Department of Diagnostic Radiology.
Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon.
Nucl Med Commun. 2023 Jun 1;44(6):471-479. doi: 10.1097/MNM.0000000000001683. Epub 2023 Mar 10.
Rarely, well-differentiated gastro-entero-pancreatic neuroendocrine tumors (GEP NETs) can have positive uptake on 18F-fluorodeoxyglucose-PET/computerized tomography ( 18 F-FDG-PET/CT), with or without a positive 68 Ga-PET/CT. We aim to evaluate the diagnostic role of 18 F-FDG-PET/CT in patients with well-differentiated GEP NETs.
We retrospectively reviewed a chart of patients diagnosed with GEP NETs between 2014 and 2021, at the American University of Beirut Medical Center, who have low (G1; Ki-67 ≤2) or intermediate (G2; and Ki-67 >2-≤20) well-differentiated tumors with positive findings on FDG-PET/CT. The primary endpoint is progression-free survival (PFS) compared to historical control, and the secondary outcome is to describe their clinical outcome.
In total 8 out of 36 patients with G1 or G2 GEP NET met the inclusion criteria for this study. The median age was 60 years (range 51-75 years) and 75% were male. One patient (12.5%) had a G1 tumor whereas 7 (87.5%) had G2, and seven patients were stage IV. The primary tumor was intestinal in 62.5% of the patients and pancreatic in 37.5%. Seven patients had both 18 F-FDG-PET/CT and 68 Ga-PET/CT positive and one patient had a positive 18 F-FDG-PET/CT and negative 68 Ga-PET/CT. Median and mean PFS in patients positive for both 68 Ga-PET/CT and 18 F-FDG-PET/CT were 49.71 months and 37.5 months (95% CI, 20.7-54.3), respectively. PFS in these patients is lower than that reported in the literature for G1/G2 NETs with positive 68 Ga-PET/CT and negative FDG-PET/CT (37.5 vs. 71 months; P = 0.0217).
A new prognostic score that includes 18 F-FDG-PET/CT in G1/G2 GEP NETs could identify more aggressive tumors.
很少有分化良好的胃肠胰腺神经内分泌肿瘤（GEP NET）在 18F-氟脱氧葡萄糖-PET/计算机断层扫描（18 F-FDG-PET/CT）上有阳性摄取，无论 68Ga-PET/CT 是否阳性。我们旨在评估 18F-FDG-PET/CT 在分化良好的 GEP NET 患者中的诊断作用。
我们回顾性分析了 2014 年至 2021 年在贝鲁特美国大学医学中心诊断为 GEP NET 的患者的图表，这些患者的肿瘤分化良好（G1；Ki-67≤2）或中分化（G2；Ki-67>2-≤20），且 FDG-PET/CT 有阳性发现。主要终点是无进展生存期（PFS）与历史对照相比，次要结果是描述其临床结果。
36 例 G1 或 G2 GEP NET 患者中，共有 8 例符合本研究纳入标准。中位年龄为 60 岁（范围 51-75 岁），75%为男性。1 例（12.5%）为 G1 肿瘤，7 例（87.5%）为 G2，7 例为 IV 期。原发肿瘤位于肠道的占 62.5%，胰腺的占 37.5%。7 例患者 18F-FDG-PET/CT 和 68Ga-PET/CT 均为阳性，1 例患者 18F-FDG-PET/CT 阳性，68Ga-PET/CT 阴性。68Ga-PET/CT 和 18F-FDG-PET/CT 均为阳性的患者中位和平均 PFS 分别为 49.71 个月和 37.5 个月（95%CI，20.7-54.3）。这些患者的 PFS 低于文献中报告的 68Ga-PET/CT 阳性和 FDG-PET/CT 阴性的 G1/G2 NETs（37.5 与 71 个月；P=0.0217）。
在 G1/G2 GEP NET 中纳入 18F-FDG-PET/CT 的新预后评分可能会识别出更具侵袭性的肿瘤。
