The Impact of ⁶⁸Ga-DOTATATE PET/CT Imaging on Management of Patients with Neuroendocrine Tumors: Experience from a National Referral Center in the United Kingdom

Abstract

68 Ga-DOTATATE PET/CT scanning is a widely accepted method for imaging of neuroendocrine tumors. This cross-sectional study was performed to review the first 8 y of patient data from a large 68 Ga-DOTATATE PET/CT database in order to establish the impact of the modality on patient treatment and survival. Methods: Demographic data, clinical outcome, survival, and change in management after 68 Ga-DOTATATE PET/CT were evaluated. Results: Between May 2005 and August 2013, 1,258 68 Ga-DOTATATE PET/CT scans were obtained in 728 patients with confirmed or suspected neuroendocrine tumors. In most patients, the primary site was located in the midgut (26.4%). Analysis of NET grading in patients with known histopathologic data revealed that 35.7% had NET grade G1, 12.2% G2, and 8.7% G3. The most common indications for 68 Ga-DOTATATE PET/CT were follow-up (24.4%) and initial tumor staging (23.4%). Of the 1,258 68 Ga-DOTATATE PET/CT scans completed, 75.7% were positive and 24.3% negative; there were 14 false-positive and 29 false-negative scans. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 97%, 95.1%, 96.6%, 98.5%, and 90.4%, respectively. In 40.9% of patients, the treatment plan was changed after the scans, owing mainly to new, unexpected findings. Statistically significant differences in survival were shown between patients with G1, G2, and G3 grade tumors (P , 0.0001) and also between patients with bone metastasis versus patients with soft-tissue metastasis (P , 0.0001). Conclusion: 68 Ga-DOTATATE PET/CT scanning is safe and influences management in a large proportion of patients. Prognosis was dependent on tumor grade, and the presence of bone metastasis was associated with worse overall survival.

Current Concepts in 68Ga-DOTATATE Imaging of Neuroendocrine Neoplasms: Interpretation, Biodistribution, Dosimetry, and Molecular Strategies

“…The results of that study are in line with those of much smaller previous studies using PET/CT with either 68 Ga-DOTATOC or 68 Ga-DOTANOC (16,20,(43)(44)(45)(46). Overall, SSR PET/CT showed a high accuracy ($96%) for the detection of welldifferentiated NENs at either the primary site or the metastatic sites (mostly lymph nodes, liver, bone, and lung) (20,39,44).…”

“…About half of these cases were provided by a single study using 68 Ga-DOTATATE (728/1,561, or 47%) (39). In that study, Skoura et al found that the treatment plan was changed in 40.9% (515/1,278) of the 68 Ga-DOTATATE PET/CT cases because of new, unexpected findings.…”

“…Over the past decade, many reports have demonstrated the superiority of SSR PET/CT (with 68 Ga-DOTATATE, 68 Ga-DOTATOC, or 68 Ga-DOTANOC) over single-photon scintigraphy (including SPECT/CT), morphologic imaging (CT/MRI), or PET/CT with other radiopharmaceuticals (16,19,20,(37)(38)(39)(40)(41). In a recent prospective trial including 131 patients with gastroenteropancreatic NENs and unknown primary NENs, 68 Ga-DOTATATE showed a higher detection rate (95.2%) than 111 In-pentetreotide SPECT/CT (30.9%) or CT or MRI (45.6%) (42).…”

Most of the Intended Management Changes After 68Ga-DOTATATE PET/CT Are Implemented

“…However, one concern about the National Oncology PET Registry is that intended management changes may not have been implemented (5,6). In the current study, 68 Ga-DOTATATE PET/CT resulted in intended management changes in 48 of 96 patients (50%), which is comparable to results from prior retrospective studies (2,3,(7)(8)(9)(10)(11). However, no prospective study has elucidated prospectively the rate of implemented management changes.…”

68Gallium DOTANOC-PET Imaging in Lung Carcinoids: Impact on Patients' Management

“…As per European Neuroendocrine Tumour Society (ENETS) [12], North American Neuroendocrine Tumor Society (NANETS) [33], and National Comprehensive Cancer Network (NCCN) [34] guidelines, the use of 68 Ga-DOTA-PET scans is preferable to standard somatostatin receptor scintigraphy whenever available, having a potential role for selection of patients for treatment with PRRT, identification of primary tumour, and presurgical staging. Unfortunately, none of these guidelines specify indications for performing such imaging to LC patients [12,13] which remains an additional challenge for daily practice, since the real impact on clinical management has not been specifically investigated in this patient population [31]. Therefore, the role of these new imaging techniques in patients with LC remains unclear.…”