Multicenter Comparison of 18F-FDG and 68Ga-DOTA-Peptide PET/CT for Pulmonary Carcinoid

Lococo, Filippo; Perotti, Germano; Cardillo, Giuseppe; Waure, Chiara de; Filice, Angelina; Graziano, Paolo; Rossi, Giulio; Sgarbi, Giorgio; Stefanelli, Antonella; Giordano, Alessandro; Granone, Pierluigi; Rindi, Guido; Versari, Annibale; Rufini, Vittoria

doi:10.1097/rlu.0000000000000641

Cited by 59 publications

(51 citation statements)

References 25 publications

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“…However, many authors now see SRI and FDG not as competitors but as complementary diagnostic tools 24-28. For example, Nilica and colleagues used dual-tracer imaging in the setting of PRRT in 66 patients with metastatic NET.…”

Section: Are Results Of Sri-pet and Fdg-pet Complementary?mentioning

confidence: 99%

“…Some teams are investigating dual-tracer imaging for preoperative prognostication and risk stratification in pancreatic tumors or pulmonary carcinoid 27,28. Lococo et al showed that a ratio of ≥1.19 between the SUVmax on SRI-PET and the SUVmax on FDG-PET can differentiate between a typical or atypical carcinoid 28. Preoperative biopsy has difficulty in distinguishing between these entities 29.…”

Section: Are Results Of Sri-pet and Fdg-pet Complementary?mentioning

confidence: 99%

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The NETPET Score: Combining FDG and Somatostatin Receptor Imaging for Optimal Management of Patients with Metastatic Well-Differentiated Neuroendocrine Tumors

Hindié¹

2017

Theranostics

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Neuroendocrine tumors (NET) are often metastatic at the time of diagnosis. Metastatic well-differentiated (G1/G2) NET may display a wide range of behaviors, ranging from indolent to aggressive, even within apparently homogeneous categories. Thus, selecting the optimal treatment strategy is a challenging task. Somatostatin receptor imaging (SRI) is the standard molecular imaging technique for well-differentiated NET. When performed with 68Ga-labeled somatostatin analogs (SRI-PET), it offers exquisite sensitivity for disease staging. SRI is also a prerequisite for using targeted radionuclide therapy (e.g. 177Lu-DOTATATE). 18F-FDG imaging has traditionally been reserved for staging poorly-differentiated G3 neuroendocrine carcinomas. However, recent data showed that FDG imaging has prognostic value in patients with well-differentiated NET: high uptake was associated with an increased risk of early progression while low uptake suggested an indolent tumor.In this issue of the Journal, Chan and colleagues propose a grading system where the results from the combined reading of SRI-PET and FDG-PET are reported as a single parameter, the “NETPET” score. While the scoring system still needs validation, it is clear that time has come to think about FDG and SRI in metastatic NET not as competitors but as complementary imaging modalities. Dual-tracer imaging can be viewed as a way to characterize disease phenotype in the whole-body. Moving from the prognostic value of dual-tracer imaging to a tool that allows for individualized management would require prospective trials. This editorial will argue that dual-tracer FDG-PET and SRI-PET might influence management of patients with well-differentiated metastatic NET and help selecting between different therapy options.

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Section: Are Results Of Sri-pet and Fdg-pet Complementary?mentioning

confidence: 99%

Section: Are Results Of Sri-pet and Fdg-pet Complementary?mentioning

confidence: 99%

The NETPET Score: Combining FDG and Somatostatin Receptor Imaging for Optimal Management of Patients with Metastatic Well-Differentiated Neuroendocrine Tumors

Hindié¹

2017

Theranostics

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“…(23) and Srirajaskanthan et al (28), who provide direct comparison to 111 In-pentetreotide imaging. Recently Has Simsek et al (29) and Lococo et al (30) reported the complementary roles of 68 Ga-DOTATATE and 18 F-FDG PET/CT.…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of ⁶⁸Ga-DOTATATE PET/CT for Diagnosis, Staging, and Treatment Management of Neuroendocrine Tumors

et al. 2016

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Our purpose was to evaluate safety and efficacy of 68Ga-DOTATATE PET/CT compared with 111In-pentetreotide imaging for diagnosis, staging, and restaging of pulmonary and gastroenteropancreatic neuroendocrine tumors. Methods 68Ga-DOTATATE PET/CT and 111In-pentetreotide scans were obtained for 78 of 97 consecutively enrolled patients with known or suspected pulmonary or gastroenteropancreatic neuroendocrine tumors. Safety and toxicity were measured by comparing vital signs, serum chemistry values, or acquisition-related medical complications before and after 68Ga-DOTATATE injection. Added value was determined by changes in treatment plan when 68Ga-DOTATATE PET/CT results were added to all prior imaging, including 111In-pentetreotide. Interobserver reproducibility of 68Ga-DOTATATE PET/CT scan interpretation was measured between blinded and nonblinded interpreters. Results 68Ga-DOTATATE PET/CT and 111In-pentetreotide scans were significantly different in impact on treatment (P < 0.001). 68Ga-DOTATATE PET/CT combined with CT or liver MRI changed care in 28 of 78 (36%) patients. Interobserver agreement between blinded and nonblinded interpreters was high. No participant had a trial-related event requiring treatment. Mild, transient events were tachycardia in 1, alanine transaminase elevation in 1, and hyperglycemia in 2 participants. No clinically significant arrhythmias occurred. 68Ga-DOTATATE PET/CT correctly identified 3 patients for peptide-receptor radiotherapy incorrectly classified by 111In-pentetreotide. Conclusion 68Ga-DOTATATE PET/CT was equivalent or superior to 111In-pentetreotide imaging in all 78 patients. No adverse events requiring treatment were observed. 68Ga-DOTATATE PET/CT changed treatment in 36% of participants. Given the lack of significant toxicity, lower radiation exposure, and improved accuracy compared with 111In-pentetreotide, 68Ga-DOTATATE imaging should be used instead of 111In-pentetreotide imaging where available.

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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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Multicenter Comparison of 18F-FDG and 68Ga-DOTA-Peptide PET/CT for Pulmonary Carcinoid

Cited by 59 publications

References 25 publications

The NETPET Score: Combining FDG and Somatostatin Receptor Imaging for Optimal Management of Patients with Metastatic Well-Differentiated Neuroendocrine Tumors

The NETPET Score: Combining FDG and Somatostatin Receptor Imaging for Optimal Management of Patients with Metastatic Well-Differentiated Neuroendocrine Tumors

Safety and Efficacy of ⁶⁸Ga-DOTATATE PET/CT for Diagnosis, Staging, and Treatment Management of Neuroendocrine Tumors

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

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Multicenter Comparison of 18F-FDG and 68Ga-DOTA-Peptide PET/CT for Pulmonary Carcinoid

Cited by 59 publications

References 25 publications

The NETPET Score: Combining FDG and Somatostatin Receptor Imaging for Optimal Management of Patients with Metastatic Well-Differentiated Neuroendocrine Tumors

The NETPET Score: Combining FDG and Somatostatin Receptor Imaging for Optimal Management of Patients with Metastatic Well-Differentiated Neuroendocrine Tumors

Safety and Efficacy of 68Ga-DOTATATE PET/CT for Diagnosis, Staging, and Treatment Management of Neuroendocrine Tumors

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

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Product

Resources

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Safety and Efficacy of ⁶⁸Ga-DOTATATE PET/CT for Diagnosis, Staging, and Treatment Management of Neuroendocrine Tumors

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