68Ga-DOTATATE PET/CT in Nonneuroendocrine Tumors

Yamaga, Lilian Yuri Itaya; Wagner, Jairo; Funari, Marcelo Buarque de Gusmão

doi:10.1097/rlu.0000000000001620

Cited by 28 publications

(23 citation statements)

References 7 publications

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“…Although the diagnosis of SLL was problematic, it showed relatively indolent behavior and could be followed until several signs of disease progression were seen (like progressive cytopenia, significant disease related symptoms, etc.). Although 68 Ga-68 DOTATATE PET-CT has considerable specificity, some benign and malignant entities, like hemangioma and meningioma, may show faint uptakes (8). Though, SLL did not show uptake in our patient, there are few reports of uptake of 68 Ga-68 DOTATATE in lymphomas.…”

Section: Discussioncontrasting

confidence: 53%

Critical Role of Ga–68 DOTATATE PET-CT in a Patient with Neuroendocrine Tumor and Second Primary Cancer

Telli¹,

Tuncel²,

Kılıçkap³

2019

Turk J Endocrinol Metab

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A 70-year-old female with the diagnosis of the metastatic neuroendocrine tumor was referred to our clinic with new abdominal lymph nodes in computed tomography (CT). This finding was considered as the disease progression, and capecitabine along with temozolomide was added to her current lanreotide therapy. The origin of the new lymph nodes was uncertain due to no response to chemotherapy and the stability of the lymph nodes. 68 Ga-DOTATATE PET-CT was performed to resolve the inconsistency in clinical and imaging findings. PET-CT images showed high 68 Ga-DOTATATE uptake in abdominal, cervical, left supraclavicular lymph nodes, and few metastatic foci in the liver, which were compatible with a neuroendocrine tumor. Additionally, there were bilaterally enlarged lymph nodes in the neck, axillary, intra-abdominal and inguinal area with no tracer uptake. The incongruent findings of PET-CT suggested a biopsy of nonradio-avid lymph nodes for the possible exclusion of other etiologies. Biopsy revealed that the enlargement of the lymph nodes was caused by small lymphocytic lymphoma (SLL) rather than neuroendocrine metastases. 68 Ga-DOTATATE PET-CT led to a critical change in the disease management and confirmed the diagnosis of the secondary tumor with the aid of biopsy. A high radiotracer uptake of neuroendocrine metastases on Ga-68 DOTATATE PET-CT suggested to change the chemotherapy (capecitabine+ temozolomide) to Y-90/Lu-177 DOTATATE therapy, which led to disease stabilization and minor regression. Her newly diagnosed stable SLL was followed accordingly. It can be concluded that 68 Ga-DOTATATE PET-CT plays a critical role in the management of patients with neuroendocrine tumors and should be used as a problem solving tool in patients with the discrepancy between clinical and imaging findings.

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Section: Discussioncontrasting

confidence: 53%

Critical Role of Ga–68 DOTATATE PET-CT in a Patient with Neuroendocrine Tumor and Second Primary Cancer

Telli¹,

Tuncel²,

Kılıçkap³

2019

Turk J Endocrinol Metab

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“…Overall, 68 Ga‐DOTATATE PET/CT has sensitivity greater than 94% and specificity greater than 92% for NETs . High levels of 68 Ga uptake also may be observed in meningioma, non‐Hodgkin lymphoma, breast cancer, papillary thyroid cancer, and thyroid adenoma . Levels of radiotracer uptake with either SRS or 68 Ga‐PET/CT correlate with the degree of SSTR expression and the response to peptide receptor radionuclide therapy (PRRT), whereas the predictive value for response to cold somatostatin analogs (SSAs) is still debated .…”

Section: Diagnosismentioning

confidence: 99%

“…87 High levels of 68 Ga uptake also may be observed in meningioma, non-Hodgkin lymphoma, breast cancer, papillary thyroid cancer, and thyroid adenoma. 88 Levels of radiotracer uptake with either SRS or 68 Ga-PET/CT correlate with the degree of SSTR expression and the response to peptide receptor radionuclide therapy (PRRT), whereas the predictive value for response to cold somatostatin analogs (SSAs) is still debated. 89,90 Given their high proliferative activity and low expression of SSTRs, poorly differentiated NETs are commonly imaged by 18 F-fluorodeoxyglucose PET/CT.…”

Section: Diagnosismentioning

confidence: 99%

Gastroenteropancreatic Neuroendocrine Tumors

Cives

Strosberg

2018

CA A Cancer J Clinicians

460

411

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Neuroendocrine tumors (NETs) are heterogeneous malignancies arising from the diffuse neuroendocrine system. They frequently originate in the gastroenteropancreatic (GEP) tract and the bronchopulmonary tree, and their incidence has steadily increased in the last 3 decades. Fundamental biologic and genomic differences underlie the clinical heterogeneity of NETs, and distinct molecular features characterize NETs of different grades and different primary sites. Although surgery remains the cornerstone of treatment for localized tumors, systemic treatment options for patients with metastatic NETs have expanded considerably. Somatostatin analogs have demonstrated both antisecretory and antitumor efficacy. Peptide receptor radionuclide therapy with lutetium‐177 dotatate (177Lu‐DOTATATE) has been approved for advanced GEP‐NETs. The antitumor activity of everolimus has been demonstrated across a wide spectrum of NETs, and the antiangiogenic agent sunitinib has been approved for pancreatic NETs (pNETs). Chemotherapy with temozolomide and capecitabine has recently demonstrated an unprecedented prolongation of progression‐free survival in a randomized trial of pNETs. Multiple retrospective series have reported the efficacy of liver‐directed therapies both for palliating symptoms of hormone excess and for controlling tumor growth. Telotristat, an oral inhibitor of tryptophan hydroxylase, has been shown to reduce diarrhea in patients with carcinoid syndrome. Defining the therapeutic algorithm and identifying biomarkers predictive of response to treatments are among the main priorities for the next decade of research in the NET field.

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“…The incidental finding of breast cancers in patients with neuroendocrine tumors was previously reported using Ga-68-DOTA-TOC [ 6 ] and Ga-68-DOTA-TATE [ 7 ] PET, but as to the authors knowledge, there is no case in the literature of an incidentally detected breast cancer while performing Ga-68-DOTA-NOC, which we report here for the first time.…”

Section: Introductionmentioning

confidence: 51%

“…[ 6 ] Additionally, a recent pictorial essay showed an incidentally detected breast carcinoma in a woman with liver neuroendocrine tumor metastases performing Ga-68-DOTA-TATE for investigation of unknown primary site. [ 7 ]…”

Section: Discussionmentioning

confidence: 99%

Incidental finding of a breast carcinoma on Ga-68-DOTA-1-Nal3-octreotide positron emission tomography/computed tomography performed for the evaluation of a pancreatic neuroendocrine tumor

Vieira¹,

Faria

Moura³

et al. 2018

Medicine

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Rationale:Functional imaging using radiolabeled somatostatin analogues plays an important role in the management of patients with neuroendocrine tumors, and it is a promising tool in the new era of theragnosis and personalized medicine.Patients Concerns:The authors present the case of a 63-year-old woman referred for evaluation of a suspected pancreatic neuroendocrine tumor by Ga-68-DOTA-1-Nal3-octreotide positron emission tomography/computed tomography (Ga-68-DOTA-NOC PET/CT).Diagnoses:PET/CT confirmed increased uptake of Ga-68-DOTA-NOC in a pancreatic lesion compatible with hyperexpression of somatostatin receptors in a neuroendocrine tumor. Furthermore, PET/CT revealed increased uptake in a breast lesion and in lymphadenomegalies (less intense than in the pancreatic tumor), which conducted to the incidental diagnosis of a breast carcinoma with lymph node metastases.Interventions:For the breast cancer, the patient underwentneoadjuvant chemotherapy and anti-HER2 monoclonal antibody, after which she was submitted to surgery. Regarding thepancreatic neuroendocrine tumor, it was decided to maintain itunder surveillance.Outcomes:Breast carcinomas are known to express somatostatin receptors and this is the first report of Ga-68-DOTA-NOC uptake in a breast tumor.Lessons:Ga-68-DOTA-NOC PET/CT could be useful for the management of breast cancer patients in the new era of theragnosis and personalized medicine.

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68Ga-DOTATATE PET/CT in Nonneuroendocrine Tumors

Cited by 28 publications

References 7 publications

Critical Role of Ga–68 DOTATATE PET-CT in a Patient with Neuroendocrine Tumor and Second Primary Cancer

Critical Role of Ga–68 DOTATATE PET-CT in a Patient with Neuroendocrine Tumor and Second Primary Cancer

Gastroenteropancreatic Neuroendocrine Tumors

Incidental finding of a breast carcinoma on Ga-68-DOTA-1-Nal3-octreotide positron emission tomography/computed tomography performed for the evaluation of a pancreatic neuroendocrine tumor

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