Bădan M I, Piciu D
"Iuliu Hațieganu" University of Medicine and Pharmacy - Doctoral School.
"Prof. Dr. Ion Chiricuta" Institute of Oncology - Nuclear Medicine, Cluj-Napoca, Romania.
Acta Endocrinol (Buchar). 2022 Oct-Dec;18(4):523-530. doi: 10.4183/aeb.2022.523.
Diagnosis of primary NETs (neuroendocrine tumors) is challenging and often late due to tumor heterogeneity, and a wide variety of general symptoms. Low grade NETs are often indolent and have a good prognosis, especially in the early stages. Even so, some tumors are diagnosed using SPECT/CT either in the metastatic stage or directly as a metastasis with an unknown primary tumor.
This study aims to characterize well and moderately differentiated NETs, using Tektrotyd SPECT/CT imaging as well as from the viewpoint of NET immunohistochemical biomarker expression.
Patients diagnosed with low grade neuroendocrine tumors (carcinoids) investigated over a period of 2 years, using SPECT/CT with 99mTc-EDDA/HYNIC-Tyr3-Octreotide (Tektrotyd) and confirmed through at least two immunohistochemical neuroendocrine markers were evaluated.
Twenty-seven cases with neuroendocrine tumors were analyzed. Four patients met the inclusion criteria. Staining intensity was scored using a weak, moderate, or strong scoring system. CD56 was quantified using criteria derived from Her2 cell membrane staining evaluations.
Patients included in the study had two well differentiated (G1) NETs and two moderately differentiated (G2) NETs. SPECT/CT with Tektrotyd showed variable intensity ranging from discreet to strong. All tumors expressed chromogranin A with at least moderate intensity, weak to moderate intensity for synaptophysin and variable CD56 intensity.
Chromogranin A and synaptophysin staining patterns may aid in primary tumor identification. CD56 stain intensity showed an inverse correlation with Tektrotyd uptake in carcinoids. Additional studies merit further investigation for use in clinical settings.
原发性神经内分泌肿瘤（NETs）的诊断具有挑战性，由于肿瘤异质性和各种各样的一般症状，诊断往往较晚。低级别NETs通常生长缓慢，预后良好，尤其是在早期阶段。即便如此，一些肿瘤在转移阶段通过单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）被诊断出来，或者直接被诊断为原发肿瘤不明的转移瘤。
本研究旨在利用锝[99mTc]依替膦酸盐/组胺酸-酪胺酸-奥曲肽（Tektrotyd）SPECT/CT成像以及从NET免疫组化生物标志物表达的角度，对高分化和中分化NETs进行特征描述。
对在两年期间被诊断为低级别神经内分泌肿瘤（类癌）的患者进行研究，使用锝[99mTc]依替膦酸盐/组胺酸-酪胺酸-奥曲肽（Tektrotyd）进行SPECT/CT检查，并通过至少两种免疫组化神经内分泌标志物进行确认。
分析了27例神经内分泌肿瘤病例。4例患者符合纳入标准。使用弱、中、强评分系统对染色强度进行评分。CD56使用源自人表皮生长因子受体2（Her2）细胞膜染色评估的标准进行定量。
纳入研究的患者中有2例高分化（G1）NETs和2例中分化（G2）NETs。使用Tektrotyd的SPECT/CT显示强度各异，从离散到强烈。所有肿瘤嗜铬粒蛋白A表达强度至少为中等，突触素表达强度为弱到中等，CD56强度各异。
嗜铬粒蛋白A和突触素的染色模式可能有助于原发性肿瘤的识别。类癌中CD56染色强度与Tektrotyd摄取呈负相关。更多研究值得在临床环境中进一步探究。
