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

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.