Sadowski Samira M, Neychev Vladimir, Millo Corina, Shih Joanna, Nilubol Naris, Herscovitch Peter, Pacak Karel, Marx Stephen J, Kebebew Electron
All authors: National Institutes of Health, Bethesda, MD.
J Clin Oncol. 2016 Feb 20;34(6):588-96. doi: 10.1200/JCO.2015.64.0987. Epub 2015 Dec 28.
Gastro-entero-pancreatic neuroendocrine tumors (GEPNETs) are increasing in incidence, and accurate staging is important for selecting the appropriate treatment. (68)Ga-DOTATATE imaging is a promising approach for detecting GEPNETs and could help in selecting optimal therapeutic strategies. The aim of this study was to prospectively determine the clinical utility of (68)Ga-DOTATATE positron emission tomography (PET)/computed tomography (CT) in detecting unknown primary and metastatic GEPNETs.
One hundred thirty-one patients were enrolled in a prospective study of patients undergoing (68)Ga-DOTATATE PET/CT, (111)In-pentetreotide single-photon emission computed tomography (SPECT)/CT and multiphasic CT scan, and/or magnetic resonance imaging in a blinded fashion with comprehensive biochemical testing. The primary outcome measure was the detection of lesions by each imaging study.
(68)Ga-DOTATATE PET/CT imaging detected 95.1% of lesions (95% CI, 92.4% to 96.8%) with an average maximum standardized uptake value of 65.4 ± 47 (range, 6.9 to 244), anatomic imaging detected 45.3% of lesions (95% CI, 37.9% to 52.9%), and (111)In-pentetreotide SPECT/CT detected 30.9% of lesions (95% CI, 25.0% to 37.5%), with a significant difference between imaging modalities (P < .001). In four of 14 patients (28.6%), (68)Ga-DOTATATE PET/CT found a previously unknown primary tumor, and detected primary GEPNET, lymph node, and distant metastases correctly in 72 of 113 lesions (63.7%) when compared with histopathology, with 22.1% and 38.9% detected by using (111)In-pentetreotide SPECT/CT and anatomic imaging, respectively. On the basis of findings with (68)Ga-DOTATATE PET/CT, 43 of 131 patients (32.8%) had a change in management recommendation. In patients with carcinoid symptoms but negative biochemical testing, (68)Ga-DOTATATE PET/CT detected lesions in 65.2% of patients, 40% of which were detected neither by anatomic imaging nor by (111)In-pentetreotide SPECT/CT.
(68)Ga-DOTATATE PET/CT imaging provides important information for accurate staging of GEPNETs and selection of appropriate treatment interventions even in the absence of biochemical evidence of disease in symptomatic patients.
胃肠胰神经内分泌肿瘤（GEPNETs）的发病率正在上升，准确分期对于选择合适的治疗方法很重要。（68）Ga - DOTATATE成像对于检测GEPNETs是一种很有前景的方法，并且有助于选择最佳治疗策略。本研究的目的是前瞻性地确定（68）Ga - DOTATATE正电子发射断层扫描（PET）/计算机断层扫描（CT）在检测未知原发灶和转移性GEPNETs中的临床应用价值。
131例患者参与了一项前瞻性研究，这些患者接受了（68）Ga - DOTATATE PET/CT、（111）In - 喷曲肽单光子发射计算机断层扫描（SPECT）/CT以及多期CT扫描和/或磁共振成像检查，并以盲法进行全面的生化检测。主要观察指标是每种成像检查对病变的检测情况。
（68）Ga - DOTATATE PET/CT成像检测到95.1%的病变（95%可信区间，92.4%至96.8%），平均最大标准化摄取值为65.4±47（范围，6.9至244）；解剖成像检测到45.3%的病变（95%可信区间，37.9%至52.9%）；（111）In - 喷曲肽SPECT/CT检测到30.9%的病变（95%可信区间，25.0%至37.5%），不同成像方式之间存在显著差异（P <.001）。在14例患者中的4例（28.6%）中，（68）Ga - DOTATATE PET/CT发现了一个先前未知的原发肿瘤，与组织病理学相比，在113个病变中的72个（63.7%）中正确检测到了原发性GEPNET、淋巴结和远处转移灶，而（111）In - 喷曲肽SPECT/CT和解剖成像分别检测到22.1%和38.9%。基于（68）Ga - DOTATATE PET/CT的结果，131例患者中的43例（32.8%）改变了治疗建议。在有类癌症状但生化检测为阴性的患者中，（68）Ga - DOTATATE PET/CT在65.2%的患者中检测到病变，其中40%的病变既未被解剖成像检测到，也未被（111）In - 喷曲肽SPECT/CT检测到。
即使在有症状的患者中没有疾病的生化证据，（68）Ga - DOTATATE PET/CT成像也能为GEPNETs的准确分期和选择合适的治疗干预措施提供重要信息。
