Role of Combined 68Ga-DOTATOC and 18F-FDG Positron Emission Tomography/Computed Tomography in the Diagnostic Workup of Pancreas Neuroendocrine Tumors

Cingarlini, Sara; Ortolani, Silvia; Salgarello, Matteo; Butturini, Giovanni; Malpaga, Anna; Malfatti, Veronica; D’Onofrio, Mirko; Davì, Maria Vittoria; Vallerio, Paola; Ruzzenente, Andrea; Capelli, Paola; Citton, Elia; Grego, Elisabetta; Trentin, Chiara; Robertis, Riccardo De; Scarpa, Aldo; Bassi, Claudio; Tortora, Giampaolo

doi:10.1097/mpa.0000000000000745

Cited by 34 publications

(71 citation statements)

References 24 publications

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“…In all nine patients the disease progressed 25. 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.…”

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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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%

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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“…To our knowledge, this is the first prospective study evaluating the impact of combined 68 Ga-DOTANOC and 18 F-FDG-PET/CT in predicting the aggressive behavior of NF-PNET. There is some previous data of the dual-tracer imaging with series of different gastroenteropancreatic neuroendocrine tumors [18,24] and retrospective series of PNETs [17,25]. The main interest of this study was to evaluate if the malignant potential of NF-PNETs could be predicted with dual-tracer PET/CT imaging.…”

Section: Discussionmentioning

confidence: 99%

“…Garin et al [24] investigated prospectively well-differentiated metastatic NETs and reported that 18 F-FDG-positivity correlated with decreased progression free survival and overall survival. Cingarlini et al [17] compared retrospectively G1 and G2 PNETs and concluded that 18 F-FDG-PET/CT was positive in a smaller proportion of G1 tumors (20%) compared with G2 tumors (76%). In our study 34% NF-PNET patients had a positive 18 F-FDG-PET/CT and the 18 F-FDG-PET/CT showed a PPV of 78% in the detection of potentially aggressive tumors (G2, G3, LN+ or M+ PNETs), and the NPV was 69%.…”

Section: Discussionmentioning

confidence: 99%

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Prediction of the aggressiveness of non-functional pancreatic neuroendocrine tumors based on the dual-tracer PET/CT

et al. 2019

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Background: Predicting the aggressive behavior of non-functional pancreatic neuroendocrine tumors (NF-PNET) remains controversial. We wanted to explore, in a prospective setting, whether the diagnostic accuracy can be improved by dual-tracer functional imaging 68 Ga-DOTANOC and 18 F-FDG-PET/CT in patients with NF-PNETs. Methods: Thirty-one patients with NF-PNET (90% asymptomatic) underwent PET-imaging with 18 F-FDG and 68 Ga-DOTANOC, followed by surgery (n = 20), an endoscopic ultrasonography and fine-needle biopsy (n = 2) or followup (n = 9). A focal activity on PET/CT greater than the background that could not be identified as physiological activity was considered to indicate tumor tissue. The imaging results were compared to histopathology. The mean follow-up time was 31.3 months. Results: Thirty-one patients presented a total of 53 lesions (40 histologically confirmed) on PET/CT. Thirty patients had a 68 Ga-DOTANOC-positive tumor (sensitivity 97%) and 10 patients had an 18 F-FDG-positive tumor. In addition, one 68 Ga-DOTANOC-negative patient was 18 F-FDG-positive. 18 F-FDG-PET/CT was positive in 19% (3/16) of the G1 tumors, 63% (5/8) of the G2 tumors and 1/1 of the well-differentiated G3 tumor. 68 Ga-DOTANOC-PET/CT was positive in 94% of the G1 tumors, 100% of the G2 tumors and 1/1 of the well-differentiated G3 tumor. Two out of six (33%) of the patients with lymph node metastases (LN+) were 18 F-FDG-positive. The 18 F-FDG-PET/CT correlated with tumor Ki-67 (P = 0.021). Further, the Krenning score correlated with tumor Ki-67 (P = 0.013). 18 F-FDG-positive tumors were significantly larger than the 18 F-FDG-negative tumors (P = 0.012). 18 F-FDG-PET/CT showed a positive predictive value of 78% in the detection of potentially aggressive tumors (G2, G3, or LN + PNETs); the negative predictive value was 69%.Conclusions: 18 F-FDG-PET/CT is useful to predict tumor grade but not the LN+ of NF-PNETs. Patients with 18 F-FDGavid NF-PNETs should be referred for surgery. The 68 Ga-DOTANOC-PET/CT also has prognostic value since the Krenning score predicts the histopathological tumor grade.Trial registration: The study has been registered at ClinicalTrials.gov; Non-functional Pancreatic NET and PET imaging, NCT02621541.

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“…However, previous studies on small groups of patients with EP NENs suggest that 18F-FDG PET might be of value for detecting more aggressive tumors with high proliferative Ki67 index [15,16]. A role for 18F-FDG PET, alone or in combination with 68Ga PET, has also been proposed, with conflicting results, in some series of NENs with a more aggressive clinical course [17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Clinical Usefulness of 18F-Fluorodeoxyglucose Positron Emission Tomography in the Diagnostic Algorithm of Advanced Entero-Pancreatic Neuroendocrine Neoplasms

et al. 2017

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Role of Combined 68Ga-DOTATOC and 18F-FDG Positron Emission Tomography/Computed Tomography in the Diagnostic Workup of Pancreas Neuroendocrine Tumors

Abstract: The high sensitivity of Ga-PET/CT in NET detection is known. The high PPV of F-PET/CT in the identification of G2 forms suggests its potential role in PanNETs prognostication and risk stratification.

Cited by 34 publications

References 24 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

Prediction of the aggressiveness of non-functional pancreatic neuroendocrine tumors based on the dual-tracer PET/CT

Clinical Usefulness of 18F-Fluorodeoxyglucose Positron Emission Tomography in the Diagnostic Algorithm of Advanced Entero-Pancreatic Neuroendocrine Neoplasms

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