gallium-ga-68-dotatate and Carcinoma--Neuroendocrine

Topics: Antineoplastic Agents; Carcinoma, Neuroendocrine; Humans; Neoplasm Metastasis; Neoplasm Staging; Organometallic Compounds; Peptides, Cyclic; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Sensitivity and Specificity; Somatostatin

Endocrine tumors comprise a range of benign and malignant conditions that produce a spectrum of clinical symptoms and signs depending on the specific hormones they produce. The symptoms and presentations of these tumors are often independent of their size and location. Because of their expression of cell membrane receptors or production of specific types of hormones or peptides, endocrine tumors can be identified with functional radionuclide imaging much more readily compared to standard cross-sectional imaging. In recent years, 18F-fluoro-deoxy- D-glucose positron emission tomography (18F-FDG-PET) has emerged as a useful tool for diagnosing and assessing many tumors. In this review we describe how PET, using 18F-FDG and other radiopharmaceuticals can be useful in the diagnosis and management of a wide range of endocrine tumors.

Topics: Adrenal Gland Neoplasms; Adrenal Medulla; Carcinoma, Neuroendocrine; Catecholamines; Cushing Syndrome; Endocrine Gland Neoplasms; Fluorodeoxyglucose F18; Humans; Organometallic Compounds; Parathyroid Neoplasms; Pituitary Neoplasms; Positron-Emission Tomography; Radiopharmaceuticals; Receptors, Somatostatin; Thyroid Neoplasms; Tomography, X-Ray Computed

Metastatic medullary thyroid cancer (MTC) is a rare malignancy with minimal treatment options. Many, but not all, MTCs express somatostatin receptors.. Our aim was to explore the role of 68Ga-DOTA-somatostatin analogue (SSA) positron emission tomography (PET)/computed tomography (CT) in patients with metastatic MTC and to determine their eligibility for peptide receptor radionuclide therapy (PRRT).. We retrospectively identified patients with metastatic MTC who had 68Ga-DOTA-SSA PET/CT at 5 centers. We collected characteristics on contrast-enhanced CT, 68Ga-DOTA-SSA and 18F-FDG PET/CT. The efficacy of PRRT was explored in a subgroup of patients. Kaplan-Meier analysis was used to estimate time to treatment failure (TTF) and overall survival (OS).. Seventy-one patients were included (10 local recurrence, 61 distant disease). Of the patients with distant disease, 16 (26%) had ≥50% of disease sites with tracer avidity greater than background liver, including 10 (10/61, 16%) with >90%. In 19 patients with contemporaneous contrast-enhanced CT, no disease regions were independently identified on 68Ga-DOTA-SSA PET/CT. Thirty-five patients had an 18F-FDG PET/CT, with 18F-FDG positive/68Ga-DOTA-SSA negative metastases identified in 15 (43%). Twenty-one patients had PRRT with a median TTF of 14 months (95% CI 8-25) and a median OS of 63 months (95% CI 21-not reached). Of the entire cohort, the median OS was 323 months (95% CI 152-not reached). Predictors of poorer OS included a short calcitonin doubling-time (≤24 months), strong 18F-FDG avidity, and age ≥60 years.. The prevalence of high tumor avidity on 68Ga-DOTA-SSA PET/CT is low in the setting of metastatic MTC; nevertheless, PRRT may still be a viable treatment option in select patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma, Neuroendocrine; Female; Follow-Up Studies; Humans; Male; Middle Aged; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Prognosis; Receptors, Peptide; Receptors, Somatostatin; Retrospective Studies; Somatostatin; Survival Rate; Thyroid Neoplasms; Young Adult

Topics: Adult; Carcinoma, Neuroendocrine; Corticotropin-Releasing Hormone; Female; Humans; Organometallic Compounds; Pancreatic Neoplasms; Positron Emission Tomography Computed Tomography

Topics: Carcinoma, Neuroendocrine; Fluorodeoxyglucose F18; Humans; Male; Middle Aged; Neoplasm Grading; Organometallic Compounds; Positron Emission Tomography Computed Tomography

Ga-DOTATATE, a positron-emitting somatostatin analog, has been approved by the Food and Drug Administration for imaging neuroendocrine tumors (NETs). The presence of a second primary malignancy is common in NETs; however, synchronous primary malignancy in the thyroid has rarely been reported. The value of Ga-DOTATATE in medullary thyroid cancer is being investigated and is currently recommended for use when treatment with somatostatin analogs is an option. We present a 55-year-old man with abdominal pain associated with well-differentiated NET liver metastases and incidental medullary thyroid carcinoma demonstrated on a Ga-DOTATATE PET/CT.

Topics: Carcinoma, Neuroendocrine; Humans; Incidental Findings; Liver Neoplasms; Male; Middle Aged; Neuroendocrine Tumors; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Thyroid Neoplasms

Persistent disease after surgery is common in medullary thyroid cancer (MTC), requiring lifelong radiological surveillance. Staging workup includes imaging of neck, chest, abdomen, and bones. A study integrating all sites would be ideal. Despite the established use of gallium-68 (68Ga) positron emission tomography (PET)/CT with somatostatin analogues in most neuroendocrine tumors, its efficacy is controversial in MTC.. Evaluate the efficacy of 68Ga PET/CT in detecting MTC lesions and evaluate tumor expression of somatostatin receptors (SSTRs) associated with 68Ga PET/CT findings.. Prospective study evaluating 30 patients with MTC [group 1 (n = 16), biochemical disease; group 2 (n = 14), metastatic disease]. Patients underwent 68Ga PET/CT, bone scan, CT and ultrasound of the neck, CT of the chest, CT/MRI of the abdomen, and MRI of the spine. 68Ga PET/CT findings were analyzed by disease site as positive or negative and as concordant or discordant with conventional studies. Sensitivity and specificity were calculated using pathological or cytological analysis or unequivocal identification by standard imaging studies. Immunohistochemical analysis of SSTRs was compared with 68Ga PET/CT findings.. In both groups, 68Ga PET/CT was inferior to currently used imaging studies except for bone scan. In group 2, 68Ga PET/CT sensitivities were 56%, 57%, and 9% for detecting neck lymph nodes, lung metastases, and liver metastases, respectively, and 100% for bone metastases, superior to the bone scan (44%). Expression of SSTRs, observed in 44% of tumors, was not associated with 68Ga-DOTATATE uptake.. 68Ga PET/CT does not provide optimal whole-body imaging as a single procedure in patients with MTC. However, it is highly sensitive in detecting bone lesions and could be a substitute for a bone scan and MRI.

Topics: Adult; Aged; Bone Neoplasms; Carcinoma, Neuroendocrine; Female; Gallium Radioisotopes; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Prospective Studies; Sensitivity and Specificity; Thyroid Neoplasms; Ultrasonography; Young Adult

Topics: Aged; Biopsy; Carcinoma, Neuroendocrine; Humans; Immunohistochemistry; Lymphoma, B-Cell; Magnetic Resonance Imaging; Male; Necrolytic Migratory Erythema; Neoplasm Grading; Neoplasms, Multiple Primary; Organometallic Compounds; Pancreatic Neoplasms; Positron Emission Tomography Computed Tomography; Predictive Value of Tests; Radiopharmaceuticals

We report a case of a medullary thyroid carcinoma noncalcified brain metastasis characterized on Ga-dotatate PET/CT but not on an F-fluoride PET/CT performed 1 month later. Subsequent F-fluoride PET/CT studies performed 7 and 19 months after the Ga-dotatate PET/CT study demonstrated focal uptake in the metastasis. The CT images of the last PET/CT study also depicted a small focus of calcification beginning in the metastatic site.

Topics: Brain Neoplasms; Carcinoma, Neuroendocrine; Fluorides; Fluorine Radioisotopes; Humans; Male; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Thyroid Neoplasms; Young Adult

Ectopic adrenocorticotropic hormone (ACTH) secretion is a less common cause of Cushing syndrome and is seen in 5 to 10% of cases with endogenous hypercortisolemia. We hereby describe our experience of patients with ectopic ACTH syndrome, who have been managed over the past 10 years at a tertiary care center in Southern India.. The inpatient and outpatient records of patients from 2006 to 2015 were retrospectively reviewed. The clinical features, clinical history, biochemical values, imaging features, including radiologic findings and positron emission tomography scans, management, details of follow-up, and outcomes, were documented. We compared the biochemical findings in these patients with 20 consecutive patients with Cushing disease (Cushing syndrome of pituitary origin).. A total of 21 patients were studied. The median age at presentation was 34 years (range, 19 to 55 years). Seven patients had thymic carcinoid, 7 had bronchial carcinoid, 3 had lung malignancies, 2 had medullary carcinoma thyroid, 1 patient had a pancreatic neuroendocrine tumor, and 1 patient had an occult source of ACTH. The most common clinical features at presentation were muscle weakness (95%), hyperpigmentation (90%), facial puffiness (76%), easy bruising (61%), edema (57%), and striae (52%). Extensive acne was seen in a large number of patients (43%). Only 3 patients (14%) had central obesity. The median 8 am cortisol was 55.5 μg/dL (range, 3.8 to 131 μg/dL), median 8 am ACTH was 207 pg/mL (range, 31.1 to 703 pg/mL), and the median 24-hour urinary free cortisol was 2,484 μg (range, 248 to 25,438 μg). Basal cortisol and ACTH, as well as midnight cortisol and ACTH level, were markedly higher in patients with ectopic Cushing syndrome as compared to patients with Cushing disease. Twelve of 21 patients had developed life-threatening infections by follow-up. Nine patients had undergone surgical intervention to address the primary tumor. However, only 1 patient exhibited a complete cure on follow-up.. In our series, ectopic Cushing syndrome was most commonly seen in association with intrathoracic tumors such as bronchial or thymic carcinoid. Hyperpigmentation and proximal myopathy were frequent, while central obesity was uncommon. Early and rapid control of hypercortisolemia was important in order to prevent life-threatening infections and metabolic complications.. ACTH = adrenocorticotropic hormone CT = computed tomography DOTATATE =

Topics: Acne Vulgaris; ACTH Syndrome, Ectopic; Adult; Bronchial Neoplasms; Carcinoid Tumor; Carcinoma, Neuroendocrine; Cushing Syndrome; Edema; Female; Humans; Hydrocortisone; Hyperpigmentation; India; Lung Neoplasms; Male; Middle Aged; Muscle Weakness; Neoplasms; Neuroendocrine Tumors; Obesity, Abdominal; Organometallic Compounds; Pancreatic Neoplasms; Positron-Emission Tomography; Radiopharmaceuticals; Retrospective Studies; Tertiary Care Centers; Thymus Neoplasms; Thyroid Neoplasms; Young Adult

The neuroendocrine small cell carcinoma of the cervix is a rare malignancy that has a poor prognosis due to early lymphatic and hematogenous spread. We herein report a case of a 27- year-old woman who was referred for initial staging of a neuroendocrine small cell carcinoma with previous unremarkable structural imaging. Ga-DOTATATE PET/CT revealed focal uptake at the primary tumor and in a solitary pelvic bone lesion suggestive of metastases that was further confirmed by CT-guided biopsy. Somatostatin receptor PET/CT may be a useful image modality for early detection of metastases to guide treatment in these patients.

Topics: Adult; Bone Neoplasms; Carcinoma, Neuroendocrine; Carcinoma, Small Cell; Female; Humans; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Uterine Cervical Neoplasms

Topics: Bone Neoplasms; Carcinoma, Neuroendocrine; Decision Making; Fluorides; Fluorine Radioisotopes; Humans; Neuroendocrine Tumors; Octreotide; Organometallic Compounds; Organophosphorus Compounds; Pain; Positron-Emission Tomography; Precision Medicine; Thyroid Neoplasms; Tomography, X-Ray Computed

a 75-year-old man with a 10-year history of nodular goitre was referred for clinical evaluation. The ultrasound scan revealed enlarged thyroid right lobe almost fully filled with a heterogeneous nodule with numerous calcifications. Fine-needle aspiration biopsy suggested medullary thyroid carcinoma (MTC). Before the surgery the patient was referred to the nuclear medicine department and somatostatin receptor imaging (SRS; 68Ga-DOTATATE) with PET/CT was performed. The scan demonstrated an increased uptake within the right thyroid mass. Subsequent PET/CT with 68Ga-gastrin analogue (MG48) revealed the same indications as the SRS: an increased alveolar uptake in the right thyroid mass without the signs of lymph node metastases. The patient underwent total thyroidectomy and central lymph nodes dissection. Histopathology examination confirmed the presence of MTC with vascular invasion, but without lymph node metastases (pT3NoMx according to the 7th edition of the AJCC Cancer Staging Manual). Immunohistochemical staining revealed positive reaction to calcitonin and CD56, whereas the reaction to thyroglobulin remained negative. The Ki-67 was 1%. Staining for SSTR2 and CCK2 showed high cytoplasmic expression in both cases. Knowledge of the presence of CCK2 receptor in MTC patients may be an important indication for the choice of diagnostic and therapeutic procedures. The presence of both the receptor types, cholecystokinin-2/gastrin and somatostatin, is possibly an interesting combination as far as the therapeutic target is concerned.

Topics: Aged; Carcinoma, Neuroendocrine; Gastrins; Humans; Male; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Receptor, Cholecystokinin B; Receptors, Somatostatin; Somatostatin; Thyroid Neoplasms; Thyroidectomy

A 51-year-old man with a history of metastatic medullary thyroid cancer (MTC) presented with high adrenocorticotropin (ACTH) and urinary free cortisol levels. The diagnosis of ectopic ACTH production, a rare MTC complication, was established in this patient. PET/CT using the somatostatin analogue DOTA-(Tyr)-octreotate labeled with gallium (Ga-DOTATATE) was performed, showing positive radionuclide uptake in multiple MTC metastases. After this therapy with the novel somatostatin analogue, pasireotide was initiated after which urinary free cortisol and ACTH levels decreased. The present case thus illustrates a potential theranostic use of Ga-DOTATATE PET/CT in MTC.

Topics: Adrenocorticotropic Hormone; Carcinoma, Neuroendocrine; Humans; Male; Middle Aged; Multimodal Imaging; Organometallic Compounds; Positron-Emission Tomography; Radiopharmaceuticals; Somatostatin; Thyroid Neoplasms; Tomography, X-Ray Computed

We aimed to compare the efficacies of gallium-68 (68Ga) DOTATATE PET-computed tomography (CT), fluorine-18 fluorodeoxyglucose (18F-FDG) PET-CT and technetium-99m (99mTc)-(V)DMSA scintigraphy in the detection of residual/metastatic medullary thyroid carcinoma (MTC).. We retrospectively evaluated DOTATATE PET-CT, 18F-FDG PET-CT and (V)DMSA scintigraphy of 22 MTC patients, all taken within a 6-month period in each patient, because of high levels of calcitonin (Ct) and carcinoembryonic antigen (CEA). We investigated the relationships between the results of the imaging modalities and tumour marker levels and the sporadic versus hereditary nature of the disease, as well as the effect of imaging results on patient management.. The ages of the patients at diagnosis were between 20 and 69 years. The median levels of Ct and CEA were 871.5 pg/ml and 11.2 ng/ml, respectively. In the patient-based analysis, we observed at least one focus of abnormal uptake in 15 of 22 DOTATATE PET-CT (68.2% sensitivity), eight of 18 18F-FDG PET-CT (44.4% sensitivity) and five of 15 (V)DMSA scans (33.3% sensitivity). These data showed a significant difference between DOTATATE PET-CT and (V)DMSA scintigraphy (P=0.016), whereas the relationships between DOTATATE PET-CT and 18F-FDG PET-CT and between 18F-FDG PET-CT and (V)DMSA scintigraphy showed no significant differences (P>0.05). In the lesion-based analysis, 134 lesions were detected with DOTATATE PET-CT, 76 lesions with 18F-FDG PET-CT and nine lesions with (V)DMSA scintigraphy.. DOTATATE PET-CT is an efficient imaging modality in MTC patients with increased Ct and CEA (especially >1000 pg/ml and 50 ng/ml, respectively) for localizing recurrent or metastatic disease. 18F-FDG PET-CT can be performed if DOTATATE PET-CT is not available, but (V)DMSA scintigraphy is not recommended.

Topics: Adult; Aged; Biomarkers, Tumor; Carcinoma, Neuroendocrine; Female; Fluorodeoxyglucose F18; Humans; Male; Middle Aged; Multimodal Imaging; Neoplasm Metastasis; Neoplasm, Residual; Organometallic Compounds; Positron-Emission Tomography; Retrospective Studies; Technetium Tc 99m Dimercaptosuccinic Acid; Thyroid Neoplasms; Tomography, X-Ray Computed; Whole Body Imaging; Young Adult

A 50-year-old male patient with a history of medullary thyroid cancer and extensive previous investigation including FDG PET 18 months earlier presented for a Ga-dotatate scan. A single area of abnormal uptake was identified in the right ninth rib. An MRI scan and bone scan confirmed the bony metastasis; however, the MRI of the liver demonstrated multiple liver metastases not apparent on the PET study. These remained occult despite coregistration of the MRI and PET data. The occult nature of these lesions may have been due to a similar degree of uptake in the liver and metastases.

Topics: Carcinoma, Neuroendocrine; Fluorodeoxyglucose F18; Humans; Liver Neoplasms; Male; Middle Aged; Organometallic Compounds; Positron-Emission Tomography; Thyroid Neoplasms