In a prospective study, we demonstrated the prognostic utility of Ga-DOTATATE TV in a large cohort of patients with NETs, in terms of PFS and disease-specific mortality.

Context. The reliable localization of insulinoma is critical for the successful surgical treatment.Objective. This study compared the accuracy of 68 Gallium (Ga)-DOTATATE PET/CT to anatomic imaging modalities, selective arterial secretagogue injection (SASI), and intraoperative ultrasound (IOUS) and palpation for localizing insulinoma in patients who were biochemically cured. Design, Setting, and Patients. We conducted a retrospective analysis of 31 patients who had an insulinoma confirmed on histology and were biochemically cured. The results of CT, MRI, transabdominal US, IOUS, 68 Ga-DOTATATE PET/CT, SASI, and operative findings were analyzed. Intervention, Main Outcome Measures, Results: The insulinomas were correctly localized in 17 out of 31 (55%) of patients by CT, in 17 out of 28 (61%) by MRI, in 6 out of 28 (21%) by US, and in 9 out of 10 (90%) by 68 Ga-DOTATATE. IOUS was performed in 31 patients, and 29 of them had an insulinoma successfully localized (93.5%). Thirty patients underwent SASI, and the insulinoma was regionalized in 28 out of 30 patients (93%). In 19 out of 23 patients (83%), manual palpation identified insulinoma. In patients who had all four noninvasive imaging studies, CT was concordant with 68 Ga-DOTATATE in 6 out of 9 patients (67%); MRI in 8 out of 9 (78%); US in 0 out of 9; and in 1 out of 9 patients (11%) the lesion was only seen by 68 Ga-DOTATATE. Conclusions:68 Ga-DOTATATE PET/CT identifies most insulinomas and may be considered as an adjunct imaging study when all imaging studies are negative and when a minimally invasive surgical approach is planned.PRECIS: We studied 68Ga-DOTATATE PET/CT imaging in patients with insulinoma and found it identifies most tumors and should be considered as an adjunct imaging study.

Objective To determine the association between neuroendocrine tumor (NET) biomarker levels and extent of disease as assessed by 68Ga DOTATATE PET/CT imaging. Design A retrospective analysis of a prospective database of patients with NETs. Methods Fasting plasma chromogranin A (CgA), neuron-specific enolase (NSE), gastrin, glucagon, vasoactive intestinal peptide (VIP) and pancreatic polypeptide (PP), and 24-hour urinary 5-hydroxyindoleacetic acid (5-HIAA) levels were measured. Correlation between biomarkers and total 68Ga-DOTATATE-avid tumor volume (TV) was analyzed. Results The analysis included 232 patients. In patients with pancreatic NETs (n=112), 68Ga-DOTATATE TV correlated with CgA (r=0.6, p=0.001, Spearman). In patients with multiple endocrine neoplasia type 1 (n=39), 68Ga-DOTATATE TV correlated with glucagon (r=0.5, p=0.02) and PP levels (r=0.5, p=0.049). In patients with von Hippel-Lindau (n=24), plasma VIP (r=0.5, p=0.02) and PP levels (r=0.7, p<0.001) correlated with 68Ga-DOTATATE TV. In patients with small intestine NET (SINET, n=74), 68Ga-DOTATATE TV correlated with CgA (r=0.5, p=0.02) and 5-HIAA levels (r=0.7, p<0.001), with 5-HIAA ≥8.1 mg/24h associated with metastatic disease with high positive (81.8%) and negative (85.7%) predictive values (p=0.001). 68Ga-DOTATATE TV in patients with NET of unknown primary (n=16) and those with NET of other primary location (n=30) correlated with 5-HIAA levels (r=0.8, p=0.002, and r=0.7, p=0.02, respectively). Conclusions Our data supports the use of specific NET biomarkers based on the site of the primary NET and the presence of hereditary syndrome-associated NET. High urinary 5-HIAA levels indicate the presence of metastatic disease in patients with SINET.

Preoperative knowledge of the germline mutation status affects the surgical approach and extent of adrenalectomy.

IMPORTANCE Neuroendocrine tumors (NETs) express somatostatin receptors, which can be targeted with radiolabeled peptides. In a variety of solid tumors, radioguided surgery (RGS) has been used to guide surgical resection. Gallium 68 (68 Ga) dota peptides have been shown to be more accurate than other radioisotopes for detecting NETs. A pilot study previously demonstrated the feasibility and safety of 68 Ga-dotatate RGS for patients with NETs. OBJECTIVE To evaluate what intraoperative techniques and thresholds define positive lesions that warrant resection during 68 Ga-dotatate RGS.

GCM2-associated primary hyperparathyroidism patients have greater preoperative parathyroid hormone levels, a greater rate of multigland disease, a lesser rate of biochemical cure, and a substantial risk of parathyroid carcinoma. Knowledge of these clinical characteristics could optimize the surgical management of GCM2-associated familial isolated hyperparathyroidism.

In addition to a family history of PHPT, male sex, age 45 years and younger, and presence of multigland disease, should prompt physicians to offer the opportunity for genetic counseling and testing, as it could influence the management of patients with PHPT.

Gallium-68 (Ga-68) DOTATATE is a radiolabeled peptide-imaging modality that targets the somatostatin receptor (SSTR), especially subtype 2 (SSTR2). Benign and malignant thyroid tumors have been observed to express SSTR. The aim of this study was to evaluate the frequency and clinical significance of incidental atypical thyroid uptake as detected by Ga-68 DOTATATE positron emission tomography/computed tomography (PET/CT)