedizin und Radiologie, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, Germany. daniel.misch@charite.de
Steffen
Ingo G
IG
Schönberger
Stefan
S
Voelker
Thomas
T
Furth
Christian
C
Stöver
Brigitte
B
Hautzel
Hubertus
H
Henze
Günter
G
Amthauer
Holger
H
Denecke
Timm
T
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007223:Infant; D008297:Male; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging / Q000379:methods*; D049268:Positron-Emission Tomography; D012008:Recurrence; D009396:Wilms Tumor / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery / Q000628:therapy
D019788:Fluorodeoxyglucose F18