Combination of clinical parameters and I-metaiodobenzylguanidine scintigraphy in the monitoring of neuroblastoma metastases.

Background: The accurate and early detection of neuroblastoma (NB) metastasis is critical for clinical diagnosis and treatment. This study aimed to explore the value of a new diagnostic model combining I-metaiodobenzylguanidine (MIBG) scintigraphy, minimal residual disease (MRD) examination, and clinical parameters in detecting NB metastasis.

Methods: The data of 76 pediatric patients (41 males and 35 females) who underwent both I-MIBG scintigraphy and bone marrow (BM)-MRD examinations were retrospectively analyzed. MRD was detected using quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) targeting the paired-like homeobox 2B () gene, while disseminated NB cells in BM were detected by flow cytometry (FCM). Diagnostic efficacy was assessed by comparing I-MIBG scintigraphy and the diagnostic model with the gold standard that included pathology, other relevant imaging examinations, and a follow-up period of more than 18 months. Diagnostic efficacy was evaluated using the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristic (ROC) curve. The Delong test was used to evaluate any improvements in diagnostic efficacy.

Results: In relation to the diagnosis of metastasis, I-MIBG scintigraphy exhibited high diagnostic value [sensitivity: 57.5%, specificity: 94.4%, PPV: 92.0%, NPV: 66.7%, area under the curve (AUC): 0.760, 95% confidence interval (CI): 0.649-0.870]. After a logistic regression analysis, I-MIBG scintigraphy, gene amplification status, chromosome 11q23 aberration, radiotherapy, and BM-MRD based on the gene were included in the multi-parameter diagnostic model, which had an AUC, sensitivity, specificity, PPV, and NPV of 0.907 (95% CI: 0.834-0.979), 82.1%, 87.9%, 88.9%, and 80.6%, respectively.

Conclusions: In the assessment of metastasis in pediatric NB patients, the multi-parameter diagnostic model showed superior diagnostic efficacy compared to I-MIBG scintigraphy, and could be a promising tool for monitoring residual disease and diagnosing the presence of metastasis.