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Prospective evaluation of 68 Ga‐ DOTATATE PET / CT in limited disease neuroendocrine tumours and/or elevated serum neuroendocrine biomarkers
Author(s) -
Gabriel Sophie,
Garrigue Philippe,
Dahan Laetitia,
Castinetti Frédéric,
Sebag Frédéric,
Baumstark Karine,
Archange Cendrine,
Jha Abhishek,
Pacak Karel,
Guillet Benjamin,
Taïeb David
Publication year - 2018
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.13745
Subject(s) - neuroendocrine tumors , medicine , chromogranin a , prospective cohort study , somatostatin , somatostatin receptor , pancreas , context (archaeology) , radionuclide therapy , gastrinoma , gastroenterology , endocrinology , immunohistochemistry , biology , secretion , gastrin , paleontology
Summary Context The 68 Ga‐labelled somatostatin analogues ( 68 Ga‐ DOTA ‐ SSA s) is becoming popular as an important diagnostic tool in neuroendocrine tumours as evidenced by a growing number of reports detailing institutional experience with various DOTA peptides. However, only few prospective studies have compared 68 Ga‐ DOTA ‐ SSA s and somatostatin receptor scintigraphy ( SRS ) in gastroenteropancreatic neuroendocrine tumours ( GEP ‐ NET s) and pulmonary neuroendocrine tumours. Objective The aim of our prospective study was to perform head‐to‐head comparison between 68 Ga‐ DOTATATE PET / CT and standard imaging work‐up ( SI ) that included multiphasic CT , liver MRI and SRS using single photon emission computed tomography. Design In this prospective study, the patients were enrolled only if they met any of the following inclusion criteria: (i) initial staging of a NET s without distant metastases on SI or neuroendocrine tumour with unknown primary on SI ; (ii) restaging of NET s that could be treated by focused therapeutic interventions; (iii) elevated serum neuroendocrine hormones or peptides. The exclusion criteria was grade 3 GEP ‐ NET s. Results Thirty‐two patients were enrolled in the study. Eleven patients (6 pancreas, 4 ileum, 1 duodenal) were included for initial evaluation and staging of NET s, 8 patients (5 pancreas, 1 ileal, 1 lung, 1 duodenal gastrinoma) for restaging, and 13 patients for elevated serum neuroendocrine biomarkers (5 ectopic Cushing's syndrome, 5 organic hypoglycaemia, 1 patient each with elevated vasoactive inhibitory peptide, chromogranin A and neuron‐specific enolase). 68 Ga‐ DOTATATE PET / CT detected more primary tumours than SRS (15/18 vs 10/18: P = .074). The missed tumours on 68 Ga‐ DOTATATE PET / CT were located in the lung in two cases and duodenum in one case. For other anatomical regions (nodal and distant metastasis), no statistical difference was observed between imaging modalities using 68 Ga‐ DOTATATE PET / CT and SRS . Overall, 68 Ga‐ DOTATATE PET / CT + CT + MRI detected 31/33 of the involved regions (including primaries) (29 and 22 for 68 Ga‐ DOTATATE and SRS , respectively). Conclusion Our study shows that 68 Ga‐ DOTATATE PET / CT detected similar number of sites than combination of SRS , liver MRI and thoraco‐abdominopelvic CT on region‐based analysis. 68 Ga‐ DOTATATE PET / CT missed half of primary lung carcinoids with ectopic Cushing's syndrome.