Dual Tracer Functional Imaging of Gastroenteropancreatic Neuroendocrine Tumors Using 68Ga-DOTA-NOC PET-CT and 18F-FDG PET-CT

Naswa, Niraj; Sharma, Punit; Gupta, Santosh Kumar; Karunanithi, Sellam; Reddy, Ramachandra C.; Patnecha, Manish; Lata, Sneh; Kumar, Rakesh; Malhotra, Arun; Bal, Chandrasekhar

doi:10.1097/rlu.0b013e31827a216b

Cited by 63 publications

(52 citation statements)

References 26 publications

(29 reference statements)

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“…Several studies have proven the superiority of 68 Ga-SMAs over conventional octreotide imaging with 111 In-diethylenetriaminepentaacetic acid ( 111 In-DTPA) and have reported high sensitivity values of up to 100% (11,12). 18 F-FDG PET/CT imaging has also been compared with SSTR imaging in several studies and has a variable sensitivity of 36%-84% in detecting GEPNETs (3,(13)(14)(15). However, the number 18 F-FDG PET/CT.…”

Section: Discussionmentioning

confidence: 99%

Can Complementary ⁶⁸Ga-DOTATATE and ¹⁸F-FDG PET/CT Establish the Missing Link Between Histopathology and Therapeutic Approach in Gastroenteropancreatic Neuroendocrine Tumors?

et al. 2014

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Gastroenteropancreatic neuroendocrine tumors (GEPNETs) are indolent neoplasms presenting unpredictable and unusual biologic behavior that causes many clinical challenges. Tumor size, existence of metastasis, and histopathologic classification remain incapable in terms of treatment decision and prognosis estimation. This study aimed to compare 68 Ga-DOTATATE and 18 F-FDG PET/CT in GEPNETs and to investigate the relation between the complementary PET/CT results and histopathologic findings in the management of therapy, particularly in intermediate-grade patients. Methods: The relation between complementary 68 Ga-DOTATATE and 18 F-FDG PET/CT results of 27 GEPNET patients (mean age, 56 y; age range, 33-79 y) and histopathologic findings was evaluated according to grade and localization using standardized maximum uptake values and Ki67 indices. Grade 2 (G2) patients were further evaluated in 2 groups as G2a (3%-9%) and G2b (10%-20%) according to Ki67 indices. Results: The sensitivity of 68 Ga-DOTATATE and 18 F-FDG PET/CT was 95% and 37%, respectively, and the positive predictive values were 93.8% and 36.2%, respectively. The sensitivity in detecting liver metastasis, lymph nodes, bone metastasis, and primary lesion was 95%, 95%, 90%, and 93% for 68 Ga-DOTATATE and 40%, 28%, 28%, and 75% for 18 F-FDG, respectively. Statistically significant differences were found between grades 1-2, 2a-2b, and 1-2b with respect to 68 Ga-DOTATATE PET/CT as well as between 1-2a and 1-2b with respect to 18 F-FDG PET/CT. However, no statistical differences were found between 1 and 2a (P . 0.05) for 68 Ga-DOTATATE and 2a and 2b (P 5 0.484) for 18 F-FDG. The impact of the combined 18 F-FDG and 68 Ga-DOTATATE PET/CT on the therapeutic decision was 59%. Conclusion: Combined 68 Ga-DOTATATE and 18 F-FDG PET/ CT is helpful in the individual therapeutic approach of GEPNETs and can overcome the shortcomings of histopathologic grading especially in intermediate-grade GEPNETs.

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Section: Discussionmentioning

confidence: 99%

Can Complementary ⁶⁸Ga-DOTATATE and ¹⁸F-FDG PET/CT Establish the Missing Link Between Histopathology and Therapeutic Approach in Gastroenteropancreatic Neuroendocrine Tumors?

et al. 2014

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“…The small size of NETs makes it difficult for conventional anatomic imaging to visualize the primary tumor or its metastases, given that these modalities are unable to depict specific endocrine features; consequently, the diagnostic accuracy of functional imaging is significantly higher than that of conventional imaging (7,(11)(12)(13)(14). 18 F-FDG PET/CT imaging has also been compared with 68 Ga-DOTA peptide imaging in several studies, which have shown it to have variable sensitivity in detecting NETs (15)(16)(17)(18)(19)(20)(21)(22). However, the presence of increased glucose in NETs highlights an increased propensity for invasion and metastasis, and 18 F-FDG PET/CT accordingly has higher sensitivity in delineating disease extent, especially in aggressive and high-grade tumors (23).…”

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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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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“…The present and future trend in oncological care heads towards personalizing treatments in order to reduce the side effects of current available therapies and individualizing management to each patient. And this is where the Nuclear Medicine Therapeutics is a cornerstone in achieving the objective [6][7][8][9][10][11][12][13][14][15][16][17].…”

Section: Discussionmentioning

confidence: 99%

Neuroendocrine Neoplasms: A Case Report with Complete Reverse Mismatch and the Correlation with Differentiation Rate

Flores¹

2017

JCPCR

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Neuroendocrine neoplasms (NENs) are a heterogeneous group of tumors with an unpredictable expression that makes diagnosis and treatment difficult [1]. A 68-year-old man with history of 3-month weight loss and rapid gastric fullness comes to the clinic. The physician indicates abdominal tomography, ultrasound and endoscopy with biopsy of the upper digestive tract where an infiltrating lesion is discovered in the greater curvature of the stomach, immunohistochemistry reports carcinoid tumor. The patient is then sent to the Nuclear Medicine service seeking Peptide Receptor Radionuclide Therapy (PRRT). A PET/CT scan is performed using 68 Ga-DOTANOC, with another one a day later with 18 F-FDG to assess whether he is a candidate for said treatment. The images show a complete reverse mismatch pattern in the liver metastasis and primary gastric tumor found, making PRRT not an option due to a high degree of dedifferentiation and low expression of somatostatin receptors in such lesions. Keywords: Neuroendocrine neoplasms; 18 F-FDG;68 Ga-DOTANOC; Complete reverse mismatch.

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Dual Tracer Functional Imaging of Gastroenteropancreatic Neuroendocrine Tumors Using 68Ga-DOTA-NOC PET-CT and 18F-FDG PET-CT

Cited by 63 publications

References 26 publications

Can Complementary ⁶⁸Ga-DOTATATE and ¹⁸F-FDG PET/CT Establish the Missing Link Between Histopathology and Therapeutic Approach in Gastroenteropancreatic Neuroendocrine Tumors?

Can Complementary ⁶⁸Ga-DOTATATE and ¹⁸F-FDG PET/CT Establish the Missing Link Between Histopathology and Therapeutic Approach in Gastroenteropancreatic Neuroendocrine Tumors?

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

Neuroendocrine Neoplasms: A Case Report with Complete Reverse Mismatch and the Correlation with Differentiation Rate

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Dual Tracer Functional Imaging of Gastroenteropancreatic Neuroendocrine Tumors Using 68Ga-DOTA-NOC PET-CT and 18F-FDG PET-CT

Cited by 63 publications

References 26 publications

Can Complementary 68Ga-DOTATATE and 18F-FDG PET/CT Establish the Missing Link Between Histopathology and Therapeutic Approach in Gastroenteropancreatic Neuroendocrine Tumors?

Can Complementary 68Ga-DOTATATE and 18F-FDG PET/CT Establish the Missing Link Between Histopathology and Therapeutic Approach in Gastroenteropancreatic Neuroendocrine Tumors?

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

Neuroendocrine Neoplasms: A Case Report with Complete Reverse Mismatch and the Correlation with Differentiation Rate

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Can Complementary ⁶⁸Ga-DOTATATE and ¹⁸F-FDG PET/CT Establish the Missing Link Between Histopathology and Therapeutic Approach in Gastroenteropancreatic Neuroendocrine Tumors?

Can Complementary ⁶⁸Ga-DOTATATE and ¹⁸F-FDG PET/CT Establish the Missing Link Between Histopathology and Therapeutic Approach in Gastroenteropancreatic Neuroendocrine Tumors?

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