Hofman Michael S, Kong Grace, Neels Oliver C, Eu Peter, Hong Emily, Hicks Rodney J
Centre for Cancer Imaging, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia.
J Med Imaging Radiat Oncol. 2012 Feb;56(1):40-7. doi: 10.1111/j.1754-9485.2011.02327.x.
Ga-68 DOTATATE (Ga-octreotate, GaTate) positron emission tomography (PET)/CT has multiple advantages compared with conventional and In-111 octreotide imaging for neuroendocrine tumours and other somatostatin-receptor expressing tumours. This study assesses the management impact of incremental diagnostic information obtained from this technique compared with conventional staging.
Fifty-nine GaTate PET/CT studies were performed over an 18-month period (52 proven or suspected gastro-entero-pancreatic or bronchial neuroendocrine tumours and seven neural crest/mesenchymal tumours). A retrospective blinded review was performed on the number of abnormalities (1, 2-5 or >5) within defined regions with comparison to conventional imaging to assess incremental diagnostic information. Subsequent management impact (high, moderate or low) was determined by clinical review and follow up to assess pre-PET stage, treatment intent and post-PET management change.
Eighty-eight percent of GaTate studies were abnormal. Compared with conventional and In-111 octreotide imaging, additional information was provided by GaTate PET/CT in 68 and 83% of patients, respectively. Management impact was high (inter-modality change) in 47%, moderate (intra-modality change) in 10% and low in 41% (not assessable in 2%). High management impact included directing patients to curative surgery by identifying a primary site and directing patients with multiple metastases to systemic therapy.
GaTate PET/CT imaging provides additional diagnostic information in a high proportion of patients with consequent high management impact. GaTate PET/CT could replace (1)In-111 octreotide scintigraphy at centres where it is available given its superior accuracy, faster acquisition and lower radiation exposure. Rapid implementation could be achieved by allowing substitutional funding in the Medicare Benefit Schedule.
与传统的和铟 - 111奥曲肽成像相比，镓 - 68 DOTATATE（镓 - 奥曲肽，GaTate）正电子发射断层扫描（PET）/CT在神经内分泌肿瘤和其他表达生长抑素受体的肿瘤方面具有多种优势。本研究评估了与传统分期相比，从该技术获得的增量诊断信息对治疗管理的影响。
在18个月期间进行了59例GaTate PET/CT检查（52例已证实或疑似胃肠胰或支气管神经内分泌肿瘤，7例神经嵴/间充质肿瘤）。对定义区域内的异常数量（1个、2 - 5个或>5个）进行回顾性盲法审查，并与传统成像进行比较，以评估增量诊断信息。随后通过临床审查和随访确定对治疗管理的影响（高、中或低），以评估PET检查前的分期、治疗意图和PET检查后的治疗管理变化。
88%的GaTate检查结果异常。与传统成像和铟 - 111奥曲肽成像相比，GaTate PET/CT分别为68%和83%的患者提供了额外信息。对治疗管理的影响为高（不同检查方式间改变）的占47%，为中（同一检查方式内改变）的占10%，为低的占41%（2%不可评估）。高治疗管理影响包括通过确定原发部位引导患者进行根治性手术，以及引导有多处转移的患者进行全身治疗。
GaTate PET/CT成像在很大比例的患者中提供了额外的诊断信息，对治疗管理产生了很大影响。鉴于其更高的准确性、更快的采集速度和更低的辐射暴露，GaTate PET/CT可以在有条件的中心取代铟 - 111奥曲肽闪烁扫描。通过在医疗保险福利计划中允许替代资金，可以实现快速实施。
