The Combined Interpretation of 68Ga-DOTATATE PET/CT and 18F-FDG PET/CT in Metastatic Gastroenteropancreatic Neuroendocrine Tumors

Introduction:The combined use of 68Gallium [68GA]-DOTA-peptides and 18Fluorine-fluoro-2-deoxyglucose [18F-FDG] PET/TC scans in the work-up of pancreatic neuroendocrine tumors (PanNETs) is controversial. This study aimed at assessing both tracers’ capability to identify tumors and to assess its association with pathological predictors of recurrence. Methods:Prospectively collected, preoperative, dual-tracer PET/CT scan data of G1-G2, non-metastatic, PanNETs that underwent surgery between January 2013 and October 2019 were retrospectively analyzed. Results:The final cohort consisted of 124 cases. There was an approximately equal distribution of males and females(50.8%/49.2%), and G1 and G2 tumors(49.2%/50.8%). The disease was detected in 122(98.4%) and 64(51.6%) cases by 68Ga-DOTATOC and by 18F-FDG PET/CT scans, respectively, with a combined sensitivity of 99.2%. 18F-FDG-positive examinations found G2 tumors more often than G1 (59.4% versus 40.6%;p = 0.036), and 18F-FDG-positive PanNETs were larger than negative ones (median tumor size 32 mm, IQR 21 versus 26 mm, IQR 20;p = 0.019). The median Ki67 for 18F-FDG-positive and -negative examinations was 3(IQR 4) and 2(IQR 4), respectively, (p = 0.029). At least one pathologic predictor of recurrence was present in 74.6% of 18F-FDG-positive cases (versus 56.7%;p = 0.039), whereas this was not found when dichotomizing the PanNETs by their dimensions (≤/> 20 mm). None of the two tracers predicted nodal metastasis. ROC curve analysis showed that 18F-FDG uptake higher than 4.2 had a sensitivity of 49.2%, and specificity of 73.3% for differentiating G1 from G2 (AUC=0.624, p=0.009). Conclusion: The complementary adoption of 68Ga-DOTATOC and 18F-FDG tracers may be valuable in the diagnostic work-up of PanNETs despite not being a game-changer for the management of PanNETs ≤ 20 mm.

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A Comparison of 68Ga-DOTATATE and 18F-FDG PET/CT in Pulmonary Neuroendocrine Tumors

Journal of Nuclear Medicine ◽

10.2967/jnumed.109.066639 ◽

2009 ◽

Vol 50 (12) ◽

pp. 1927-1932 ◽

Cited By ~ 134

Author(s):

I. Kayani ◽

B. G. Conry ◽

A. M. Groves ◽

T. Win ◽

J. Dickson ◽

...

Keyword(s):

Neuroendocrine Tumors ◽

Fdg Pet ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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NETest liquid biopsy is diagnostic of small intestine and pancreatic neuroendocrine tumors and correlates with imaging

Endocrine Connections ◽

10.1530/ec-19-0030 ◽

2019 ◽

Vol 8 (4) ◽

pp. 442-453 ◽

Cited By ~ 13

Author(s):

Anna Malczewska ◽

Magdalena Witkowska ◽

Karolina Makulik ◽

Agnes Bocian ◽

Agata Walter ◽

...

Keyword(s):

Small Intestine ◽

Neuroendocrine Tumors ◽

Fdg Pet ◽

Disease Status ◽

Blood Draw ◽

Gastroenteropancreatic Neuroendocrine Tumors ◽

Disease Extent ◽

Tertiary Referral Center ◽

Pet Ct ◽

Fdg Pet Ct

Introduction Current monoanalyte biomarkers are ineffective in gastroenteropancreatic neuroendocrine tumors (GEP-NETs). NETest, a novel multianalyte signature, provides molecular information relevant to disease biology. Aim(s) Independently validate NETest to diagnose GEP-NETs and identify progression in a tertiary referral center. Materials and methods Cohorts are 67 pancreatic NETs (PNETs), 44 small intestine NETs (SINETs) and 63 controls. Well-differentiated (WD) PNETs, n = 62, SINETs, all (n = 44). Disease extent assessment at blood draw: anatomical (n = 110) CT (n = 106), MRI (n = 7) and/or functional 68Ga-SSA-PET/CT (n = 69) or 18F-FDG-PET/CT (n = 8). Image-positive disease (IPD) was defined as either CT/MRI or 68Ga-SSA-PET/CT/18F-FDG-PET/CT-positive. Both CT/MRI and 68Ga-SSA-PET/CT negative diagnosis in WD-NETs was considered image-negative disease (IND). NETest (normal: 20): PCR (spotted plates). Data: mean ± SD. Results Diagnosis NETest was significantly increased in NETs (n = 111; 26 ± 21) vs controls (8 ± 4, p < 0.0001). Seventy-five (42 PNET, 33 SINET) were image positive. Eleven (8 PNET, 3 SINET; all WD) were IND. In IPD, NETest was significantly higher (36 ± 22) vs IND (8 ± 7, P < 0.0001). NETest accuracy, sensitivity and specificity are 97, 99 and 95%, respectively Concordance with imaging NETest was 92% (101/110) concordant with anatomical imaging, 94% (65/69) with 68Ga-SSA-PET/CT and 96% (65/68) dual modality (CT/MRI and 68Ga-SSA-PET/CT). In 70 CT/MRI positive, NETest was elevated in all (37 ± 22). In 40 CT/MRI negative, NETest was normal (11 ± 10) in 31. In 56 68Ga-SSA-PET/CT positive, NETest was elevated (36 ± 22) in 55. In 13 68Ga-SSA-PET/CT negative, NETest was normal (9 ± 8) in ten. Disease status NETest was significantly higher in progressive (61 ± 26; n = 11) vs stable disease (29 ± 14; n = 64; P < 0.0001) (RECIST 1.1). Conclusion NETest is an effective diagnostic for PNETs and SINETs. Elevated NETest is as effective as imaging in diagnosis and accurately identifies progression.

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Combined imaging with 68Ga-DOTA-TATE and 18F-FDG PET/CT on the basis of volumetric parameters in neuroendocrine tumors

Nuclear Medicine Communications ◽

10.1097/mnm.0000000000000522 ◽

2016 ◽

Vol 37 (8) ◽

pp. 874-881 ◽

Cited By ~ 11

Author(s):

Ummuhan Abdulrezzak ◽

Yurdagul K. Kurt ◽

Mustafa Kula ◽

Ahmet Tutus

Keyword(s):

Neuroendocrine Tumors ◽

Fdg Pet ◽

Pet Ct ◽

Combined Imaging ◽

18F Fdg ◽

Fdg Pet Ct

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Prognostic Value of Volume-Based Metabolic Parameters Measured by 18F-FDG PET/CT of Pancreatic Neuroendocrine Tumors

Nuclear Medicine and Molecular Imaging ◽

10.1007/s13139-013-0262-0 ◽

2014 ◽

Vol 48 (3) ◽

pp. 180-186 ◽

Cited By ~ 15

Author(s):

Ho Seong Kim ◽

Joon Young Choi ◽

Dong Wook Choi ◽

Ho Yeong Lim ◽

Joo Hee Lee ◽

...

Keyword(s):

Neuroendocrine Tumors ◽

Fdg Pet ◽

Prognostic Value ◽

Metabolic Parameters ◽

Pancreatic Neuroendocrine Tumors ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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68Ga-DOTATOC and 18F-FDG PET/CT for identifying the primary lesions of suspected and metastatic neuroendocrine tumors: A prospective study in Taiwan

Journal of the Formosan Medical Association ◽

10.1016/j.jfma.2017.07.007 ◽

2018 ◽

Vol 117 (6) ◽

pp. 480-487 ◽

Cited By ~ 10

Author(s):

Shih-Hsin Chen ◽

Yu-Chuan Chang ◽

Tsann-Long Hwang ◽

Jen-Shi Chen ◽

Wen-Chi Chou ◽

...

Keyword(s):

Prospective Study ◽

Neuroendocrine Tumors ◽

Fdg Pet ◽

Pet Ct ◽

18F Fdg ◽

A Prospective Study ◽

Fdg Pet Ct

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18F-FDG PET/CT in Primary Hepatic Neuroendocrine Tumors

Clinical Nuclear Medicine ◽

10.1097/rlu.0000000000001938 ◽

2018 ◽

Vol 43 (3) ◽

pp. 192-194 ◽

Cited By ~ 5

Author(s):

Guangyu Ma ◽

Jie Li ◽

Baixuan Xu ◽

Liping Fu

Keyword(s):

Neuroendocrine Tumors ◽

Fdg Pet ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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Clinical application of 18F-FDG PET/CT in oncology: Rare gastrointestinal malignant tumors (literature review)

Oncologia i radiologia Kazakhstana ◽

10.52532/2663-4864-2020-3-57-31-34 ◽

2020 ◽

Vol 57 (3) ◽

pp. 31-34

Author(s):

A. G. DYO ◽

G. R. AKHMETOVA ◽

ZH. ZH. ZHOLDYBAY ◽

A. D. AKYZHANOVA ◽

J. M. AMANKULOV ◽

...

Keyword(s):

Neuroendocrine Tumors ◽

Fdg Pet ◽

Differential Diagnostics ◽

Gastrointestinal Neoplasms ◽

Low Grade ◽

Cancer Management ◽

Primary Staging ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

Relevance: PET/CT is now becoming an integral part of cancer management protocols. 18F-fluorodeoxyglucose (18F-FDG) is the most common radiopharmaceutical for PET. However, the 18F-FDG PET/CT sensitivity and specificity vary widely in tumors of different histological structures and cell atypia degrees. The role of PET/CT in complex diagnostics of lymphomas is known. However, the specific use of this method in gastrointestinal neoplasms, especially at the initial stage of examination and in differential diagnostics, is not clearly defined since lymphomas account for only 1-5% of GI tumors. Neuroendocrine tumors (NETs) are a heterogeneous group of tumors that arise from the diffuse neuroendocrine system enterochromaffin cells. NETs account for 0.5% of all neoplasms but become more common recently due to the advances in diagnostics. However, the significant achievements in the study of biological and molecular mechanisms of NETs’ behavior have not yet resulted in a common algorithm for their diagnostics and treatment. The purpose of this study was to review the experience of using 18F-FDG PET/CT in diagnostics of lymphomas and gastrointestinal neuroendocrine tumors as rare tumors to improve the criteria for the rational use of the 18F-FDG PET/CT method in their diagnostics and monitoring. Results: The use of 18F-FDG PET/CT is advisable at any stage of non-Hodgkin lymphomas, which are most common in the gastrointestinal tract, and for differential diagnostics, primary staging, and treatment efficiency monitoring in gastrointestinal lymphomas. 18F-FDG PET CT is also most valuable in aggressive non-Hodgkin lymphomas. Despite the importance of functional imaging in NETs, 18F-FDG PET/CT plays a supporting role in monitoring gastrointestinal NETs. 18F-FDG PET/CT is known to be efficient in prognosing the outcome of radionuclide therapy with peptide receptors in low-grade and progressive metastatic NETs. Conclusion: In lymphomas, 18F-FDG PET/CT is useful for primary staging, assessing early response to treatment, and re-staging. 18F-FDG PET/CT has a diagnostic value in undifferentiated gastrointestinal NETs, while its usefulness in well-differentiated gastrointestinal NETs is limited.

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