PET-CT Studies Help Detect Tumors in Patients with Neurologic Symptoms

"In the assessment of patients with suspected paraneoplastic neurologic disorders, routine noninvasive oncologic evaluations may be unrevealing,” the investigators reported in their article, published online that is intended to appear in the March 2010 print issue of Archives of Neurology, one of the JAMA/Archives journals.

"These standard evaluations include physical examination; computed tomography of the chest, abdomen, and pelvis; mammography in women; and testicular ultrasonography and prostate-specific antigen testing in men.” Tumors underlying paraneoplastic neurologic disorders are typically small, restricted to one site, and are often not detected until autopsy.

Andrew McKeon, M.B., M.R.C.P.I., and colleagues from the Mayo Clinic (Rochester, Mn, USA) analyzed the medical records of 56 consecutive patients with suspected paraneoplastic neurologic disorders whose standard evaluations (including CT) did not reveal cancer. All of them underwent PET-CT at Mayo Clinic between 2005 and 2008.

PET-CT identified abnormalities suggestive of cancer in 22 of the patients (39%), of whom 10 (18%) had cancer diagnoses confirmed by biopsy or another method. Of these cancers, two were in the thyroid, one was in the tonsil, three were in the lungs, one was in the colon, and three were cancerous lymph nodes with unknown primary cancer sites. Nine of the 10 were early-stage cancers, and detection facilitated early treatment. Cancer remission was reported in seven patients and improvement in neurologic symptoms in five patients after a median (midpoint) of 11 months of follow-up.

Before their PET-CT scanning, patients underwent a median of three other screening tests; the most common was CT of the chest, abdomen, and pelvis. "However, four of the 10 detected cancers using PET-CT were outside the anatomical scope of CT of the chest, abdomen and pelvis [thyroid, two; cervical lymph node, one; and palatine tonsil, one],” the authors reported. "The other six detected cancers were too small to be detected by appropriate regional CT [lung, four; axillary lymph node, one; and colon, one]. Clearly, CT alone is not sufficient to exclude cancer in cases with a high index of suspicion for cancer.”

Some types of cancer, including bladder and kidney cancers, are more difficult to detect by PET-CT, the researchers noted. "Recognizing the limitations of PET-CT, we favor this modality for initial oncologic evaluation of patients in whom a paraneoplastic neurologic disorder is strongly suspected,” they concluded. "Elimination of whole-body imaging with CT alone before further imaging with PET-CT could reduce radiation exposure and the total financial burden of testing.”

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