Kaltsas Gregory, Rockall Andrea, Papadogias Dimitrios, Reznek Rodney, Grossman Ashley B
Department of Endocrinology, St Bartholomew's Hospital, London ECIA 7BE, UK.
Eur J Endocrinol. 2004 Jul;151(1):15-27. doi: 10.1530/eje.0.1510015.
Neuroendocrine tumours (NETs) constitute a heterogeneous group of tumours that are able to express cell membrane neuroamine uptake mechanisms and/or specific receptors, such as somatostatin receptors, which can be of great value in the localization and treatment of these tumours. Scintigraphy with (111)In-pentetreotide has become one of the most important imaging investigations in the initial identification and staging of gastro-enteropancreatic (GEP) tumours, whereas helical computed tomography (CT), magnetic resonance imaging (MRI), endoscopic and/or peri-operative ultrasonography are used for the precise localization of GEPs and in monitoring their response to treatment. Scintigraphy with (123)I-MIBG (meta-iodobenzylguanidine) is sensitive in the identification of chromaffin cell tumours, although scintigraphy with (111)In-pentetreotide may also have a role in the localization of malignant chromaffin cell tumours and medullary thyroid carcinoma; for further localization and monitoring of the response to treatment both CT and MRI are used with high diagnostic accuracy. More recently, positron emission tomography (PET) scanning is being increasingly used for the localization of NETs, particularly when other imaging modalities have failed, although its precise role and utility remain to be defined. Surgery is still the usual initial therapeutic, and only curative, modality of choice; however, the majority of NETs will require further treatment with somatostatin analogues and/or interferon; chemotherapy may be used for progressive and highly aggressive NETs, but its role has not been clearly defined. For those NETs that demonstrate uptake to a diagnostic scan with (123)I-MIBG or (111)In-octreotide, therapy with radionuclides such as (131)I-MIBG or (111)In/(90)Y-octreotide or other isotopes, presents a further evolving therapeutic modality.
神经内分泌肿瘤(NETs)是一组异质性肿瘤,能够表达细胞膜神经胺摄取机制和/或特定受体,如生长抑素受体,这对这些肿瘤的定位和治疗具有重要价值。用(111)铟-喷曲肽进行闪烁扫描已成为胃肠胰(GEP)肿瘤初始识别和分期中最重要的影像学检查之一,而螺旋计算机断层扫描(CT)、磁共振成像(MRI)、内镜和/或术中超声则用于GEP肿瘤的精确定位以及监测其对治疗的反应。用(123)碘-间碘苄胍(MIBG)进行闪烁扫描对嗜铬细胞瘤的识别很敏感,尽管用(111)铟-喷曲肽进行闪烁扫描在恶性嗜铬细胞瘤和甲状腺髓样癌的定位中也可能发挥作用;为了进一步定位和监测对治疗的反应,CT和MRI都具有很高的诊断准确性。最近,正电子发射断层扫描(PET)越来越多地用于NETs的定位,特别是在其他成像方式失败时,尽管其确切作用和效用仍有待确定。手术仍然是通常的初始治疗方法,也是唯一的治愈性选择;然而,大多数NETs需要用生长抑素类似物和/或干扰素进行进一步治疗;化疗可用于进展性和高度侵袭性的NETs,但其作用尚未明确界定。对于那些对(123)碘-MIBG或(111)铟-奥曲肽诊断扫描有摄取的NETs,用(131)碘-MIBG或(111)铟/(90)钇-奥曲肽或其他同位素等放射性核素进行治疗是一种不断发展的治疗方式。