Localization of Unknown Primary Site with <sup>68</sup>Ga-DOTATOC PET/CT in Patients with Metastatic Neuroendocrine Tumor

Menda, Yusuf; O’Dorisio, Thomas M.; Howe, James R.; Schultz, Michael K.; Dillon, Joseph S.; Dick, David; Watkins, G. Leonard; Ginader, Timothy; Bushnell, David; Sunderland, John; Zamba, Gideon; Graham, Michael M.; O’Dorisio, M. Sue

doi:10.2967/jnumed.116.180984

Cited by 32 publications

(23 citation statements)

References 20 publications

(18 reference statements)

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“…A more recent study conducted by Menda, and colleagues studied the value of 68 Ga-DOTATOC PET/CT scan in 40 patients with metastatic NET but no identified primary site. They reported that 68 Ga-DOTATOC PET/ CT identified primary site in 38% of the cases [17]. These results agree with our data, where 68 Ga-DOTATOC PET/ CT identified the primary NET site in 45% of our cases with unknown primary.…”

Section: Discussionsupporting

confidence: 92%

Post FDA approval analysis of 200 gallium-68 DOTATATE imaging: A retrospective analysis in neuroendocrine tumor patients

et al. 2020

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Gallium-68 DOTATATE provides physiologic imaging and assists in disease localization for somatostatin receptor (SSTR) positive neuroendocrine tumor (NET) patients. However, questions regarding usefulness of gallium-68 DOTATATE imaging in identifying the primary site in neuroendocrine tumors (NETS) of unknown primary, correlation of NET grade with median Standardized Uptake Value (SUV) and effects of long acting somatostatin analog on gallium-68 DOTATATE imaging quality needs to be evaluated. A single institution retrospective review of the first 200 NET patients with gallium-68 DOTATATE imaging from Dec 2016 to Dec 2017 was conducted. Questions related to NETs of unknown primary, correlation of Standardized Uptake Value (SUV) to Ki-67 (which signifies proliferation rate), the effects of long-acting systemic somatostatin analog (SSA) on SUV were part of our data analysis. From these 200 patients, 59.5% (119) were females, 40.5% (81) were males; the median age was 62 years. The following primary tumor sites were identified: small bowel-37.5%; pancreas-18.5%; bronchial-14%; colon-3.5%; rectum-2%; appendix-1.5%; adrenal-0.5%; prostate-0.5%; others-3% and unknown primary-19%. Mean hepatic SUV of the lesion with the greatest radiolabeled uptake in 96 patients was similar irrespective to exposure to long acting SSA. Patients exposed to long acting SSA had mean SUV of 31.3 vs 27.8 for SSA naïve patients. The difference was not statistically significant. Gallium-68 DOTATATE imaging seems to distinguished G3 NET from G1/G2 based on mean SUV, and also identified the primary tumor site in 17 of 38 (45%) patients with unknown primary. Systemic exposure to long acting SSA does not appear to influence mean SUV of gallium-68 DOTATATE scan.

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Section: Discussionsupporting

confidence: 92%

Post FDA approval analysis of 200 gallium-68 DOTATATE imaging: A retrospective analysis in neuroendocrine tumor patients

et al. 2020

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“…Although CT exposes patients to negative effects of ionising radiation, it is easy, fast, relatively cheap, and recommended by most oncological guidelines for determining the stage of disease. The diagnostic examination tools that are also used to determine the primary focus are magnetic resonance imaging (MRI) and scintigraphic tests, such as somatostatin receptor scintigraphy (SRS) [ 8 ]. However, MRI is expensive and not easily available in some facilities.…”

Section: Discussionmentioning

confidence: 99%

“…Neuroendocrine tumours can also be imaged with nuclear medicine techniques that utilise two types of radiolabelling, namely, receptor expression and metabolic activity of the tumour [ 13 ]. In 2017, a study showed that 68 Ga-DOTA-TOC PET/CT using the 68 Ga-DOTA-D-Phe 1 -Try 3 -Octreotide label was helpful in localising primary neuroendocrine tumours in 37% of patients with disseminated neoplastic disease in whom conventional imaging techniques, such as CT or MRI, could not contribute to final diagnosis [ 8 ]. This examination is particularly useful in patients with an unknown primary focus in low-grade and intermediate-grade metastases.…”

Section: Discussionmentioning

confidence: 99%

Imaging in a rare case of neuroendocrine tumour with skin metastases

Białecki¹,

Białecka²,

Męcińska-Jundziłł³

et al. 2018

Pol J Radiol

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PurposeDisseminated malignancies are a diagnostic and therapeutic challenge that is often encountered in radiology. Finding the primary tumour is crucial for planning proper surgical and oncological treatment. Computed tomography (CT) of the thorax and abdomen is typically the initial examination. However, abdominal magnetic resonance imaging (MRI) or positron emission tomography (PET/CT) or PET/MRI are often subsequently performed. Histopathological examination of metastatic tumours is performed as well, followed by immunohistochemistry. The aim of the report was to present diagnostic workup in a rare case of skin metastases.Case reportA 72-year-old patient was admitted to a dermatology ward because of skin lesions – violaceous nodules localised on the hair-covered skin of the head. On abdominal CT, a generalised neoplastic process with metastases in the liver, pancreas, adrenal glands, lymph nodes, bones, thoracic wall, and a suspected metastasis in the right breast was revealed. Histopathology of the skin nodules confirmed a neuroendocrine tumour. Metastases of a pancreatic neuroendocrine tumour or small-cell lung cancer were suspected on immunohistochemistry. The patient died before we were able to localise the primary source of the tumour and provide treatment.ConclusionsSkin metastases are relatively rare, aggravate the prognosis, and usually indicate spread of the neoplastic process in the internal organs. It is not always possible to localise the primary tumour using radiological imaging. In such cases, co-operation with the pathologist is crucial as are the results of histopathological and immunohistochemical examinations.

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“…There were 4 eligible papers (Table 3) that reported on performance of 68 Ga-DOTATOC PET/CT for detecting an unknown primary in patients with extensive metastatic disease (15,18,22,23). The overall success rate was 40 of 91 or 43.9%.…”

Section: Unknown Primary (Summary Statistics)mentioning

confidence: 99%

⁶⁸Ga-DOTATOC Imaging of Neuroendocrine Tumors: A Systematic Review and Metaanalysis

Graham

Ginader

et al. 2017

J Nucl Med

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Ga-DOTATOC, a somatostatin receptor-targeted ligand, has been used clinically in Europe over the past decade for imaging neuroendocrine tumors (NETs). It appears to be quite sensitive and effective for clinical management decision making. This metaanalysis summarizes the efficacy of Ga-DOTATOC for several distinct indications and is intended to support approval of this agent by the U.S. Food and Drug Administration. The major electronic medical databases were searched for relevant papers over the period from January 2001 to November 2015. Papers were selected for review in 3 categories: clinical trials that reported sensitivity and specificity, comparison studies with In-octreotide, and change of management studies. All the eligible papers underwent Quality Assessment of Diagnostic Accuracy Studies (QUADAS) assessment, which was useful in the final selection of papers for review. The initial search yielded 468 papers. After detailed evaluation, 17 papers were finally selected. Five types of studies emerged: workup of patients with symptoms and biomarker findings suggestive of NET, but with negative conventional imaging (3 papers, yield was only 13%); sensitivity (12 papers; sensitivity, 92%) and specificity (7 papers; specificity, 82%); identification of site of unknown primary in patients with metastatic NET (4 papers, yield was 44%); impact on subsequent NET patient management (4 papers, change in management in 51%); and comparison with In-octreotide (2 papers, sensitivity of DOTATOC on a per-lesion basis was 100%, forIn-octreotide it was 78.2%; specificity was not available). Safety was not explicitly addressed in any study, but there were no reports of adverse events. Ga-DOTATOC is useful for evaluating the presence and extent in disease for staging and restaging and for assisting in treatment decision making for patients with NET. It is also effective in locating the site of an unknown primary in NET patients who present with metastatic NET, but no known primary tumor. It also appears to be more accurate thanIn-octreotide. Although Ga-DOTATOC would seem to be useful in evaluating patients with suggestive symptoms and biomarker findings, it does not perform well in this setting and has low yield. Overall, it appears to be an excellent imaging agent to assess patients with known NET and frequently leads to a change in management.

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Localization of Unknown Primary Site with ⁶⁸Ga-DOTATOC PET/CT in Patients with Metastatic Neuroendocrine Tumor

Cited by 32 publications

References 20 publications

Post FDA approval analysis of 200 gallium-68 DOTATATE imaging: A retrospective analysis in neuroendocrine tumor patients

Post FDA approval analysis of 200 gallium-68 DOTATATE imaging: A retrospective analysis in neuroendocrine tumor patients

Imaging in a rare case of neuroendocrine tumour with skin metastases

⁶⁸Ga-DOTATOC Imaging of Neuroendocrine Tumors: A Systematic Review and Metaanalysis

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Localization of Unknown Primary Site with 68Ga-DOTATOC PET/CT in Patients with Metastatic Neuroendocrine Tumor

Cited by 32 publications

References 20 publications

Post FDA approval analysis of 200 gallium-68 DOTATATE imaging: A retrospective analysis in neuroendocrine tumor patients

Post FDA approval analysis of 200 gallium-68 DOTATATE imaging: A retrospective analysis in neuroendocrine tumor patients

Imaging in a rare case of neuroendocrine tumour with skin metastases

68Ga-DOTATOC Imaging of Neuroendocrine Tumors: A Systematic Review and Metaanalysis

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Localization of Unknown Primary Site with ⁶⁸Ga-DOTATOC PET/CT in Patients with Metastatic Neuroendocrine Tumor

⁶⁸Ga-DOTATOC Imaging of Neuroendocrine Tumors: A Systematic Review and Metaanalysis