Albers Max B, Librizzi Damiano, Lopez Caroline L, Manoharan Jerena, Apitzsch Jonas C, Slater Emily P, Bollmann Carmen, Kann Peter H, Bartsch Detlef K
Department of Visceral, Thoracic and Vascular Surgery, University Hospital of Giessen and Marburg, Philipps University of Marburg, Marburg, Germany.
Department of Nuclear Medicine, University Hospital of Giessen and Marburg, Philipps University of Marburg, Marburg, Germany.
World J Surg. 2017 Jun;41(6):1521-1527. doi: 10.1007/s00268-017-3907-9.
Routine screening is recommended for patients with multiple endocrine neoplasia type 1 (MEN1) to enable early detection and treatment of associated neuroendocrine neoplasms (NEN). Gallium-DOTATOC-Positron emission tomography combined with computed tomography (Ga-68-DOTATOC-PET-CT) is a very sensitive and specific imaging technique for the detection of sporadic neuroendocrine tumors. The present study evaluated the value of Ga-68-DOTATOC-PET-CT in routine screening of patients with MEN1.
Between January 2014 and March 2016, all MEN1 patients underwent Ga-68-DOTATOC-PET-CT in addition to conventional imaging (computed tomography of the thorax, magnetic resonance imaging of the abdomen and pituitary, endoscopic ultrasonography). The diagnostic yield of conventional imaging and Ga-68-DOTATOC-PET-CT was prospectively documented and compared, and treatment changes caused by the addition of Ga-68-DOTATOC-PET-CT were recorded.
Conventional imaging detected 145 NENs, mainly pancreaticoduodenal NENs (n = 117, 81%), in 31 of 33 MEN1 patients. Ga-68-DOTATOC-PET-CT detected 55 NENs in 23 of the 33 patients (p = 0.0001). Ninety (62%) NENs detected by conventional imaging were missed by DOTATOC-PET-CT. The majority of missed lesions were pNEN (n = 68; 74%). The sensitivity of Ga-68-DOTATOC-PET-CT for NENs <5, 5-9, 10-19 and ≥20 mm was 0, 29, 81 and 100%, respectively. However, Ga-68-DOTATOC-PET-CT detected more liver and lymph node metastases in patients with known metastatic disease, which did not lead to a change of patients' management. In one patient (3%), Ga-68-DOTATOC-PET-CT was the only imaging modality that detected a small intestine NEN and led to potentially curative surgery.
Ga-68-DOTATOC-PET-CT cannot be recommended for routine screening of MEN1 patients. It might provide important additional information in patients with suspected or known metastatic disease.
建议对1型多发性内分泌肿瘤（MEN1）患者进行常规筛查，以便早期发现并治疗相关神经内分泌肿瘤（NEN）。镓-奥曲肽-正电子发射断层扫描联合计算机断层扫描（Ga-68-DOTATOC-PET-CT）是一种检测散发性神经内分泌肿瘤的非常敏感且特异的成像技术。本研究评估了Ga-68-DOTATOC-PET-CT在MEN1患者常规筛查中的价值。
2014年1月至2016年3月期间，所有MEN1患者除接受传统成像检查（胸部计算机断层扫描、腹部和垂体磁共振成像、内镜超声检查）外，还接受了Ga-68-DOTATOC-PET-CT检查。前瞻性记录并比较传统成像检查和Ga-68-DOTATOC-PET-CT的诊断率，并记录因增加Ga-68-DOTATOC-PET-CT检查而导致的治疗方案变化。
传统成像检查在33例MEN1患者中的31例中检测到145个NEN，主要是胰十二指肠NEN（n = 117，81%）。Ga-68-DOTATOC-PET-CT在33例患者中的23例中检测到55个NEN（p = 0.0001）。传统成像检查检测到的90个（62%）NEN未被奥曲肽-PET-CT检测到。大多数漏诊病变为胰腺神经内分泌肿瘤（pNEN，n = 68；74%）。Ga-68-DOTATOC-PET-CT对直径<5、5 - 9、10 - 19和≥20 mm的NEN的敏感性分别为0、29%、81%和100%。然而，Ga-68-DOTATOC-PET-CT在已知有转移疾病的患者中检测到更多的肝转移和淋巴结转移，但这并未导致患者治疗方案的改变。在1例患者（3%）中，Ga-68-DOTATOC-PET-CT是唯一检测到小肠NEN并导致可能治愈性手术的成像方式。
不建议将Ga-68-DOTATOC-PET-CT用于MEN1患者的常规筛查。它可能为疑似或已知有转移疾病的患者提供重要的额外信息。
