Prela Orjola, Caveney Brennen, Strawderman Myla, Linehan David, Galka Eva, Schoeniger Luke, Hezel Aram, Badri Nabeel, Carpizo Darren R
Department of Surgery, Division of General Surgery, University of Rochester, Rochester, New York, USA.
University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
J Surg Oncol. 2025 Jun;131(7):1336-1342. doi: 10.1002/jso.28061. Epub 2025 Jan 5.
Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are a rare and biologically diverse group of tumors that are challenging to image. Ga-DOTATATE PET/CT is the most sensitive imaging tool for these tumors, and while its use has increased over time, its clinical impact remains unclear, particularly for clinical scenarios involving surveillance after treatment. We sought to reassess its clinical utility across all stages.
Retrospective study of pathologically confirmed GEP-NET patients between 1/1/2020 and 9/1/2022 at a tertiary care center. Demographic, clinical, and radiographic data were analyzed. The primary objective was to determine if PET/CT use was associated with a change in clinical management. The secondary objective was to determine if PET/CT was superior in identifying primary or metastatic lesions compared to traditional imaging.
One hundred twenty-four patients with GEP-NETs underwent 207 PET/CT scans. The majority of scans were obtained for disease surveillance (70.2%) or staging (37.9%), and the remaining (3.2%) were used to aid in diagnosis or before PRRT initiation (3.2%). Following PET/CT scan, 51 patients (41.1%) had a change in clinical management, with change being higher among those with metastatic disease (44.9% vs. 14.5%). Of the 124, 72 patients had traditional imaging available for comparison. In this subgroup, 34 patients (47.2%) had new lesions identified on PET/CT that were not identified using traditional imaging resulting in a change in management in 79.4% favoring patients with M1 versus M0 disease (26.9% M0 vs. 58.7% M1, p = 0.010).
Ga-DOTATATE PET/CT imaging is clinically most useful for initial staging and in surveillance and monitoring response to therapy in the metastatic setting. It is least useful for surveillance in the early-stage setting and does not support its use following curative intent surgery. It remains superior to unlabeled imaging in sensitivity and the additional disease burden detected is highly likely to change management.
胃肠胰神经内分泌肿瘤（GEP-NETs）是一类罕见且生物学特性多样的肿瘤，其影像学检查具有挑战性。镓[68Ga] DOTATATE PET/CT是用于这些肿瘤最敏感的成像工具，尽管随着时间推移其使用有所增加，但其临床影响仍不明确，特别是对于治疗后监测的临床情况。我们试图重新评估其在所有阶段的临床效用。
对2020年1月1日至2022年9月1日在一家三级医疗中心经病理确诊的GEP-NET患者进行回顾性研究。分析人口统计学、临床和影像学数据。主要目的是确定PET/CT的使用是否与临床管理的改变相关。次要目的是确定与传统成像相比，PET/CT在识别原发或转移病灶方面是否更具优势。
124例GEP-NET患者接受了207次PET/CT扫描。大多数扫描是用于疾病监测（70.2%）或分期（37.9%），其余（3.2%）用于辅助诊断或在肽受体放射性核素治疗（PRRT）开始前（3.2%）。PET/CT扫描后，51例患者（41.1%）的临床管理发生了改变，转移性疾病患者的改变比例更高（44.9%对14.5%）。在124例患者中，72例有可用于比较的传统成像。在这个亚组中，34例患者（47.2%）在PET/CT上发现了传统成像未发现的新病灶，导致79.4%的患者管理发生改变，M1期患者比M0期患者更占优势（M0期为26.9%，M1期为58.7%，p = 0.010）。
镓[68Ga] DOTATATE PET/CT成像在临床最适用于初始分期以及转移性疾病的治疗反应监测。它在早期疾病监测中最无用，并且不支持在根治性手术后使用。它在敏感性方面仍优于未标记成像，并且检测到的额外疾病负担很可能改变管理方式。
