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Recommendations for oncologic screening in paraneoplastic neurologic syndromes according to the type of tumor or cancer suspected

Recommendations for oncologic screening in paraneoplastic neurologic syndromes according to the type of tumor or cancer suspected
Type of tumor or cancer suspected Recommendations for oncologic screening
SCLC and malignant thymoma CT chest ± FDG-PET/CT. For thymomas, chest MRI might be useful as well, especially in children.
Breast cancer Mammography (breast US in young females and/or dense breast) ± breast MRI. If negative, FDG-PET/CT.
Ovarian teratoma Transvaginal US (may not be feasible in young patients) ± MRI pelvis/abdomen. If negative, CT chest searching for extrapelvic teratomas.
Ovarian carcinoma Transvaginal US ± MRI abdomen/pelvis or FDG-PET/CT.
Testicular tumors US ± CT of the pelvic region; MRI might be an alternative to CT, especially in children. Orchiectomy is recommended in males <50 years old with microcalcifications on US, confirmed Ma2 antibodies, and a compatible neurologic phenotype. FDG-PET/CT is recommended when retroperitoneal or mediastinal germ cell tumors are suspected based on unremarkable testicular US or the detection of regressed tumors on testicular biopsy.
Hodgkin lymphoma Full-body CT or FDG-PET/CT.
Neuroblastoma CT ± MRI (CT is usually more sensitive since it identifies calcifications more easily, but MRI is preferred for staging of thoracic tumors); chest radiograph, abdominal US, and metabolic investigations lack sensitivity.
Unknown Full-body CT followed, if negative, by FDG-PET/CT.
SCLC: small cell lung cancer; CT: computed tomography; FDG-PET: 18-F fluorodeoxyglucose positron emission tomography; MRI: magnetic resonance imaging; US: ultrasound.
Adapted from: Graus F, Vogrig A, Muñiz-Castrillo S, et al. Updated diagnostic criteria for paraneoplastic neurologic syndromes. Neurol Neuroimmunol Neuroinflamm 2021; 8:e1014. Copyright © The Authors. Available at: https://nn.neurology.org/content/8/4/e1014.long (Accessed on March 28, 2022). Adapted under the terms of the Creative Commons Attribution License 4.0.
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