68ga-dotanoc and Carcinoid-Tumor

Purpose of this study was to assess the utility of Ga-DOTA-NOC-PET/computed tomography (CT) (Ga-NOC-PET) in tumor detection, pathological differentiation and baseline staging of pulmonary carcinoids as well as to study its impact on therapeutic decision making.. Patients who underwent a Ga-NOC-PET for initial evaluation of bronchopulmonary carcinoid tumors from August 2014 to December 2019 were included. Detection rate of Ga-NOC-PET for the primary lesion was calculated by visual estimation of tracer uptake as per Krenning score. SUVmax of typical and atypical carcinoid tumors was measured and difference compared using nonparametric statistical tests. Proportion of patients with distant metastases was also calculated and its impact on intended treatment was assessed.. Imaging, histopathology and treatment details of 119 patients were available for analysis. Majority of tumors had an endobronchial location (74.7%) and showed histopathologic features of typical carcinoid (82.3%). Ga-NOC-PET showed a detection rate/sensitivity of 92.4%. Oncocytic variant on histopathology and smaller tumor size accounted for majority of negative results. Typical carcinoids showed significantly higher SUVmax than atypical tumors (median SUVmax 38.4 vs. 15.7, P = 0.002). Metastases to distant sites outside the thorax were seen in 14 patients (11.7%), primarily in liver and bones changing the intent of treatment from surgery to systemic therapy.. Ga-NOC-PET detects asymptomatic distant metastatic disease in a sizeable number of patients (11.7%) with pulmonary carcinoid and thus contribute to clinical management by precluding futile surgeries. It shows a high sensitivity for tumor detection and can help differentiate between typical and atypical carcinoid variants by virtue of their variable tracer uptake. PET/CT using Ga-labeled DOTA peptides should be an integral part of diagnostic workup of patients with lung carcinoid.

Topics: Adult; Aged; Carcinoid Tumor; Clinical Decision-Making; Female; Humans; Lung Neoplasms; Male; Middle Aged; Neoplasm Metastasis; Neoplasm Staging; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Retrospective Studies

Neuroendocrine tumors are slow-growing indolent tumors and often present with metastatic disease at the outset. We hereby discuss the Ga DOTANOC PET-CT findings of a 48-year-old man who has underwent lobectomy for bronchial carcinoid and developed multiple metastatic disease thereafter with event-free survival for the last 12 years.

Topics: Bronchial Neoplasms; Carcinoid Tumor; Humans; Male; Middle Aged; Neoplasm Metastasis; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals

68Gallium DOTA-PET imaging is preferable to standard somatostatin receptor scintigraphy where available; however, its role in the management of lung carcinoid tumours (LC) remains unclear.. All consecutive patients with histologically confirmed LC from two ENETS Centres of Excellence were identified retrospectively. The primary objective was to assess the impact of 68Ga-DOTANOC-PET on clinical management in patients with LC.. Of 166 patients screened, 46 were eligible: 52% female, median age 57 years (range 21-86); type of LC: diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (4%), typical (44%), atypical (35%), not reported (17%); stage: localised (63%), locally advanced (13%), and metastatic (17%) (7% unknown). A total of 47 68Ga-DOTANOCs were performed with the following rationale: LC diagnosis confirmation (4; 9%), primary tumour identification (2; 4%), post-surgical assessment (19; 40%), staging (patients with known LC present at time of 68Ga-DOTANOC) (19; 40%), and consideration of peptide receptor radionuclide therapy (3; 7%). Twenty-seven (57%) scans showed evidence of non-physiological uptake: median maximum standardised uptake value 7.2 (range 1.42-53). 68Ga-DOTANOC provided additional information in 37% (95% CI 22-51) of patients and impacted on management in 26% (95% CI 12-41); 9 patients (21%) were identified to have occult sites of metastases. Out of the 19 patients with post-surgical 68Ga-DOTANOC, 3 (16%) were identified to have distant metastases. There were no differences in the rate of practice changing 68Ga-DOTANOC results by type of LC (p value 0.5).. Our results support the role of 68Ga-DOTANOC for optimising the management of patients with LC, including post-surgical re-staging due to the potential for identifying occult metastases.

Topics: Adult; Aged; Aged, 80 and over; Carcinoid Tumor; Disease Management; Female; Humans; Lung; Lung Neoplasms; Male; Middle Aged; Neoplasm Metastasis; Organometallic Compounds; Positron-Emission Tomography; Radiopharmaceuticals; Retrospective Studies; Young Adult

Malignant tumors account for most sources of ectopic ACTH Cushing syndrome (EA-CS). Early localization of the source and complete removal can be curative and also prevent metastasis. Diagnostic CT is known to perform better than PET/CT (low dose) in characterizing lung pathologies. However, bronchial carcinoids, a common source of EA-CS, may be difficult to detect on chest CT scan especially when it is small and located close to the hilar region. We present a case of EA-CS due to bronchial carcinoid, which was easily seen on Ga DOTANOC PET/CT after a diagnostic chest CT was reported as normal.

Topics: ACTH Syndrome, Ectopic; Bronchial Neoplasms; Carcinoid Tumor; Cushing Syndrome; Female; Humans; Middle Aged; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals

The aims of this study were to retrospectively evaluate and compare the detection rate (DR) of 68Ga-DOTA-peptide and 18F-FDG PET/CT in the preoperative workup of patients with pulmonary carcinoid (PC) and to assess the utility of various functional indices obtained with the 2 tracers in predicting the histological characterization of PC, that is, typical versus atypical.. Thirty-three consecutive patients with confirmed PC referred for 18F-FDG and 68Ga-DOTA-peptide PET/CT in 2 centers between January 2009 and April 2013 were included. The semiquantitative evaluation included the SUV max, the SUV of the tumor relative to the maximal liver uptake for 18F-FDG (SUV T/L) or the maximal spleen uptake for 68Ga-DOTA-peptides (SUV T/S), the ratio between SUV max of 68Ga-DOTA-peptides PET/CT, and the SUV max of 18F-FDG PET/CT (SUV max ratio). Histology was used as reference standard.. Definitive diagnosis consisted of 23 typical carcinoids (TCs) and 10 atypical carcinoids. 18F-FDG PET/CT was positive in 18 cases and negative in 15 (55% DR). 68Ga-DOTA-peptide PET/CT was positive in 26 cases and negative in 7 (79% DR). In the subgroup analysis, 68Ga-DOTA-peptide PET/CT was superior in detecting TC (91% DR; P < 0.001), whereas 18F-FDG PET/CT was superior in detecting atypical carcinoid (100% DR; P = 0.04). The SUV max ratio was the most accurate semiquantitative index in identifying TC.. Overall diagnostic performance of PET/CT in detecting PC is optimal when integrating 18F-FDG and 68Ga-DOTA-peptide PET/CT findings. In the subgroup analysis, the SUV max ratio seems to be the most accurate index in predicting TC. Both methods should be performed when PC is suspected or when the histological subtype is undefined.

Topics: Adult; Aged; Aged, 80 and over; Carcinoid Tumor; Female; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Male; Middle Aged; Multimodal Imaging; Octreotide; Organometallic Compounds; Positron-Emission Tomography; Retrospective Studies; Tomography, X-Ray Computed

A 37-year-old woman with clinical and biochemical features of ectopic adrenocorticotropic hormone (ACTH) syndrome underwent 68Ga DOTANOC PET/CT to localize the source of ectopic ACTH secretion. The images showed 35 × 45-mm retroperitoneal mass with significantly increased tracer uptake. Plasma-free metanephrines and serum chromogranin levels were normal. Whole-body 131I-MIBG scan including the retroperitoneal mass did not show any abnormal uptake. On excision, histopathology of this paravertebral abdominal mass revealed carcinoid tumor. We suggest the use of 68Ga DOTANOC PET/CT as a first-line imaging modality for localization of source of ACTH secretion in ectopic ACTH syndrome.

Topics: 3-Iodobenzylguanidine; ACTH Syndrome, Ectopic; Adult; Carcinoid Tumor; Female; Humans; Multimodal Imaging; Organometallic Compounds; Positron-Emission Tomography; Retroperitoneal Neoplasms; Tomography, X-Ray Computed

Topics: Aged; Carcinoid Tumor; Gallium Radioisotopes; Humans; Lung Neoplasms; Male; Multimodal Imaging; Neoplasm Metastasis; Organometallic Compounds; Positron-Emission Tomography; Tomography, X-Ray Computed

The management of neuroendocrine tumours is challenging when curative surgery is ruled out because of distant metastases. We report a case of gastrointestinal carcinoid with bilateral ovarian metastases in a 50-year-old female who received octreotide therapy followed by peptide receptor radionuclide therapy and surgery thereafter. Somatostatin receptor expression on neuroendocrine tumours has implications in diagnosis and therapy. (68)Ga-DOTA-NOC PET is a recent advancement in the field of somatostatin receptor imaging. The lesions which demonstrate tracer uptake on positron emission tomographic studies can be further planned for treatment with octreotide and (177)Lu-DOTA-TATE. The case in discussion responded well to non-invasive treatment options before proceeding to definitive surgical management.

Topics: Antineoplastic Agents; Carcinoid Tumor; Female; Gastrointestinal Neoplasms; Humans; Middle Aged; Octreotide; Organometallic Compounds; Ovarian Neoplasms; Positron-Emission Tomography; Radiopharmaceuticals; Receptors, Somatostatin

Topics: Carcinoid Tumor; Cushing Syndrome; Humans; Lung Neoplasms; Octreotide; Organometallic Compounds; Positron-Emission Tomography; Radiopharmaceuticals; Tomography, X-Ray Computed

Conventional imaging techniques [computed tomography (CT), ultrasound, magnetic resonance] and somatostatin receptor scintigraphy are often insufficient to make a conclusive diagnosis of bronchial carcinoid (BC). PET is commonly used for the assessment of lung cancer but 18F-fluorodeoxyglucose, the most frequently used PET tracer, presents a low sensitivity for the detection of neuroendocrine tumours (NETs). New PET radiopharmaceuticals such as 68Ga-DOTA peptides, which directly bind to somatostatin receptors and are usually expressed on NET cell surfaces, have been reported to be superior to both morphological and somatostatin receptor scintigraphy imaging for gastroenteropancreatic NETs. However, their role in BC has never been evaluated. Our aim is to evaluate the role of 68Ga-DOTA-NOC (68Ga-labelled [1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid]-1-Nal3-octreotide) PET for the assessment of BC patients.. Ten patients with pathologically proven well-differentiated BC and one patient with highly suggestive CT images for BC were studied by 68Ga-DOTA-NOC PET/CT. PET findings were compared with clinical follow-up, pathology and contrast-enhanced CT findings.. 68Ga-DOTA-NOC PET/CT detected at least one lesion in nine of 11 patients and was negative in two. PET/CT and contrast-enhanced CT were discordant in eight of 11 patients, whereas in only three patients both provided similar results. PET/CT detected a higher number of lesions in five patients and excluded malignancy at sites considered positive on CT in three of 11; follow-up confirmed PET/CT findings in all patients. In PET/CT-positive patients, the mean maximal standardized uptake value was 25.9 [4.4-60.5]. On a clinical basis, PET/CT provided additional information in nine of 11 patients leading to the changes in the clinical management of three of nine patients.. PET/CT with Ga-DOTA-NOC was useful in BC patients because it led to a better evaluation of the extent of the disease.

Topics: Aged; Aged, 80 and over; Autoradiography; Bronchial Neoplasms; Carcinoid Tumor; Female; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Neoplasm Metastasis; Octreotide; Organometallic Compounds; Positron-Emission Tomography; Radiopharmaceuticals; Tomography, Emission-Computed

Topics: Aged; Aged, 80 and over; Autoradiography; Bronchial Neoplasms; Carcinoid Tumor; Female; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Neoplasm Metastasis; Octreotide; Organometallic Compounds; Positron-Emission Tomography; Radiopharmaceuticals; Tomography, Emission-Computed