{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T19:57:30Z","timestamp":1778529450234,"version":"3.51.4"},"reference-count":21,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,7,5]],"date-time":"2023-07-05T00:00:00Z","timestamp":1688515200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Predicting malignancy among pheochromocytoma paragangliomas (PPGLs) remains a challenge, with only limited understanding of the clinical and molecular characteristics. It has been suggested that reduced avidity of a PPGL on <jats:sup>68<\/jats:sup>Ga\u2010DOTATATE PET\/CT could be a sign of not only altered metabolic activity, but also of increased biologic aggressiveness, possibly due to loss of SSTR\u2010expression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective cohort review.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Measurements<\/jats:title><jats:p>Thirty\u2010seven patients who underwent treatment for PPGL at a tertiary institution over the period 2010\u22122022, had their biochemical, radiological, and clinicopathological variables collected.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Five of 37 (13%) patients (5 males) with a mean age of 42 years were found to have malignant PPGLs. The mean size of the tumors were 5.4\u2009cm, with 4 located in the paraaortic area and 1 in right adrenal. Functional imaging with <jats:sup>68<\/jats:sup>Ga\u2010DOTATATE PET\/CT showed a mean SUV<jats:sub>max<\/jats:sub> of 4.5. Four of 5\u00a0patients underwent open resection of the tumors under general anesthesia following preoperative alpha blockade with oral phenoxybenzamine. The mean PASS score of the excised tumors was 5.5 in keeping with biologically aggressive tumors, with evidence of necrosis. All but 1 patient had germline SDHB\u2010mutation (Deletion Exon 1). Postintervention after a mean follow\u2010up of 31 months, 2 of 5 (40%) patient developed spinal metastasis and 1 patients (25%) died of cardiac complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A non\u2010highly avid PPGL on DOTATE scan should be considered as possibly having necrosis of tumors indicating a more aggressive tumor\u2010biology. There might be a subgroup of patients in whom FDG\u2010PET scan should be considered to gain additional information.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jso.27388","type":"journal-article","created":{"date-parts":[[2023,7,5]],"date-time":"2023-07-05T07:44:15Z","timestamp":1688543055000},"page":"764-768","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Reduced uptake pattern on <sup>68<\/sup>Ga\u2010DOTATATE\u2010scan may indicate necrosis predicting aggressive behavior in pheochromocytoma and paragangliomas (PPGLs)"],"prefix":"10.1002","volume":"128","author":[{"given":"Mechteld Christine","family":"de Jong","sequence":"first","affiliation":[{"name":"Division of Endocrine Surgery Leeds Teaching Hospitals NHS Trust  Leeds UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diluka","family":"Pinto","sequence":"additional","affiliation":[{"name":"Division of Endocrine Surgery, University Surgical 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