Spanu Angela, Schillaci Orazio, Piras Bastiana, Calvisi Diego F, Falchi Antonio, Danieli Roberta, Nuvoli Susanna, Dore Franca, Madeddu Giuseppe
Unit of Nuclear Medicine, Department of Clinical and Experimental Medicine, University of SassariSassari, Italy.
Unit of Nuclear Medicine, Department of Biomedicine and Prevention, University of Rome Tor VergataRome, Italy.
Am J Nucl Med Mol Imaging. 2017 Sep 1;7(4):181-194. eCollection 2017.
In a retrospective study performed in non-functioning GEP tumor patients we further investigated In-Pentetreotide SPECT/CT usefulness in diagnosis, staging and follow-up also evaluating whether the procedure may give more information than conventional imaging procedures (CIP), such as CT, MRI, US. We enrolled 104 consecutive patients with non-functioning GEP tumors, 30 in initial diagnosis and staging phases (IDS) and 74 in follow-up (FU). All patients underwent somatostatin receptor scintigraphy (SRS) whole body scan at 4, 24 and, if necessary, 48 hours followed by abdominal and chest SPECT/CT after In-Pentetreotide 148-222 MBq i.v. injection. The patients previously underwent 2 to 3 CIP. At both CIP and SPECT/CT, 34/104 patients were classified as no evidence of disease (NED); in 70/104 patients, neoplastic lesions were ascertained and 12 IDS and 17 FU were classified as not operable and treated with octeotride or chemotherapy. SPECT/CT and CIP were concordantly positive in 44 patients, while only CIP was positive in 6 cases and only SPECT/CT in 20. Both per-patient sensitivity and accuracy of SPECT/CT (91.4 and 94.2%, respectively) were higher than CIP (71.4 and 80.8%, respectively), but not significantly. Globally, 292 lesions were ascertained: 141 hepatic, 78 abdominal extra-hepatic and 73 extra-abdominal. CIP detected 191/292 (65.4%) lesions in 50 patients, while SPECT/CT 244/292 (83.6%) in 64, the difference being significant (p<0.0001). No false positive results were found at both SPECT/CT and CIP. Both SPECT/CT sensitivity and accuracy were higher than CIP in G1, G2, neuroendocrine carcinoma (NEC) and mixed adeno-neuroendocrine carcinoma (MANEC) patients, but significantly only for G1. Globally, SPECT/CT incremental value than CIP was 35.6%. SPECT/CT correctly modified CIP classification and patient management in 27.9% of cases, while it down-staged the disease than CIP in 9.6% of cases. However, the two procedures combined use could achieve the highest accuracy value. In-Pentetreotide SRS, acquired as SPECT/CT, showing high sensitivity and accuracy values, more elevated than CIP in the present study, can still have a wide employment in the routine diagnostic protocol of non-functioning GEP tumors with significant impact on patient management and therapy planning. The procedure is simple to perform, has limited cost and wide availability in all Nuclear Medicine Centers.
在一项针对无功能性胃肠胰（GEP）肿瘤患者的回顾性研究中，我们进一步探究了铟 - 喷替肽单光子发射计算机断层显像/计算机断层扫描（In - Pentetreotide SPECT/CT）在诊断、分期及随访中的作用，同时评估该检查是否能比传统成像检查（CIP），如CT、MRI、超声，提供更多信息。我们纳入了104例连续的无功能性GEP肿瘤患者，其中30例处于初始诊断和分期阶段（IDS），74例处于随访阶段（FU）。所有患者在静脉注射148 - 222 MBq铟 - 喷替肽后，于4小时、24小时（必要时48小时）进行生长抑素受体闪烁显像（SRS）全身扫描，随后进行腹部和胸部SPECT/CT检查。患者之前均接受过2至3次CIP检查。在CIP和SPECT/CT检查中，104例患者中有34例被分类为无疾病证据（NED）；在104例患者中的70例中，确定存在肿瘤性病变，其中12例IDS患者和17例FU患者被分类为不可手术，并接受奥曲肽或化疗。SPECT/CT和CIP检查结果一致为阳性的有44例，仅CIP检查为阳性的有6例，仅SPECT/CT检查为阳性的有20例。SPECT/CT检查每位患者的敏感性和准确性分别为91.4%和94.2%，高于CIP检查（分别为71.4%和80.8%），但差异无统计学意义。总体而言，共确定了292个病变：141个肝脏病变；78个腹部肝外病变；73个腹部外病变。CIP检查在50例患者中检测到191/292（65.4%）个病变，而SPECT/CT检查在64例患者中检测到244/292（83.6%）个病变，差异有统计学意义（p<0.0001）。在SPECT/CT和CIP检查中均未发现假阳性结果。在G1、G2、神经内分泌癌（NEC）和混合性腺神经内分泌癌（MANEC）患者中，SPECT/CT检查的敏感性和准确性均高于CIP检查，但仅G1组差异有统计学意义。总体而言，SPECT/CT检查相对于CIP检查的增加值为35.6%。SPECT/CT检查在27.9%的病例中正确地修改了CIP检查的分类及患者管理方案，而在9.6%的病例中其对疾病的分期比CIP检查更低。然而，两种检查联合使用可获得最高的准确性。作为SPECT/CT获取的铟 - 喷替肽SRS，显示出高敏感性和准确性，在本研究中高于CIP检查，在无功能性GEP肿瘤的常规诊断方案中仍可广泛应用，对患者管理和治疗计划有重大影响。该检查操作简单，成本有限，在所有核医学中心均可广泛开展。
