Adrenal Bez Tümörlerinin Evrelemesi ve Evrelendirmede Nükleer Tıp Yöntemleri
Özet
Adrenokortikal karsinom (AKK), feokromositoma ve nöroblastoma gibi adrenal bez tümörlerinin evrelendirilmesinde nükleer tıp yöntemlerinin rolünü inceleyen bu çalışmada, doğru evrelemenin prognoz, tedavi planlaması ve sağkalım üzerindeki kritik etkisi ele alınmaktadır. Nadir görülen ve kötü prognoza sahip AKK'de UICC/WHO ve ENSAT gibi TNM tabanlı sistemler kullanılırken, lokal yayılım ve uzak metastazların saptanmasında BT, MR ve 18F-FDG PET/BT gibi görüntüleme yöntemleri hayati öneme sahiptir. Adrenal medulladan köken alan katekolamin üreten feokromositomalarda metastaz riskini belirlemek ve lezyonları saptamak amacıyla konvansiyonel yöntemlerin yanı sıra fonksiyonel görüntülemede MIBG sintigrafisi, DOTATATE-PET/BT ve FDOPA PET/BT öne çıkmaktadır. Çocukluk çağının en sık görülen ekstrakraniyal solid tümörü olan nöroblastomda ise tedavi öncesi risk değerlendirmesi için cerrahi sonrasına dayanan INSS yerine ameliyat öncesi IDRF kriterlerini içeren INRGSS sistemi yaygın olarak kullanılmaktadır. Nöroblastom yaygınlığının takibinde ve semikantitatif değerlendirilmesinde Curie ve SIOP-EN skorlama sistemleri ile I-123 MIBG planar ve SPECT-BT görüntülemeleri standart nükleer tıp yöntemleri olup, MIBG tutulumu göstermeyen heterojen tümör olgularında F-18 FDG PET kılavuzlarca önerilen temel alternatif yöntemi oluşturmaktadır.
Adrenocortical carcinoma (ACC), pheochromocytoma, and neuroblastoma are adrenal gland tumors where nuclear medicine methods play a critical role in staging, which directly impacts prognosis, treatment planning, and survival. In rare and poor-prognosis ACC, TNM-based staging systems like UICC/WHO and ENSAT are utilized, with CT, MRI, and 18F-FDG PET/CT serving as vital imaging modalities to detect local invasion and distant metastases. For pheochromocytomas—catecholamine-producing tumors originating from the adrenal medulla—MIBG scintigraphy, DOTATATE-PET/CT, and FDOPA PET/CT are prominent functional imaging techniques used alongside conventional methods to assess metastatic risk and localize lesions. In neuroblastoma, the most common extracranial solid tumor in childhood, the pre-operative INRGSS system incorporates IDRF criteria for risk assessment, widely replacing the post-operative surgery-based INSS. To monitor and semiquantitatively evaluate neuroblastoma disease burden using the Curie and SIOP-EN scoring systems, I-123 MIBG planar and SPECT-CT imaging remain the standard nuclear medicine modalities, whereas F-18 FDG PET is recommended by guidelines as the primary alternative for heterogeneous, MIBG-negative tumor cases.
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