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Context When an SDHx mutation is identified in a patient with a pheochromocytoma (PCC) or a paraganglioma (PGL), predictive genetic testing can detect mutation carriers that would benefit from screening protocols. Objective To define the tumor detection rate in a large cohort of asymptomatic SDHX mutation carriers. Design and Setting Retrospective multicentric study in 6 referral centers. Patients Between 2005 and 2019, 249 asymptomatic SDHx (171 SDHB, 31 SDHC, 47 SDHD) mutation carriers, with at least 1 imaging work-up were enrolled. Results Initial work-up, including anatomical (98% of subjects [97–100% according to center]) and/or functional imaging (67% [14–90%]) detected 48 tumors in 40 patients. After a negative initial work-up, 124 patients benefited from 1 to 9 subsequent follow-up assessments (mean: 1.9 per patient), with a median follow-up time of 5 (1–13) years. Anatomical (86% [49–100 %]) and/or functional imaging (36% [7–60 %]) identified 10 new tumors (mean size: 16 mm [4–50]) in 10 patients. Altogether, 58 tumors (55 paraganglioma [PGL], including 45 head and neck PGL, 2 pheochromocytoma [PCC], 1 gastrointestinal stromal tumor [GIST]), were detected in 50 patients (22 [13%] SDHB, 1 [3.2%] SDHC, and 27 [57%] SDHD), with a median age of 41 years old [11–86], 76% without catecholamine secretion and 80% during initial imaging work-up. Conclusions Imaging screening enabled detection of tumors in 20% of asymptomatic SDHx mutation carriers, with a higher detection rate in SDHD (57%) than in SDHB (13%) and SDHC (3%) mutation carriers, arguing for a gene-by-gene approach. Prospective studies using well-defined protocols are needed to obtain strong and useful data.

Screening of a Large Cohort of Asymptomatic SDHx Mutation Carriers in Routine Practice