Department of Oncology, Program in Evidence-Based Care, Cancer Care Ontario, McMaster University, Juravinski Hospital and Cancer Centre, Hamilton.
Department of Radiation Oncology, University of Toronto and Princess Margaret Hospital, University Health Network.
Clin Nucl Med. 2018 Nov;43(11):802-810. doi: 10.1097/RLU.0000000000002276.
The aim of this study was to systematically review the literature to assess the role of Ga PET imaging in neuroendocrine tumors (NETs).
The literature was searched using MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews databases through OVID. Studies comparing PET or PET/CT with conventional imaging in the initial diagnosis, staging and restaging, assessment of treatment response, and routine surveillance of NETs were deemed eligible for inclusion. Risk of bias and applicability concerns were assessed using the Quality Assessment of Diagnostic Accuracy Studies tool.
Twenty-two studies met the inclusion criteria. For the initial diagnosis of NETs, PET or PET/CT had a pooled sensitivity of 91% (95% confidence interval [CI], 85%-94%) and a pooled specificity of 94% (95% CI, 86%-98%). In the setting of staging and restaging, the sensitivity of PET or PET/CT for detecting primary and/or metastatic lesions ranged from 78.3% to 100%, whereas specificity ranged from 83% to 100%. Change in management occurred in 45% (95% CI, 36%-55%) of the cases, with majority of the changes involving surgical planning and patient selection for peptide receptor radionuclide therapy.
Ga PET or PET/CT is recommended for initial diagnosis where conventional testing remained equivocal, for staging of patients with localized primary and/or limited metastasis where definitive surgery is planned, to determine somatostatin receptor status and suitability for peptide receptor radionuclide therapy, and for staging of patients where detection of occult disease will alter treatment options and decision making.
本研究旨在系统回顾文献，评估镓 PET 成像在神经内分泌肿瘤（NETs）中的作用。
通过 OVID 在 MEDLINE、EMBASE 和 Cochrane 系统评价数据库中检索文献。将比较 PET 或 PET/CT 与常规成像在 NETs 的初始诊断、分期和再分期、治疗反应评估以及常规监测中的研究纳入标准。使用诊断准确性研究质量评估工具评估偏倚风险和适用性问题。
22 项研究符合纳入标准。对于 NETs 的初始诊断，PET 或 PET/CT 的汇总敏感性为 91%（95%置信区间 [CI]，85%-94%），汇总特异性为 94%（95% CI，86%-98%）。在分期和再分期方面，PET 或 PET/CT 检测原发和/或转移性病变的敏感性为 78.3%至 100%，特异性为 83%至 100%。45%（95% CI，36%-55%）的病例发生了治疗方案的改变，其中大多数改变涉及手术计划和肽受体放射性核素治疗的患者选择。
建议在常规检查结果不确定时进行初始诊断，在计划进行确定性手术的局限性原发性和/或有限转移患者中进行分期，以确定生长抑素受体状态和肽受体放射性核素治疗的适用性，以及在隐匿性疾病的检测将改变治疗选择和决策的患者中进行分期。
