Comparison of the prognostic values of 68Ga-DOTANOC PET/CT and 18F-FDG PET/CT in patients with well-differentiated neuroendocrine tumor

Sharma, Punit; Naswa, Niraj; Kc, Sudhir Suman; Alvarado, Luis; Dwivedi, Alok; Yadav, Y. C.; Kumar, Rakesh; Ammini, Ariachery C.; Bal, Chandrasekhar

doi:10.1007/s00259-014-2850-3

Cited by 46 publications

(49 citation statements)

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“…Interestingly, there was no relation between FDG SUV max and grade. The only report with similar findings was by Sharma et al in a limited population of NET patients with different primary sites (36). In their study, SUV max for 68 Ga-DOTANOC correlated with prognosis, whereas that for 18 F-FDG did not.…”

Section: Discussionsupporting

confidence: 61%

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Comparison of the Impact of ⁶⁸Ga-DOTATATE and ¹⁸F-FDG PET/CT on Clinical Management in Patients with Neuroendocrine Tumors

et al. 2016

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This study aimed to assess the clinical impact of 68 Ga-DOTATATE and 18 F-FDG with respect to the management plan and to evaluate the prognostic value of both tracers. Methods: A total of 104 patients (55 male and 49 female; median age, 58 y; range, 20-90 y) with histologically proven neuroendocrine tumors (NETs) underwent both 68 Ga-DOTATATE and 18 F-FDG PET/CT. . Results: The 68 Ga-DOTATATE and 18 F-FDG PET/CT findings were discordant in 65 patients (62.5%) and concordant in 39 patients (37.5%). The results changed the therapeutic plan in 84 patients (80.8%). In 22 patients (21.1%), decision making was based on the 18 F-FDG findings; in 32 (30.8%), on the findings with both radiotracers; and in 50 (48.1%), on the 68 Ga-DOTATATE findings. The most frequent management decision based on 18 F-FDG was initiation of chemotherapy (10 patients, 47.6%). The most common treatment decision due to 68 Ga-DOTATATE was initiation of peptide receptor radionuclide therapy (14 patients, 27.4%). In 11 (39.2%) of 28 patients with poorly differentiated NETs, the management decision was based on only the 18 F-FDG results. For 68 Ga-DOTATATE, SUV max was higher for G1 tumors and lower for G3 tumors (P 5 0.012). However, no significant differences in 18 F-FDGderived SUVs were observed between different grades (P 5 0.38). The Mann-Whitney test showed significant differences in 68 Ga-DOTATATE SUV max between tumors with a Ki-67 of less than 5% and tumors with a Ki-67 of more than 5% (P 5 0.004), without significance differences in 18 F-FDG SUV max . Log-rank analysis showed statistically significant differences in survival for patients with bone metastasis versus soft-tissue or no metastasis for both 18 F-FDG (P 5 0.037) and 68 Ga-DOTATATE (P 5 0.047). Overall survival declined rapidly with increasing grade (P 5 0.001), at an estimated 91 mo for G1, 59 mo for G2, and 48 mo for G3. Conclusion: 18 F-FDG PET/CT had no clinical impact on G1 NETs and a moderate impact on G2 NETs. However, in poorly differentiated NETs, 18 F-FDG PET/CT plays a significant clinical role in combination with 68 Ga-DOTATATE. 68 Ga DOTATATE SUV max relates to grade and Ki-67 and can be used prognostically.

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Section: Discussionsupporting

confidence: 61%

“…Recent papers have investigated the value of 68 Ga-DOTANOC SUV max as a potential prognostic factor (35)(36)(37). We used a cutoff of 5% when relating Ki-67 to SUV max based on the study of Panzuto et al reporting that patients with a Ki-67 of more than 5% show more aggressive disease (37).…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Impact of ⁶⁸Ga-DOTATATE and ¹⁸F-FDG PET/CT on Clinical Management in Patients with Neuroendocrine Tumors

et al. 2016

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“…Furthermore, regarding the correlation between the 68 Ga-DOTATATE PET/CT results and patient survival, our study revealed statistically significant differences (P 5 0.000) in 1-, 3-, and 5-y survival, as expected, between patients with true-negative and true-positive scans. There are small published reports regarding the prognostic value of the SUV max on 68 Ga-DOTA-peptide PET scanning in patients with NETs (21,22) and the change in tumor-to-spleen SUV ratio as an independent predictor of progression-free survival after PRRT (23). In our study, we did not attempt to correlate the SUV, as a semiquantitative marker of SSTR expression, with survival, as it is part of a separate study.…”

Section: Discussionmentioning

confidence: 98%

The Impact of ⁶⁸Ga-DOTATATE PET/CT Imaging on Management of Patients with Neuroendocrine Tumors: Experience from a National Referral Center in the United Kingdom

et al. 2015

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68 Ga-DOTATATE PET/CT scanning is a widely accepted method for imaging of neuroendocrine tumors. This cross-sectional study was performed to review the first 8 y of patient data from a large 68 Ga-DOTATATE PET/CT database in order to establish the impact of the modality on patient treatment and survival. Methods: Demographic data, clinical outcome, survival, and change in management after 68 Ga-DOTATATE PET/CT were evaluated. Results: Between May 2005 and August 2013, 1,258 68 Ga-DOTATATE PET/CT scans were obtained in 728 patients with confirmed or suspected neuroendocrine tumors. In most patients, the primary site was located in the midgut (26.4%). Analysis of NET grading in patients with known histopathologic data revealed that 35.7% had NET grade G1, 12.2% G2, and 8.7% G3. The most common indications for 68 Ga-DOTATATE PET/CT were follow-up (24.4%) and initial tumor staging (23.4%). Of the 1,258 68 Ga-DOTATATE PET/CT scans completed, 75.7% were positive and 24.3% negative; there were 14 false-positive and 29 false-negative scans. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 97%, 95.1%, 96.6%, 98.5%, and 90.4%, respectively. In 40.9% of patients, the treatment plan was changed after the scans, owing mainly to new, unexpected findings. Statistically significant differences in survival were shown between patients with G1, G2, and G3 grade tumors (P , 0.0001) and also between patients with bone metastasis versus patients with soft-tissue metastasis (P , 0.0001). Conclusion: 68 Ga-DOTATATE PET/CT scanning is safe and influences management in a large proportion of patients. Prognosis was dependent on tumor grade, and the presence of bone metastasis was associated with worse overall survival.

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“…Studies have investigated the role of grading, staging, functioning status, and somatostatin receptor density as potential prognostic factors in pNETs (8). Two studies indicated that SUV max measured in the lesion with the highest 68 Ga-DOTANOC uptake was a prognostic parameter in heterogeneous populations of neuroendocrine tumors with different primary sites (including gastroenteropancreatic and lung tumors) (9,10).…”

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confidence: 99%

Prognostic Value of ⁶⁸Ga-DOTANOC PET/CT SUV_max in Patients with Neuroendocrine Tumors of the Pancreas

et al. 2015

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This study was performed to investigate the role of 68 Ga-DOTANOC SUV max as a potential prognostic factor in patients with pancreatic neuroendocrine tumor (pNET). Methods: Among the patients who underwent 68 Ga-DOTANOC PET/CT, we retrospectively collected the data of those who had G1 or G2 pNET (2010 World Health Organization classification), presented with disease on PET/CT and CT, and had at least 6 mo of follow-up. Patients with multiple endocrine neoplasia were excluded. Results: Overall, 43 patients were included. No significant differences in SUV max were observed with respect to sex, tumor syndrome, stage, World Health Organization classification, or Ki-67. During follow-up (median, 20 mo), 11 patients (35.6%; median, 33 mo; interquartile range, 20-48 mo) had stable disease and 32 (74.4%; median, 19 mo; interquartile range, 14-26 mo) had progressive disease. SUV max at 24 mo of follow-up was significantly higher (P 5 0.022) in patients with stable disease than in patients with progressive disease. The best SUV max cutoff ranged from 37.8 to 38.0. The major risk factors for progression included an SUV max of no more than 37.8 (hazard ratio, 3.09; P 5 0.003), a Ki-67 of more than 5% (hazard ratio, 2.89; P 5 0.009), and medical therapy alone (hazard ratio, 2.36; P 5 0.018). Advanced stage (IV) (P 5 0.026), an SUV max of less than 37.8 (P 5 0.043), and medical therapy alone (P 5 0.015) were also confirmed at multivariate analysis. Median progression-free survival was 23 mo. Significant differences in progression-free survival were observed in relationship to Ki-67 (median, 45 mo for Ki-67 # 5% and 20 mo for Ki-67 . 5%; P 5 0.005), SUV max (,37.8 vs. .38.0: 16.0 vs. 27.0 mo; P 5 0.002), and type of therapy (medical vs. peptide receptor radionuclide therapy: 16.0 vs. 26.0 mo; P 5 0.014). Conclusion: 68 Ga-DOTANOC SUV max is a relevant prognostic factor in patients with G1 and G2 pNET, and its routine use will improve disease characterization and management in these patients, who may present with atypical cases showing heterogeneous clinical behavior.

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Comparison of the prognostic values of 68Ga-DOTANOC PET/CT and 18F-FDG PET/CT in patients with well-differentiated neuroendocrine tumor

Abstract: SUVmax measured on (68)Ga-DOTANOC PET/CT is an independent, positive prognostic factor in patients with well-differentiated NET and is superior to SUVmax on (18)F-FDG PET/CT and conventional clinicopathological factors for predicting PFS.

Cited by 46 publications

References 24 publications

Comparison of the Impact of ⁶⁸Ga-DOTATATE and ¹⁸F-FDG PET/CT on Clinical Management in Patients with Neuroendocrine Tumors

Comparison of the Impact of ⁶⁸Ga-DOTATATE and ¹⁸F-FDG PET/CT on Clinical Management in Patients with Neuroendocrine Tumors

The Impact of ⁶⁸Ga-DOTATATE PET/CT Imaging on Management of Patients with Neuroendocrine Tumors: Experience from a National Referral Center in the United Kingdom

Prognostic Value of ⁶⁸Ga-DOTANOC PET/CT SUV_max in Patients with Neuroendocrine Tumors of the Pancreas

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Comparison of the prognostic values of 68Ga-DOTANOC PET/CT and 18F-FDG PET/CT in patients with well-differentiated neuroendocrine tumor

Abstract: SUVmax measured on (68)Ga-DOTANOC PET/CT is an independent, positive prognostic factor in patients with well-differentiated NET and is superior to SUVmax on (18)F-FDG PET/CT and conventional clinicopathological factors for predicting PFS.

Cited by 46 publications

References 24 publications

Comparison of the Impact of 68Ga-DOTATATE and 18F-FDG PET/CT on Clinical Management in Patients with Neuroendocrine Tumors

Comparison of the Impact of 68Ga-DOTATATE and 18F-FDG PET/CT on Clinical Management in Patients with Neuroendocrine Tumors

The Impact of 68Ga-DOTATATE PET/CT Imaging on Management of Patients with Neuroendocrine Tumors: Experience from a National Referral Center in the United Kingdom

Prognostic Value of 68Ga-DOTANOC PET/CT SUVmax in Patients with Neuroendocrine Tumors of the Pancreas

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Comparison of the Impact of ⁶⁸Ga-DOTATATE and ¹⁸F-FDG PET/CT on Clinical Management in Patients with Neuroendocrine Tumors

Comparison of the Impact of ⁶⁸Ga-DOTATATE and ¹⁸F-FDG PET/CT on Clinical Management in Patients with Neuroendocrine Tumors

The Impact of ⁶⁸Ga-DOTATATE PET/CT Imaging on Management of Patients with Neuroendocrine Tumors: Experience from a National Referral Center in the United Kingdom

Prognostic Value of ⁶⁸Ga-DOTANOC PET/CT SUV_max in Patients with Neuroendocrine Tumors of the Pancreas