The future of nuclear medicine imaging of neuroendocrine tumors: on a clear day one might see forever…

Bodei, Lisa; Kidd, Mark; Prasad, Vikas; Baüm, Richard; Drozdov, Ignat; Modlin, Irvin M.

doi:10.1007/s00259-014-2836-1

Cited by 8 publications

(6 citation statements)

References 43 publications

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“…Local confounders such as necrosis, hemorrhaging or fibrosis complicate assessment [36] while the spatial resolution of CT/MRI (∼2 mm) approaches the limits of tumor measurement, particularly for recurrent or micrometastatic disease. This issue together with observer-dependent accuracy (low kappa) further confounds accuracy.…”

Section: Discussionmentioning

confidence: 99%

NET Blood Transcript Analysis Defines the Crossing of the Clinical Rubicon: When Stable Disease Becomes Progressive

et al. 2016

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Background/Aims: A key issue in gastroenteropancreatic neuroendocrine tumors (GEP-NETs) is early identification and prediction of disease progression. Clinical evaluation and imaging are limited due to the lack of sensitivity and disease indolence. We assessed the NETest as a predictive and prognostic marker of progression in a long-term follow-up study. Methods: GEP-NETs (n = 34) followed for a median 4 years (2.2-5.4) were evaluated. WHO tumor grade/stage grade 1: n = 17, grade 2: n = 14, grade 3: n = 1 (for 2, no grade was available); 31 (91%) were stage IV. Baseline and longitudinal imaging and blood biomarkers were available in all, and progression was defined per standard clinical protocols (RECIST 1.0). The NETest was measured by quantitative PCR of blood and multianalyte algorithmic analysis (disease activity scaled 0-100% with low <40% and high activity risk cutoffs >80%); chromogranin A (CgA) was measured by radioimmunoassay (normal <150 µg/l); progression-free survival (PFS) was analyzed by Cox proportional-hazard regression and Kaplan-Meier analysis. Results: At baseline, 100% were NETest positive, and CgA was elevated in 50%. The only baseline variable (Cox modeling) associated with PFS was NETest (hazard ratio = 1.022, 95% confidence interval = 1.005-1.04; p < 0.012). Using Kaplan-Meier analyses, the baseline NETest (>80%) was significantly associated (p = 0.01) with disease progression (median PFS 0.68 vs. 2.78 years with <40% levels). The NETest was more informative (96%) than CgA changes (>25%) in consistently predicting disease alterations (40%, p < 2 × 10^-5, χ² = 18). The NETest had an earlier time point change than imaging (1.02 ± 0.15 years). Baseline NETest levels >40% in stable disease were 100% prognostic of disease progression versus CgA (χ² = 5, p < 0.03). Baseline NETest values <40% accurately (100%) predicted stability over 5 years (p = 0.05, χ² = 3.8 vs. CgA). Conclusion: The NETest correlated with a well-differentiated GEP-NET clinical status. The NETest has predictive and prognostic utility for GEP-NETs identifying clinically actionable alterations ∼1 year before image-based evidence of progression.

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Section: Discussionmentioning

confidence: 99%

NET Blood Transcript Analysis Defines the Crossing of the Clinical Rubicon: When Stable Disease Becomes Progressive

et al. 2016

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“…These, particularly in indolent tumors, often fail to accurately reflect the response to therapy. Although multiple consecutive assessments with visual changes are required, the diverse patient characteristics (SSA treatment, splenic uptake), the PET model (resolution specifics, acquisition mode, acquisition time per bed position, reconstruction method, attenuation correction, and image analysis) as well as image analysis (ROI reconstruction algorithms) can all affect image interpretation [11,30]. A circulating tumor MAAA can be easily acquired (simple blood draw) at multiple time points in the intervals between sequential receptor PET assessments.…”

Section: Discussionmentioning

confidence: 99%

“…Alternative criteria, like attenuation measurements on CT (Choi criteria) initially proposed for gastrointestinal stromal tumors (GISTs), have been evaluated in NETs [9] but remain to be validated. Combinations of morphological and functional techniques, with 68 Ga-somatostatin analog (SSA) positron emission tomography (PET)/CT, are also under consideration [10,11].…”

Section: Introductionmentioning

confidence: 99%

Gene transcript analysis blood values correlate with 68Ga-DOTA-somatostatin analog (SSA) PET/CT imaging in neuroendocrine tumors and can define disease status

Bodei

Kidd

Modlin

et al. 2015

Eur J Nucl Med Mol Imaging

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“…In addition, spatial resolution of both structural (computed tomography/magnetic resonance imaging [CT/MRI]: 2 mm) and functional imaging (positron emission tomography/CT: 4 -5 mm; and single photon emission computed tomography/CT somatostatin receptor scintigraphy: 7-8 mm) approaches limits of tumor measurement. In addition, local confounders such as necrosis, hemorrhaging, or fibrosis may complicate assessment (9). The alternative strategy of disease assessment by biomarker measurement is also problematic (10).…”

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confidence: 99%

Circulating Transcript Analysis (NETest) in GEP-NETs Treated With Somatostatin Analogs Defines Therapy

Ćwikła

Bodei

Kolasińska-Ćwikła

et al. 2015

The Journal of Clinical Endocrinology &Amp; Metabolism

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111

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The future of nuclear medicine imaging of neuroendocrine tumors: on a clear day one might see forever…

Cited by 8 publications

References 43 publications

NET Blood Transcript Analysis Defines the Crossing of the Clinical Rubicon: When Stable Disease Becomes Progressive

NET Blood Transcript Analysis Defines the Crossing of the Clinical Rubicon: When Stable Disease Becomes Progressive

Gene transcript analysis blood values correlate with 68Ga-DOTA-somatostatin analog (SSA) PET/CT imaging in neuroendocrine tumors and can define disease status

Circulating Transcript Analysis (NETest) in GEP-NETs Treated With Somatostatin Analogs Defines Therapy

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