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Year : 2020  |  Volume : 35  |  Issue : 4  |  Page : 372-373  

Clinical utility of 68Ga-DOTANOC positron emission tomography-computed tomography scan on postoperative assessment of juvenile nasal angiofibroma


1 Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
2 Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India

Date of Submission10-Jun-2020
Date of Decision23-Jun-2020
Date of Acceptance24-Jun-2020
Date of Web Publication21-Oct-2020

Correspondence Address:
Dr. Rakesh Kumar
Department of Nuclear Medicine, Division of Diagnostic Nuclear Medicine, All India Institute of Medical Sciences, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.IJNM_131_20

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   Abstract 


Somatostatin cell surface receptors are expressed on the peritumoral vessels of various benign and malignant neoplasms including angiofibromas. Positive initial uptake on positron emission tomography-computed tomography (PET/CT) imaging with 68Ga-labeled DOTANOC is noted in a patient with juvenile nasal angiofibroma (JNA), and the same is noted to be absent following complete surgical excision. Functional 68Ga-DOTANOC PET/CT may be an early useful tool for JNA residual/recurrence identification and precise postoperative surveillance.

Keywords: Angiofibroma, DOTANOC positron emission tomography-computed tomography, juvenile nasopharyngeal angiofibroma


How to cite this article:
Sakthivel P, Thakar A, Prashanth A, Arunraj ST, Kumar R, Kumar R. Clinical utility of 68Ga-DOTANOC positron emission tomography-computed tomography scan on postoperative assessment of juvenile nasal angiofibroma. Indian J Nucl Med 2020;35:372-3

How to cite this URL:
Sakthivel P, Thakar A, Prashanth A, Arunraj ST, Kumar R, Kumar R. Clinical utility of 68Ga-DOTANOC positron emission tomography-computed tomography scan on postoperative assessment of juvenile nasal angiofibroma. Indian J Nucl Med [serial online] 2020 [cited 2020 Dec 2];35:372-3. Available from: https://www.ijnm.in/text.asp?2020/35/4/372/298738



We recently published the case of a patient with primary juvenile nasal angiofibroma (JNA), in whom 68 Ga-DOTANOC positron emission tomography-computed tomography (PET/CT) showed avid DOTANOC uptake in primary tumor along with intracranial extension.[1] The 19-year-old adolescent boy underwent right transmaxillary approach and gross total excision of the tumor (clinical image depicting scar of lateral rhinotomy [arrow in [Figure 1]a, excised specimen [Figure 1]b). On 4-month follow-up, the patient was asymptomatic, and nasal endoscopy was normal. We performed 68 Ga-DOTANOC PET/CT scan for postoperative disease surveillance after 4 months. To limit the radiation exposure, only head-and-neck spot imaging was obtained as the disease is benign. The scan revealed no abnormal uptake in the postoperative site. There was intense uptake only in the pituitary gland (maximum standardized uptake value [SUVmax] = 6.24). On comparison with preoperative and postoperative scans, it was clearly visualized that there was no residual disease in our patient (preoperative maximum intensity projection [MIP], axial, coronal, and sagittal fused PET/CT images [Figure 1]c, [Figure 1]d, [Figure 1]e, [Figure 1]f and postoperative MIP, axial, coronal, and sagittal fused PET/CT images [Figure 1]g, [Figure 1]h, [Figure 1]i, [Figure 1]j, respectively). The patient is currently asymptomatic at 9 months post surgery and will be in yearly follow-up for 3 years.
Figure 1: Clinical image depicting scar of lateral rhinotomy (arrow in a), excised specimen (b), preoperative maximum intensity projection, axial, coronal, and sagittal fused positron emission tomography-computed tomography images (c-f) and postoperative maximum intensity projection, axial, coronal, and sagittal fused positron emission tomography-computed tomography images (g-j), respectively

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Somatostatin (SST) (also known as growth hormone-inhibiting hormone or somatotropin release-inhibiting factor) is a short-peptide hormone with numerous autocrine, paracrine, and neurotransmitter regulatory functions.[2] SST cell surface receptors (SSTRs) are expressed in many different malignant, benign, and neuroendocrine tumors. SSTRs are also expressed in the endothelium of human vessels during angiogenesis and not in nonproliferating vessels.[3],[4] Kukwa et al. performed immunohistochemical evaluation in nine patients of JNA and proved the overexpression of SSTRs in them.[5] Furthermore, in a study by Gronkiewicz et al., the 68 Ga-DOTATATE PET data correlated with immunohistochemistry for SSTRs in six cases of JNA.[6]

JNA is a rare, benign, locally aggressive, fibrovascular neoplasm arising from the posterior part of the nasal cavity, exclusively seen in adolescent males. Radical surgery remains the treatment of choice. Due to propensity for notorious massive intraoperative bleeding and the difficulty in extirpating the disease completely, the rate of residual disease even after surgical treatment varies from 13% to 50%.[7],[8] Hence, postoperative assessment of residual/recurrent disease remains a major determinant during follow-up. The performance of postoperative 68 Ga-DOTANOC PET/CT to assess SSTR expression may assist in early functional residual/recurrent disease identification compared to conventional structural imaging (CT and magnetic resonance imaging), which might be affected by postoperative changes.[4],[9],[10],[11],[12],[13] Compared to PSMA PET, DOTANOC PET may be superior for postoperative functional surveillance in JNA as there is no uptake in the salivary glands and nasopharynx, making interpretation straightforward.[10],[11],[12],[13]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initial will not be published, and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Sakthivel P, Thakar A, Prashanth A, Kumar R, Sharma SC, Kumar R. Juvenile Nasal Angiofibroma on 68 Ga-DOTANOC PET/CT: Exploring theranostic avenues. Indian J Nucl Med 2020;35:176-7.  Back to cited text no. 1
  [Full text]  
2.
Hoyer D, Bell GI, Berelowitz M, Epelbaum J, Feniuk W, Humphrey PP, et al. Classification and nomenclature of somatostatin receptors. Trends Pharmacol Sci 1995;16:86-8.  Back to cited text no. 2
    
3.
Barnett P. Somatostatin and somatostatin receptor physiology. Endocrine 2003;20:255-64.  Back to cited text no. 3
    
4.
Denzler B, Reubi JC. Expression of somatostatin receptors in peritumoral veins of human tumors. Cancer 1999;85:188-98.  Back to cited text no. 4
    
5.
Kukwa W, Andrysiak R, Kukwa A, Hubalewska-Dydejczyk A, Gronkiewicz Z, Wojtowicz P, et al. (99 m) TC-octreotide scintigraphy and somatostatin receptor subtype expression in juvenile nasopharyngeal angiofibromas. Head Neck. 2011;33:1739-46.  Back to cited text no. 5
    
6.
Gronkiewicz Z, Kukwa W, Krolicki L, Cyran-Chlebicka A, Pawlak D, Stankiewicz C, et al. (68) Ga-DOTATATE PET in juvenile angiofibroma. Future Oncol 2016;12:1483-91.  Back to cited text no. 6
    
7.
Nicolai P, Berlucchi M, Tomenzoli D, Cappiello J, Trimarchi M, Maroldi R, et al. Endoscopic surgery for juvenile angiofibroma: When and how. Laryngoscope 2003;113:775-82.  Back to cited text no. 7
    
8.
López F, Triantafyllou A, Snyderman CH, Hunt JL, Suárez C, Lund VJ, et al. Nasal juvenile angiofibroma: Current perspectives with emphasis on management. Head Neck 2017;39:1033-45.  Back to cited text no. 8
    
9.
Chagnaud C, Petit P, Bartoli J, Champsaur P, Gaubert J, Dessi P, et al. Postoperative follow-up of juvenile nasopharyngeal angiofibromas: assessment by CT scan and MR imaging. Eur Radiol 1998;8:756-64.  Back to cited text no. 9
    
10.
Sakthivel P, Prashanth A, Thakar A, Kumar R, Kumar R. Juvenile Nasal Angiofibroma on 68 Ga-PSMA PET/CT: Opening new frontiers. Clin Nucl Med 2019;44:e118-e119.  Back to cited text no. 10
    
11.
Sakthivel P, Thakar A, Prashanth A, Bhalla AS, Kakkar A, Sikka K, et al. Prostate-specific membrane antigen expression in primary Juvenile Nasal Angiofibroma-A pilot study. Clin Nucl Med 2020;45:195-9.  Back to cited text no. 11
    
12.
Thakar A, Sakthivel P, Prashanth A, Kumar R, Sharma SC, Kumar R. Clinical utility of 68Ga-prostate-specific membrane antigen PET/CT scan on postoperative assessment of Juvenile Nasal Angiofibroma. Clin Nucl Med 2020;45:e83-e84.  Back to cited text no. 12
    
13.
Thakar A, Sakthivel P, Prashanth A, Bhalla AS, Sharma SC, Kumar R. Comparison of 68Ga-PSMA PET/CT and Contrast-Enhanced MRI on Residual Disease Assessment of Juvenile Nasal Angiofibroma. Clin Nucl Med. 2020;45:308-9.  Back to cited text no. 13
    


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