Diagnostics of neuroendocrine tumours: role of the therapist

IIntroduction: Pancreatic Neuroendocrine Tumours (p-NETs) are an important disease entity and comprise of peptide-secreting tumours often with a functional syndrome. : Accounting for a small percentage of all pancreatic tumours, they have a good overall survival rate when diagnosed early, with surgery being curative. The role of nuclear medicine in the diagnosis and treatment of these tumours is evident. However, the vast majority of patients will require extensive imaging in the form of conventional radiological techniques. It is important for clinicians to have a fundamental understanding of the p-NET appearances to aid prompt identification and to help direct management through neoplastic staging. Methods: This article will review the advantages and disadvantages of conventional radiological techniques in the context of p-NETs and highlight features that these tumours exhibit. Conclusion: Pancreatic neuroendocrine tumours are a unique collection of neoplasms that have markedly disparate clinical features but similar imaging characteristics. Most p-NETs are small and welldefined with homogenous enhancement following contrast administration, although larger and less welldifferentiated tumours can demonstrate areas of necrosis and cystic architecture with heterogeneous enhancement characteristics. : Prognosis is generally favourable for these tumours with various treatment options available. However, conventional radiological techniques will remain the foundation for the initial diagnosis and staging of these tumours, and a grasp of these modalities is extremely important for physicians.

Download Full-text

Role of 68Ga-DOTATOC PET-CT in the diagnosis and staging of pancreatic neuroendocrine tumours

European Radiology ◽

10.1007/s00330-011-2199-y ◽

2011 ◽

Vol 21 (11) ◽

pp. 2408-2416 ◽

Cited By ~ 52

Author(s):

Rakesh Kumar ◽

Punit Sharma ◽

Pramod Garg ◽

Sellam Karunanithi ◽

Niraj Naswa ◽

...

Keyword(s):

Neuroendocrine Tumours ◽

Pet Ct ◽

Pancreatic Neuroendocrine Tumours

Download Full-text

RADIONUCLIDE IMAGING AND THERAPY OF NEUROENDOCRINE TUMOURS

Journal of Cancer & Allied Specialties ◽

10.37029/jcas.v1i2.30 ◽

2015 ◽

Vol 1 (2) ◽

Author(s):

Shaunak Navalkissoor ◽

Gopinath Gnanasegaran

Keyword(s):

Radionuclide Imaging ◽

Radionuclide Therapy ◽

Neuroendocrine Tumours ◽

Somatostatin Receptor ◽

Peptide Receptor Radionuclide Therapy ◽

Clinical Results ◽

It Use ◽

Peptide Receptor ◽

Mibg Therapy

The incidence and prevalence of neuroendocrine tumours (NETs) are on the rise. Although NETs are a heterogeneous group of tumours, they have some similar properties, for example, that they can concentrate neuroamines and tend to have a high degree of somatostatin receptor (SSR) expression. These mechanisms can be exploited and this article discusses the important role of radionculide imaging and radionculide therapy in the management of NETs based on these mechanisms. This article reviews the current literature and discusses the role of radionuclide imaging in NETs both in terms of SSR imaging and neuroamine (metaiodobenzylguanidine [MIBG]) imaging. We discuss state-of- the-art 68Ga-radiopeptide imaging and indications for it use. We also discuss the role of 18F-FDG and other tracers in the management of NETs. The second half of the article focuses on radiotargeted treatment of NETs, discussing I-131 MIBG therapy and focussing on the emergence of peptide receptor radionuclide therapy. We discuss the clinical results, toxicities and patient selection for PRRT. Key words: DOTA octreotide, DOTATATE, Ga-68, Lu-177, metaiodobenzylguanidine, neuroendocrine tumours, peptide receptor radionuclide therapy, Y-90

Download Full-text

Role of 18FDG PET/CT in patients treated with 177Lu-DOTATATE for advanced differentiated neuroendocrine tumours

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-013-2369-z ◽

2013 ◽

Vol 40 (6) ◽

pp. 881-888 ◽

Cited By ~ 65

Author(s):

Stefano Severi ◽

Oriana Nanni ◽

Lisa Bodei ◽

Maddalena Sansovini ◽

Annarita Ianniello ◽

...

Keyword(s):

Neuroendocrine Tumours ◽

18Fdg Pet ◽

Pet Ct

Download Full-text

The role of somatostatin analogues in the treatment of neuroendocrine tumours

Molecular and Cellular Endocrinology ◽

10.1016/j.mce.2007.10.006 ◽

2008 ◽

Vol 286 (1-2) ◽

pp. 238-250 ◽

Cited By ~ 29

Author(s):

Simona Grozinsky-Glasberg ◽

Ashley B. Grossman ◽

Márta Korbonits

Keyword(s):

Neuroendocrine Tumours ◽

Somatostatin Analogues

Download Full-text

Role of high dose octreotide LAR for the treatment of GEP-NETs

Clinical Management Issues ◽

10.7175/cmi.v3i1.555 ◽

2009 ◽

Vol 3 (1) ◽

pp. 7-14

Author(s):

Giulia M. Franchi ◽

Chiara Cappelletti ◽

Valentina V. Villa ◽

Emanuele Bosi ◽

Marco F. Manzoni

Keyword(s):

Quality Of Life ◽

Tumour Growth ◽

Neuroendocrine Tumours ◽

Clinical Symptoms ◽

Standard Dose ◽

Diagnostic Tools ◽

High Dose ◽

Octreotide Lar

Neuroendocrine Tumours (NETs) are a heterogeneous group of rare neoplasms that account for 0,5% of all malignancies. The increased incidence observed in the last few decades may be accounted for by increased awareness, improved diagnostic tools and a revision in the definition. The main primary sites are the gastro-entero-pancreatic (GEP) tract (62-67%), and the lung (22-27%). In patients with GEP-NETs, the strongest predictor of 5-years survival is the staging. An adequate clinical management of GEP-NETs should be multidisciplinary and should aim at assuring a good quality of life. Somatostatin (sst) analogues are widely used in these tumours, which often express sst receptors, since they are demonstrated to reduce clinical symptoms and tumour growth. Herein we explore the usefulness of doubling octreotide LAR dose in selected patients after escaping from symptoms control and/or tumour stabilization in course of treatment with standard dose.

Download Full-text

The role of surgery in high grade neuroendocrine tumours of the lung

Journal of Thoracic Disease ◽

10.21037/jtd.2017.01.60 ◽

2017 ◽

Vol 9 (S15) ◽

pp. S1474-S1483 ◽

Cited By ~ 2

Author(s):

Stefan Welter ◽

Clemens Aigner ◽

Christian Roesel

Keyword(s):

Neuroendocrine Tumours ◽

High Grade

Download Full-text

The role of endoscopic ultrasound in diagnosing pancreatic neuroendocrine tumours

Oncoreview ◽

10.24292/01.or.160218 ◽

2018 ◽

Vol 8 (1) ◽

pp. 19-23

Author(s):

Przemysław Dyrla ◽

Magdalena Chmielewska ◽

Marta Mazur ◽

Przemysław Witek

Keyword(s):

Endoscopic Ultrasound ◽

Neuroendocrine Tumours ◽

Pancreatic Neuroendocrine Tumours

Download Full-text

Detection of unknown primary neuroendocrine tumors (CUP-NET) using 68Ga DOTA-NOC receptor PET/CT

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.4599 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 4599-4599

Author(s):

D. Hörsch ◽

V. Prasad ◽

V. Ambrosini ◽

M. Hommann ◽

S. Fanti ◽

...

Keyword(s):

Neuroendocrine Tumours ◽

Primary Tumour ◽

Unknown Primary ◽

Low Grade ◽

Pet Ct ◽

Pancreatic Net ◽

The Mean ◽

Standardised Uptake Values ◽

F 33

4599 Background: This bi-centric study aimed at determining the role of receptor PET/CT using 68Ga-DOTA-NOC in the detection of undiagnosed primary sites of neuroendocrine tumours (NETs). Methods: Overall 59 patients (M: F 33:26, age 65±9 yr) with documented NET and unknown primary, were enrolled. PET/CT was performed after injection of approximately 100 MBq (46–260 MBq) of 68Ga-DOTA-NOC. The maximum standardised uptake values (SUVmax) were calculated and compared with SUVmax in known pancreatic NET (pNET) and ileum / jejunum / duodenum (SI-NET). The results of PET/CT were also correlated with CT alone. Results: In 35/59 (59%) of patients, 68Ga-DOTA-NOC PET/CT localised the site of the primary: ileum/jejunum (14), pancreas (16), rectum (2), lungs (2) and paraganglioma (1). CT alone (on retrospective analyses) confirmed the findings in 12/59 (20%) patients. The mean SUVmax of identified previously unknown pNET and SI-Net were 18.6 ± 9.8 (range 7.8–34.8) and 9.1± 6.0 (range 4.2–27.8), respectively. SUVmax in patients with previously known pNET and SI-NET were 26.1± 14.5 (range 8.7–42.4) and 11.3±3.7 (range 5.6- 17.9). The SUVmax of the unknown pNET and SI-NET were significantly lower (p< 0.05) as compared to the ones with known primary tumour sites. 19% of the patients had high grade, and 81% low grade NET. In 4/59 patients the primary tumour was subsequently resected (2 pancretic, one ileal and one rectal tumour). Conclusions: Our data indicate that 68Ga- DOTA-NOC PET/CT is highly superior to 111In Octreoscan (17% detection rate for CUP according to literature) and can play a major role in the management of patients with CUP-NET. No significant financial relationships to disclose.

Download Full-text