The utility of 18F-FDG and 68Ga-DOTA-Peptide PET/CT in the evaluation of primary pulmonary carcinoid

Abstract

Background:Pulmonary carcinoids (PC) are histologically classified into typical carcinoid (TC) and atypical carcinoid (AC). The diagnosis of pulmonary carcinoid and possibly the differentiation between TC and AC could make a significant effect on the treatment planning as well as prognosis.[1] Several studies have explored the utility of 68Ga-DOTA-Peptide (68Ga-labelled [1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid]-peptide) and 18F-flurodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) in the evaluation of primary pulmonary carcinoids. Therefore, we performed a meta-analysis to evaluate the diagnostic accuracy and prediction efficiency of histological subtypes of these two imaging modalities in primary PC.Methods:Relevant studies were identified by searching PubMed, Web of Science, and EMBASE published from 2006 to 2016. Two authors extracted characteristics of patients and their lesions using predefined criteria.Results:Fourteen studies comprising 352 patients were included in this meta-analysis. The pooled sensitivity of 68Ga-DOTA-Peptide and 18F-FDG PET/CT in detecting pulmonary carcinoid were 90.0% (95% CI = 82.0–95.0%; P = .07; I2 = 49.6%) and 71.0% (95% CI = 66.0–76.0%; P < .001; I2 = 59.3%), respectively. An SUVmax ratio between 68Ga-DOTA-Peptide and 18F-FDG higher than the cutoff value of 4.28 was predictive of TC with 89.3% sensitivity and 100% specificity (AUC, 96.4%; 95% CI, 91.1–100%). The ratio of tumor uptake to atelectatic lung uptake was significantly higher for 68Ga-DOTA-peptide (2.5–91, mean 30.5 ± 28.1) than for 18F-FDG (0.3–10.3, mean 2.1 ± 2.3) (P < .001).Conclusions:Both 68Ga-DOTA-peptide and 18F-FDG are highly sensitive in detecting pulmonary carcinoid, while 68Ga-DOTA-peptide is more sensitive than 18F-FDG (90.0% vs 71.0%). The SUVmax ratio was an accurate predictor of the histopathologic variety of the carcinoid tumor, and 68Ga-DOTA-peptide was better than 18F-FDG in cases with atelectasis.

Diagnostic Value of Conventional PET Parameters and Radiomic Features Extracted from 18F-FDG-PET/CT for Histologic Subtype Classification and Characterization of Lung Neuroendocrine Neoplasms

“…These grey levels and the absolute intensity resampling were based on the results of previous studies assessing RFs’ robustness in 18F-FDG-PET/CT [ 32 , 40 ]. Otherwise, SUV 0–20 corresponds to the typical range of tumor SUVs encountered in Lu-NENs [ 6 , 39 ]. To avoid the redundancy of RFs, we used the “glmnet” package in R to perform a LASSO logistic regression to select the most predictive RFs for the classification, as recently reported [ 36 , 37 ].…”

“…In cases of locally confined disease, Lu-NETs are generally treated with radical surgery and eventual nodal dissection is considered in cases of findings suspected for malignancy at pre-operative staging [ 4 , 5 ]. Thus, correct identification of the different Lu-NENs histological patterns is crucial in the decision-making process [ 6 ].…”

Pulmonary large cell neuroendocrine carcinoma (LCNEC) with confirmed liver metastases negative on 18F-FDG and 68Ga-DOTATATE PET

“…While no or minimal uptake of 68 Ga-DOTATATE is expected in intermediate and high-grade NENs, due to their lack of differentiation and lost SSTR expression, FDG negativity is not. De- or undifferentiated NENs, being characterized by a high proliferation rate and thus high glucose consumption, are 18 F-FDG-avid [ 4 , 5 ]. Grondahl et al.…”

Bronchoscopic diagnosis and treatment of endobronchial carcinoid: case report and review of the literature

“…Overall, 68 Ga DOTATOC has a high negative predictive value in diagnosing typical carcinoids, but not atypical carcinoids [30]. In a recent meta-analysis, JIANG et al [31] suggested a possible combination of these two tracers ( 18 F-FDG and 68 Ga) with the use of the ratios of maximum standard unit value on ( 68 Ga) DOTATOC and FDG-PET/CT for prediction of the histological type of pulmonary carcinoids.…”