68Gallium DOTANOC-PET Imaging in Lung Carcinoids: Impact on Patients' Management

Abstract

Background:⁶⁸Gallium DOTA-PET imaging is preferable to standard somatostatin receptor scintigraphy where available; however, its role in the management of lung carcinoid tumours (LC) remains unclear. Methods: All consecutive patients with histologically confirmed LC from two ENETS Centres of Excellence were identified retrospectively. The primary objective was to assess the impact of ⁶⁸Ga-DOTANOC-PET on clinical management in patients with LC. Results: Of 166 patients screened, 46 were eligible: 52% female, median age 57 years (range 21-86); type of LC: diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (4%), typical (44%), atypical (35%), not reported (17%); stage: localised (63%), locally advanced (13%), and metastatic (17%) (7% unknown). A total of 47 ⁶⁸Ga-DOTANOCs were performed with the following rationale: LC diagnosis confirmation (4; 9%), primary tumour identification (2; 4%), post-surgical assessment (19; 40%), staging (patients with known LC present at time of ⁶⁸Ga-DOTANOC) (19; 40%), and consideration of peptide receptor radionuclide therapy (3; 7%). Twenty-seven (57%) scans showed evidence of non-physiological uptake: median maximum standardised uptake value 7.2 (range 1.42-53). ⁶⁸Ga-DOTANOC provided additional information in 37% (95% CI 22-51) of patients and impacted on management in 26% (95% CI 12-41); 9 patients (21%) were identified to have occult sites of metastases. Out of the 19 patients with post-surgical ⁶⁸Ga-DOTANOC, 3 (16%) were identified to have distant metastases. There were no differences in the rate of practice changing ⁶⁸Ga-DOTANOC results by type of LC (p value 0.5). Conclusions: Our results support the role of ⁶⁸Ga-DOTANOC for optimising the management of patients with LC, including post-surgical re-staging due to the potential for identifying occult metastases.

Natural History of Localized and Locally Advanced Atypical Lung Carcinoids after Complete Resection: A Joined French-Italian Retrospective Multicenter Study

“…Indeed, expression of somatostatin receptors has been demonstrated in lung NET [37,38]. On this basis, recent series, using 68 Ga-DOTANOC-PET and DOTATATE-PET, showed promising results in patients with lung NET [39,40].…”

Unmet Medical Needs in Pulmonary Neuroendocrine (Carcinoid) Neoplasms

“…Whilst 68 Ga-DOTA somatostatin analogue PET/CT generally reveals additional metastases compared to conventional imaging (e.g., CT/MRI) in well-differentiated NET [35], especially of lymph nodes, bone, and peritoneum, there are no dedicated studies yet to determine the performance of SRI in the pre- or postoperative setting of early-stage PC, namely for the detection of mediastinal node metastases. A few studies dedicated to advanced PC have provided first evidence that the rate of new sites discovered by SRI is above 10%, supporting its routine use [36]. 18 F-FDG PET/CT is currently recommended in aggressive PC, but due to its historical role in lung cancer 18 F-FDG PET/CT is frequently performed first [37].…”

Follow-Up Recommendations after Curative Resection of Well-Differentiated Neuroendocrine Tumours: Review of Current Evidence and Clinical Practice

“…In the last decade, several clinical studies have compared the diagnostic role of 68 Ga-DOTA-PET to somatostatin receptor scintigraphy (Octreoscan ® ) in patients diagnosed with NETs. These studies have confirmed an increased sensitivity and image quality, together with an increased capacity to detect additional lesions and alter management in favour of 68 Ga-DOTA-PET [72,73,74,75,76,77,78].…”