Date: 24 May 2003

111In-DOTA-dPhe1-Tyr3-octreotide, 111In-DOTA-lanreotide and 67Ga citrate scintigraphy for visualisation of extranodal marginal zone B-cell lymphoma of the MALT type: a comparative study

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Somatostatin receptor (SSTR) scintigraphy and gallium-67 citrate (67Ga) scintigraphy have been used for visualisation of Hodgkin's lymphoma and non-Hodgkin's lymphoma. However, experience with B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT) type is very limited. The aim of this study was to prospectively compare the 67Ga scintigraphy results with those obtained by 111In-DOTA-dPhe1-Tyr3-octreotide (111In-DOTA-TOCT) and 111In-DOTA-lanreotide (111In-DOTA-LAN) scintigraphy in patients with proven MALT-type lymphoma. Comparative scintigraphic examinations using 67Ga, 111In-DOTA-TOCT and 111In-DOTA-LAN were performed in 18 patients (11 female and 7 male, median age 64±15 years) with histologically verified MALT-type lymphomas of various origin. Planar and single-photon emission tomography imaging acquisitions were performed after injection of a mean dose of 185±26 MBq 67Ga and 165±20 MBq 111In-DOTA-TOCT or 111In-DOTA-LAN. All scintigraphic results were correlated with other conventional examinations including gastroscopy, colonoscopy, endosonoscopy, ophthalmologic investigation, CT of the thorax and abdomen and bone marrow biopsy. This comparative study showed that 67Ga scintigraphy found abnormalities in 10 of 16 patients (63%) and detected 18 of 31 clinically involved sites (58%), but was false positive in three patients. 111In-DOTA-TOCT found abnormalities in 9 of 15 patients (60%) and detected 15 of 27 clinical lesions (56%); it was false positive in two patients. 111In-DOTA-LAN scintigraphy showed abnormalities in 7 of 11 patients (64%) and found 12 of 22 clinical lesions (55%). False-positive 111In-DOTA-LAN scan results were found in two patients. For supra-diaphragmatic lesions, 67Ga scintigraphy detected 12 of 16 sites (75%). 111In-DOTA-TOCT scintigraphy revealed 7 of 15 lesions (47%). 111In-DOTA-LAN showed 6 of 12 positive sites (50%). For infra-diaphragmatic involvement, the sensitivities of 67Ga, 111In-DOTA-TOCT and 111In-DOTA-LAN were 40%, 67% and 60%, respectively. It is concluded that MALT-type lymphoma can be visualised by 67Ga, 111In-DOTA-TOCT and 111In-DOTA-LAN scintigraphy. Although there were no statistically significant differences in patient-related and site-related sensitivities when using 67Ga compared with 111In-DOTA-TOCT and 111In-DOTA-LAN, the sensitivity of 67Ga tended to be superior to that of 111In-DOTA-TOCT and 111In-DOTA-LAN for supra-diaphragmatic lesions but inferior for infra-diaphragmatic involvement. In selected cases, the combination of 67Ga and 111In-DOTA-LAN or 111In-DOTA-TOCT may increase the diagnostic efficiency in patients with MALT-type lymphoma.