General Surgery Residency Program, University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy.
Digestive Surgery, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy.
Langenbecks Arch Surg. 2024 Feb 16;409(1):63. doi: 10.1007/s00423-024-03254-7.
Pre-operative diagnosis and staging of small intestine neuroendocrine tumors (SI-NETs) remain sub-optimal, with open palpation during surgery still considered the gold standard. This limits a standardized implementation of minimally invasive surgery (MIS). The aim of this single-center retrospective study was to assess a tailored diagnostic work-up to identify candidates at low risk of undetected disease who may benefit from MIS.
Patients diagnosed with SI-NETs between 2013 and 2022 who underwent contrast-enhanced computed tomography enterography (CTE) and Ga68-DOTATOC-positron emission tomography-CT (68 Ga DOTATATE PET/CT) preoperatively and subsequently underwent open surgical resection were included. Imaging studies were reassessed by two radiologists. Combined use of CTE and 68 Ga DOTATATE PET/CT in determining primary lesion disease burden (number of lesions) and LN disease stage (distal and proximal relative to superior mesenteric vessels) was assessed, using surgical reports and pathology as gold standard.
Overall, 56 patients were included. Sensitivity of CTE and 68 Ga DOTATATE PET/CT for at least one primary SI-NET was 100% and 94%, respectively. In the presence of concordance between studies, combined use of CTE and 68 Ga DOTATATE PET/CT for detection of single primary tumors improved specificity to 89% (n = 25/28) with a positive predictive value of 87.5% (n = 21/24). Distal LN disease was identified in 89.2% of cases (n = 33/37). The association of single lesion and distal LN disease was found pre-operatively in 32% of patients (n = 18).
Combined use of CTE and 68 Ga DOTATATE PET/CT enables identifying low-risk surgical candidates (single SI-NET lesions with distal LN disease).
小肠神经内分泌肿瘤（SI-NETs）的术前诊断和分期仍然不理想，手术中进行开放性触诊仍被认为是金标准。这限制了微创手术（MIS）的标准化实施。本单中心回顾性研究的目的是评估一种针对性的诊断方法，以确定低风险未检出疾病的患者，这些患者可能受益于 MIS。
纳入 2013 年至 2022 年间经对比增强 CT 肠造影（CTE）和 Ga68-DOTATOC-正电子发射断层扫描-CT（68Ga DOTATATE PET/CT）术前诊断为 SI-NETs 并随后接受开放性手术切除的患者。两名放射科医生对影像学研究进行重新评估。使用手术报告和病理作为金标准，评估 CTE 和 68Ga DOTATATE PET/CT 联合用于确定原发病变疾病负担（病变数量）和淋巴结疾病分期（肠系膜上血管远近端）的情况。
共纳入 56 例患者。CTE 和 68Ga DOTATATE PET/CT 对至少一个原发 SI-NET 的敏感度分别为 100%和 94%。在研究结果一致的情况下，联合使用 CTE 和 68Ga DOTATATE PET/CT 检测单个原发肿瘤可将特异性提高至 89%（n=25/28），阳性预测值为 87.5%（n=21/24）。89.2%（n=33/37）的病例中发现了远端淋巴结疾病。37 例中有 89.2%（n=33/37）发现了远端淋巴结疾病。32%的患者（n=18）术前发现单个病变和远端淋巴结疾病之间存在关联。
联合使用 CTE 和 68Ga DOTATATE PET/CT 可以识别低风险手术候选者（存在远端淋巴结疾病的单个 SI-NET 病变）。
