gallium-ga-68-dotatate and Intestinal-Neoplasms

Neuroendocrine tumors (NETs) are uncommon tumors with increasing incidence and prevalence. Current reports suggest that (68)Ga-DOTATATE PET/CT imaging improves diagnosis and staging of NETs compared with (111)In-DTPA-octreotide and conventional imaging. We performed a systematic review of (68)Ga-DOTATATE for safety and efficacy compared with octreotide and conventional imaging to determine whether available evidence supports U.S. Food and Drug Administration approval.. Medline, EMBASE, Web of Science, and Cochrane Reviews electronic databases were searched from January 1999 to September 2015. Results were restricted to human studies comparing diagnostic accuracy of (68)Ga-DOTATATE with octreotide or conventional imaging for pulmonary or gastroenteropancreatic NET and for human studies reporting safety/toxicity for (68)Ga-DOTATATE with 10 subjects or more thought to have NETs. Direct communication with corresponding authors was attempted to obtain missing information. Abstracts meeting eligibility criteria were collected by a research librarian and assembled for reviewers; 2 reviewers independently determined whether or not to include each abstract. If either reviewer chose inclusion, the abstract was accepted for review.. Database and bibliography searches yielded 2,479 articles, of which 42 were eligible. Three studies compared the 2 radiopharmaceuticals in the same patient, finding (68)Ga-DOTATATE to be more sensitive than octreotide. Nine studies compared (68)Ga-DOTATATE with conventional imaging. (68)Ga-DOTATATE estimated sensitivity, 90.9% (95% confidence interval, 81.4%-96.4%), and specificity, 90.6% (95% confidence interval, 77.8%-96.1%), were high. Five studies were retained for safety reporting only. Report of harm possibly related to (68)Ga-DOTATATE was rare (6 of 974), and no study reported major toxicity or safety issues.. No direct comparison of octreotide and (68)Ga-DOTATATE imaging for diagnosis and staging in an unbiased population of NETs has been published. Available information in the peer-reviewed literature regarding diagnostic efficacy and safety supports the use of (68)Ga-DOTATATE for imaging of NETs where it is available.

Topics: Humans; Intestinal Neoplasms; Lung Neoplasms; Neuroendocrine Tumors; Octreotide; Organometallic Compounds; Pancreatic Neoplasms; Pentetic Acid; Positron Emission Tomography Computed Tomography; Stomach Neoplasms

A prospective clinical trial evaluated the effect of Ga-DOTATOC positron emission tomography-computerized axial tomography (PET-CT) on change in management of patients with lung, pancreatic, and small bowel neuroendocrine tumors. The primary eligibility criterion was a histologically proven tumor with positive somatostatin receptor subtype 2A immunohistochemistry. The primary and secondary end points were change in patient management and safety.. Referring physicians completed questionnaires pre- and post-Ga-DOTATOC PET-CT, stating current and planned patient management, respectively, with tumor board adjudication of final management decisions. Change in management was categorized as follows: no change; minor change (additional imaging, supportive care); or major change (octreotide/lanreotide therapy, tumor biopsy, surgery, peptide receptor radiotherapy, chemotherapy, biological therapy, liver embolization).. A major change in management was recommended for 54 (47.37%) of 114 subjects and a minor change for 6 (5.26%) of 114 subjects, with no change for 54 (47.37%) of 114 subjects. Grade 1 adverse events were observed in 26 of 114 subjects (nausea, headache, back pain, diarrhea); one grade 2 (petechiae) and one grade 3 (abdominal pain) adverse event were observed. No grade 2 or 3 adverse events were related to study drug and none required intervention.. Imaging with Ga-DOTATOC PET-CT has a significant impact on management of patients with neuroendocrine tumors.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Humans; Infant; Intestinal Neoplasms; Male; Middle Aged; Neuroendocrine Tumors; Organometallic Compounds; Outcome Assessment, Health Care; Pancreatic Neoplasms; Positron Emission Tomography Computed Tomography; Prospective Studies; Young Adult

Topics: Abdominal Pain; Biopsy; Diagnosis, Differential; Humans; Intestinal Neoplasms; Lymph Nodes; Lymphatic Metastasis; Male; Mesenteric Artery, Superior; Mesenteric Veins; Mesentery; Middle Aged; Neuroendocrine Tumors; Organometallic Compounds; Panniculitis, Peritoneal; Peritoneal Neoplasms; Radionuclide Imaging; Tomography, X-Ray Computed; Weight Loss

Somatostatin analog functional imaging with gallium-68 (Ga-68) dotatate positron emission tomography/computed tomography (PET/CT) has demonstrated superiority in lesion detection in patients with neuroendocrine tumors (NETs). The clinical impact of this imaging modality on US surgical and medical oncology practices has not been established.. Consecutive patients with NET at our institution who received an initial Ga-68 dotatate PET/CT between July 2017 and September 2018 were included. Ga-68 dotatate PET/CT was compared with prior imaging.. Among 101 eligible patients, 51 of 50 were female/male, site of origin was gastroenteropancreatic (75%), unknown primary (13%), lung (8%), thymus (2%), and other (2%). All NETs were histologically well/moderately differentiated. Ga-68 dotatate imaging findings altered management in 36 (35.6%) patients: documentation of progression led to the initiation of systemic therapy in 14 patients, obviated the need for biopsy in four patients, and altered surgical plans in 7 of 14 (50%) patients referred for surgery. In 11 patients, decisions regarding peptide receptor radionucleotide therapy and somatostatin analogs were altered.. In this series, Ga-68 dotatate PET/CT altered diagnosis and management in one-third of patients and changed operative plans in half of the patients who were referred for surgical evaluation. These results support the routine use of this imaging in the care of patients with early-stage and advanced NETs.

Topics: Female; Gallium Radioisotopes; Humans; Intestinal Neoplasms; Lung Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasms, Unknown Primary; Neuroendocrine Tumors; Organometallic Compounds; Pancreatic Neoplasms; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Retrospective Studies; Stomach Neoplasms; Thymus Neoplasms

In our study, tumor heterogeneity was evaluated using the parameters skewness and kurtosis on pretreatment Ga-68 DOTA-TATE PET/CT to assess therapy responses of lesions in patients with gastroenteropancreatic neuroendocrine tumors (GEP NETs) treated with peptide receptor radionuclide therapy (PRRT).. We retrospectively studied the texture analysis with relatively simple first-order parameters skewness and kurtosis on pretreatment Ga-68 DOTA-TATE PET/CT from 22 patients (eight females, 14 males; with a mean age: 54 ± 11 years) with GEP NETs who were treated with 2-6 therapy cycles of Lu-177 DOTA-TATE. A total of 326 lesions of 22 patients were evaluated in terms of treatment response by Ga-68 DOTA-TATE PET/CT examination performed before and after treatment. Receiver-operating characteristic (ROC) curves were generated to assess skewness and kurtosis to discriminate between responder and nonresponder lesions.. A total of 326 lesions of 22 patients were evaluated and 137 lesions responded partially or completely to the treatment, 189 lesions did not respond to treatment, remained stable or progressed. The skewness and kurtosis values of the lesions which did not respond to the PRRT were significantly higher than those with response to PRRT treatment (P < 0.001 and P = 0.004, respectively). However, ROC curves provided a moderate area under the curve value for skewness and a relatively low value for kurtosis (0.619 and 0.518, respectively).. Texture analysis using skewness and kurtosis of the lesions on pretreatment Ga-68 DOTA-TATE PET/CT was able to predict their responsiveness to PRRT.

Topics: Female; Humans; Image Processing, Computer-Assisted; Intestinal Neoplasms; Male; Middle Aged; Neuroendocrine Tumors; Organometallic Compounds; Pancreatic Neoplasms; Positron Emission Tomography Computed Tomography; Receptors, Peptide; Retrospective Studies; ROC Curve; Stomach Neoplasms; Treatment Outcome

The small bowel neuroendocrine tumor is a rare but ever-increasing tumor, most of the time asymptomatic and found incidentally. An early diagnosis can consistently change the prognosis.

Topics: Asymptomatic Diseases; Biopsy; Endoscopy, Gastrointestinal; Female; Humans; Incidental Findings; Intestinal Neoplasms; Intestine, Small; Middle Aged; Neuroendocrine Tumors; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals

A 71-year-old man with history of prostate cancer is evaluated for rising prostate-specific antigen. The patient also has a history of rectal well-differentiated neuroendocrine tumor. On F-fluciclovine PET/CT, 2 retroperitoneal lymph nodes exhibited intense fluciclovine avidity, whereas one enlarged perirectal lymph node only showed background uptake. On further Ga-DOTATATE PET/CT, the perirectal lymph node revealed intense DOTATATE avidity, whereas the 2 retroperitoneal lymph nodes only with similar to background DOTATATE avidity. Biopsy of the perirectal lymph node confirmed metastasis from neuroendocrine tumor. The distinct imaging characteristics of metastases from different primary malignancies correlated with their underlying different pathology.

Topics: Adenocarcinoma; Aged; Carboxylic Acids; Carcinoid Tumor; Cyclobutanes; Humans; Intestinal Neoplasms; Male; Neoplasm Metastasis; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Radiopharmaceuticals; Rectal Neoplasms

Carcinoid is a subtype of neuroendocrine tumor, a rare group of tumors that are known to express somatostatin receptor 2. Ga-DOTATATE is a somatostatin analog that is specific for somatostatin receptor 2 and therefore allows visualization of neuroendocrine tumors. We present 2 cases of primary multifocal small bowel carcinoid evaluated using Ga-DOTATATE PET/CT, along with contrast-enhanced CT corollary findings. Given the increased sensitivity of Ga-DOTATATE PET/CT compared with CT and In-octreotide scintigraphy, we expect multifocal carcinoid to become increasingly recognized.

Topics: Aged; Carcinoid Tumor; Humans; Intestinal Neoplasms; Intestine, Small; Male; Middle Aged; Organometallic Compounds; Positron Emission Tomography Computed Tomography

Of the GEP-NEN cases (73 males, 53 females; age 18-77 years) with pathologically proven primary and/or metastatic lesions, 126 were studied. All of the short axes of lesions were larger than 0.5 cm in order to avoid the partial volume effect. Patients fasted for 6 h before the PET/CT scans. The dose of [. In the total sample, the sensitivity of [68Ga]DOTATATE was 69.05 %. The sensitivities were significantly different among G1, G2, and G3 groups (72.22 %, 91.53 %, and 40.82 %, respectively; p < 0.01). The SUVmax of the G3 group was lowest. We also found that the sensitivity and SUVmax were significantly higher (p < 0.05) in patients with pancreatic NENs (Pan-NENs) than in patients with gastrointestinal NENs (Gi-NENs) and unknown primary NENs (Up-NENs). A significant negative correlation between SUVmax and Ki-67 was found (r = - 0.429, p < 0.01). Using SUVmax to differentiate neuroendocrine tumors (NETs) and neuroendocrine cancers (NECs), the area under the ROC curve (AUC) was 0.771 and the cutoff value of SUVmax was 11.25 (sensitivity 79.2 %, specificity 65.3 %). However, Pan-NENs did not show any statistical significance results in correlation and ROC analysis.

Topics: Adolescent; Adult; Aged; Area Under Curve; Cell Proliferation; Female; Humans; Intestinal Neoplasms; Ki-67 Antigen; Male; Middle Aged; Neuroendocrine Tumors; Organometallic Compounds; Pancreatic Neoplasms; Positron Emission Tomography Computed Tomography; Stomach Neoplasms; Young Adult

Incidental findings on PET CT studies are common. The distribution of Ga-DOTATATE is dependent on cell surface expression of somatostatin receptors, which may be pathologic or physiologic. Osteoporosis circumscripta is the early lytic phase of Paget disease associated with well-defined osteopenia, most commonly seen within the skull on imaging. The appearance has been well demonstrated on Tc HDP/MDP bone scans. Here, we present the case of a 76-year-old man with a small bowel carcinoid tumor who underwent staging imaging with Ga-DOTATATE PET CT with the incidental finding of osteoporosis circumscripta.

Topics: Aged; Carcinoid Tumor; Humans; Incidental Findings; Intestinal Neoplasms; Male; Neoplasm Staging; Organometallic Compounds; Osteitis Deformans; Positron Emission Tomography Computed Tomography

Out of 82 PT, 43 PT were not detected by any imaging modality. More PT lesions were detected with PET/CT (n = 39 [47.5%]) than with CE-CT (n = 10 [12.2%], p < 0.001). Also, PET/CT identified significantly more PC lesions than CE-CT (78 and 38%, p = 0.004, respectively).. PET/CT detected more PT and PC lesions than CE-CT. Some PTs and PC lesions were only detected by one of the modalities, and CT performed in conjunction with PET/CT should therefore be performed as a fully diagnostic CE-CT for optimal results. Palpation of the small bowel remains crucial during surgery in these patients because several PTs escaped detection by both PET/CT and CE-CT.

Topics: Adult; Aged; Contrast Media; Female; Gallium Radioisotopes; Humans; Intestinal Neoplasms; Intestine, Small; Male; Middle Aged; Neuroendocrine Tumors; Organometallic Compounds; Positron Emission Tomography Computed Tomography; Preoperative Period; Retrospective Studies; Somatostatin; Tomography, X-Ray Computed; Young Adult

A 40-year-old man with history of extramedullary plasmacytoma in nasal cavity presented with right submandibular mass for 3 months. F-FDG PET/CT demonstrated mild radioactivity in the right submandibular mass, pancreatic mass, and lymph nodes in the abdomen and left hilum of the lung. To differentiate from pancreatic neuroendocrine tumor, Ga-DOTATATE PET/CT was performed. The above lesions were TATE avid, and additional lesions with intense radioactivity were also detected in the right internal mammary node and intrapericardial node. Finally, biopsy of the right submandibular mass confirmed recurrence of extramedullary plasmacytoma.

Topics: Adult; Diagnosis, Differential; Fluorodeoxyglucose F18; Humans; Intestinal Neoplasms; Lymph Nodes; Male; Neuroendocrine Tumors; Nose Neoplasms; Organometallic Compounds; Pancreatic Neoplasms; Plasmacytoma; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Stomach Neoplasms

Metastases to the orbit occur rarely in midgut neuroendocrine tumor (NET) patients with only 20 cases reported to date. Patients typically present with bilateral involvement of the recti muscles and experience symptoms such as diplopia, proptosis, and decreased vision. Although orbital MRI remains the gold standard for imaging orbital disease, many orbital lesions are now detected on somatostatin-receptor (SSTR) based imaging such as 68Ga-DOTATATE PET-CT.. Patient 1 is a 72 year-old female with a well-differentiated G3 ileal NET who was incidentally diagnosed with orbital metastases during a hospitalization for pre-septal cellulitis in 2018. Her disease has been controlled with capecitabine rather than local therapy. Patient 2 is a 68 year-old male with a G2 ileal NET who was diagnosed with orbital involvement after developing left peri-orbital swelling in 2017. He was found to have bilateral rectus muscle involvement and was treated with image-guided radiation therapy (IGRT) to both orbits and achieved disease control. Patient 3 is a 63 year-old female with a well-differentiated G3 ileal NET who was incidentally diagnosed with bilateral orbital masses in her recti after undergoing a 68Ga-DOTATATE PET-CT in 2015. She was asymptomatic initially however has now developed diplopia. She will be starting 177Lu-DOTATATE peptide radionuclide receptor therapy (PRRT) shortly. Patient 4 is a 72 year-old male with a grade 2 ileal NET who was incidentally diagnosed with a left lateral rectus metastasis in 2007. This was monitored via surveillance MRI until it began to grow and became symptomatic in 2015. The patient received stereotactic radiation to the site and has been asymptomatic since. Patient 5 is a 61 year-old female with a grade 2 ileal NET who developed progressive diplopia in 2016. Bilateral orbital metastases were noted on orbital MRI and she completed IGRT to the sites shortly thereafter. In the setting of continued growth of the masses she was switched to chemotherapy with capecitabine which has controlled her orbital disease.. NETs can metastasize to the orbits. Orbital disease now often is detected on SSTR-based imaging rather than orbital MRI; when found, it changes treatment approach and surveillance for patients.

Topics: Aged; Female; Humans; Ileal Neoplasms; Intestinal Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neuroendocrine Tumors; Orbital Neoplasms; Organometallic Compounds; Pancreatic Neoplasms; Positron Emission Tomography Computed Tomography; Receptors, Somatostatin; Stomach Neoplasms

Functional imaging tests (FITs) detecting somatostatin receptor expression [i.e., somatostatin receptor scintigraphy, 68Ga-DOTA positron emission tomography/computed tomography (CT)] have a pivotal role in the diagnosis of neuroendocrine tumors (NETs), although their indication during follow-up still needs to be clarified.. Investigate the role of FITs after diagnosis of metastatic enteropancreatic NETs, identifying patients who might benefit from these exams.. Multicenter retrospective analysis of metastatic enteropancreatic NETs.. Analysis of imaging tests performed between January 1995 and December 2015 in Rome, Berlin, Milan, Marburg, or Graz.. One hundred forty-three patients with metastatic pancreatic NETs and small intestine NETs, at least 2-year follow-up, and positive FITs.. Patients had received CT every 6 months (unless clinical conditions and tumor behavior required shorter intervals) and FIT every 12 months.. Clinical usefulness of FITs, defined as changes in patient management (indication to biopsy, medical therapy, surgery, or further imaging tests) due only to FITs.. FITs affected management in 73.4% of patients, mostly when G2 vs G1 [odds ratio (OR), 2.40; 95% confidence interval (CI), 1.09 to 5.27; P = 0.03]. Changes were observed in a 12-month time frame especially with pancreatic NETs vs small intestine NETs (OR, 2.89; 95% CI, 1.09 - 7.67; P = 0.03) or metastases since diagnosis vs developed during follow-up (OR, 4.00; 95% CI, 1.43 to 11.17; P < 0.01).. FITs used in addition to CT in the follow-up of stage IV enteropancreatic NETs improve patient management (especially for G2 tumors). Follow-up program should be tailored according to tumor features.

Topics: Adult; Aged; Female; Follow-Up Studies; Humans; Intestinal Neoplasms; Intestine, Small; Lymph Nodes; Male; Middle Aged; Neoplasm Metastasis; Neuroendocrine Tumors; Organometallic Compounds; Pancreatic Neoplasms; Peritoneal Neoplasms; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Retrospective Studies

Gastro-entero-pancreatic neuroendocrine tumors (GEPNETs) are increasing in incidence, and accurate staging is important for selecting the appropriate treatment. (68)Ga-DOTATATE imaging is a promising approach for detecting GEPNETs and could help in selecting optimal therapeutic strategies. The aim of this study was to prospectively determine the clinical utility of (68)Ga-DOTATATE positron emission tomography (PET)/computed tomography (CT) in detecting unknown primary and metastatic GEPNETs.. One hundred thirty-one patients were enrolled in a prospective study of patients undergoing (68)Ga-DOTATATE PET/CT, (111)In-pentetreotide single-photon emission computed tomography (SPECT)/CT and multiphasic CT scan, and/or magnetic resonance imaging in a blinded fashion with comprehensive biochemical testing. The primary outcome measure was the detection of lesions by each imaging study.. (68)Ga-DOTATATE PET/CT imaging detected 95.1% of lesions (95% CI, 92.4% to 96.8%) with an average maximum standardized uptake value of 65.4 ± 47 (range, 6.9 to 244), anatomic imaging detected 45.3% of lesions (95% CI, 37.9% to 52.9%), and (111)In-pentetreotide SPECT/CT detected 30.9% of lesions (95% CI, 25.0% to 37.5%), with a significant difference between imaging modalities (P < .001). In four of 14 patients (28.6%), (68)Ga-DOTATATE PET/CT found a previously unknown primary tumor, and detected primary GEPNET, lymph node, and distant metastases correctly in 72 of 113 lesions (63.7%) when compared with histopathology, with 22.1% and 38.9% detected by using (111)In-pentetreotide SPECT/CT and anatomic imaging, respectively. On the basis of findings with (68)Ga-DOTATATE PET/CT, 43 of 131 patients (32.8%) had a change in management recommendation. In patients with carcinoid symptoms but negative biochemical testing, (68)Ga-DOTATATE PET/CT detected lesions in 65.2% of patients, 40% of which were detected neither by anatomic imaging nor by (111)In-pentetreotide SPECT/CT.. (68)Ga-DOTATATE PET/CT imaging provides important information for accurate staging of GEPNETs and selection of appropriate treatment interventions even in the absence of biochemical evidence of disease in symptomatic patients.

Topics: Adult; Aged; Aged, 80 and over; Chromogranin A; Female; Humans; Hydroxyindoleacetic Acid; Intestinal Neoplasms; Liver Neoplasms; Lymphatic Metastasis; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Neoplasms, Unknown Primary; Neuroendocrine Tumors; Organometallic Compounds; Pancreatic Neoplasms; Pancreatic Polypeptide; Phosphopyruvate Hydratase; Positron-Emission Tomography; Prospective Studies; Somatostatin; Stomach Neoplasms; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Vasoactive Intestinal Peptide; Young Adult

Our purpose was to evaluate the safety and efficacy of (68)Ga-DOTATATE PET/CT compared with (111)In-pentetreotide imaging for diagnosis, staging, and restaging of pulmonary and gastroenteropancreatic neuroendocrine tumors.. (68)Ga-DOTATATE PET/CT and (111)In-pentetreotide scans were obtained for 78 of 97 consecutively enrolled patients with known or suspected pulmonary or gastroenteropancreatic neuroendocrine tumors. Safety and toxicity were measured by comparing vital signs, serum chemistry values, or acquisition-related medical complications before and after (68)Ga-DOTATATE injection. Added value was determined by changes in treatment plan when (68)Ga-DOTATATE PET/CT results were added to all prior imaging, including (111)In-pentetreotide. Interobserver reproducibility of (68)Ga-DOTATATE PET/CT scan interpretation was measured between blinded and nonblinded interpreters.. (68)Ga-DOTATATE PET/CT and (111)In-pentetreotide scans were significantly different in impact on treatment (P < 0.001). (68)Ga-DOTATATE PET/CT combined with CT or liver MRI changed care in 28 of 78 (36%) patients. Interobserver agreement between blinded and nonblinded interpreters was high. No participant had a trial-related event requiring treatment. Mild, transient events were tachycardia in 1, alanine transaminase elevation in 1, and hyperglycemia in 2 participants. No clinically significant arrhythmias occurred. (68)Ga-DOTATATE PET/CT correctly identified 3 patients for peptide-receptor radiotherapy incorrectly classified by (111)In-pentetreotide.. (68)Ga-DOTATATE PET/CT was equivalent or superior to (111)In-pentetreotide imaging in all 78 patients. No adverse events requiring treatment were observed. (68)Ga-DOTATATE PET/CT changed treatment in 36% of participants. Given the lack of significant toxicity, lower radiation exposure, and improved accuracy compared with (111)In-pentetreotide, (68)Ga-DOTATATE imaging should be used instead of (111)In-pentetreotide imaging where available.

Topics: Female; Humans; Indium Radioisotopes; Intestinal Neoplasms; Lung Neoplasms; Male; Middle Aged; Neoplasm Staging; Neuroendocrine Tumors; Observer Variation; Organometallic Compounds; Pancreatic Neoplasms; Positron Emission Tomography Computed Tomography; Safety; Somatostatin; Stomach Neoplasms

Ga-DOTATATE PET/CT is increasingly used to image somatostatin receptor expressing tumors. Various intracranial tumors including medulloblastoma are known to express somatostatin receptors. We present a case of incidental cerebellar medulloblastoma on a staging Ga-DOTATATE PET/CT for appendiceal carcinoid.

Topics: Adult; Appendiceal Neoplasms; Carcinoid Tumor; Cerebellar Neoplasms; Female; Humans; Incidental Findings; Intestinal Neoplasms; Medulloblastoma; Organometallic Compounds; Positron Emission Tomography Computed Tomography

Surgery is the only definitive therapy for gastro-entero-pancreatic neuroendocrine tumors (GEPNETs), and achieving complete tumor resection is an important prognostic factor. Radiopharmaceuticals such as (68)Ga-DOTA peptides have been developed that offer superior accuracy for localization of GEPNETs. The study aim was to determine the feasibility of radio-guided surgery (RGS) using (68)Ga-DOTATATE in patients with primary and recurrent GEPNETs.. Fourteen patients with GEPNETs were enrolled onto a prospective study to determine the feasibility of RGS with (68)Ga-DOTATATE. Findings from preoperative imaging, intraoperative exploration, RGS, and pathology were analyzed.. The median decay corrected target count rate was 172.6 (range 28.15-2341) for tumors, with a tumor-to-background ratio (TBR) of 4.46 (range 1.6-43.56). The median lesion size was 1.55 (range 0.5-15) cm. There was no significant correlation between preoperative imaging maximum standardized uptake value (SUVmax) of the lesions and TBR (Spearman r = - 0.01, p = 0.9), TBR and tumor size (Spearman r = 0.29, p = 0.14), and SUVmax and tumor size (Spearman r = 0.22, p = 0.28). The probe showed correct identification for gastric and small intestine neuroendocrine tumor (NET), including lymph node metastasis in 17 (81.0 %) of 21 cases, with a median TBR of 3.5 (1.6-40.2). For pancreatic NETs and lymph node metastasis, 16 (66.7 %) of 24 were correctly identified by RGS.. Our study shows that RGS with (68)Ga-DOTATATE is feasible and correctly confirms bowel NETs and metastatic mesenteric lymph nodes. Further studies are needed to determine the benefit of RGS with (68)Ga-DOTATATE.

Topics: Adult; Aged; Biomarkers, Tumor; Feasibility Studies; Female; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Immunoenzyme Techniques; Intestinal Neoplasms; Male; Middle Aged; Multimodal Imaging; Neoplasm Grading; Neoplasm Staging; Neuroendocrine Tumors; Organometallic Compounds; Pancreatic Neoplasms; Positron-Emission Tomography; Prognosis; Prospective Studies; Radiopharmaceuticals; Radiotherapy, Image-Guided; Stomach Neoplasms; Tissue Distribution; Tomography, X-Ray Computed

Gastroenteropancreatic neuroendocrine tumors (GEPNETs) are indolent neoplasms presenting unpredictable and unusual biologic behavior that causes many clinical challenges. Tumor size, existence of metastasis, and histopathologic classification remain incapable in terms of treatment decision and prognosis estimation. This study aimed to compare (68)Ga-DOTATATE and (18)F-FDG PET/CT in GEPNETs and to investigate the relation between the complementary PET/CT results and histopathologic findings in the management of therapy, particularly in intermediate-grade patients.. The relation between complementary (68)Ga-DOTATATE and (18)F-FDG PET/CT results of 27 GEPNET patients (mean age, 56 y; age range, 33-79 y) and histopathologic findings was evaluated according to grade and localization using standardized maximum uptake values and Ki67 indices. Grade 2 (G2) patients were further evaluated in 2 groups as G2a (3%-9%) and G2b (10%-20%) according to Ki67 indices.. The sensitivity of (68)Ga-DOTATATE and (18)F-FDG PET/CT was 95% and 37%, respectively, and the positive predictive values were 93.8% and 36.2%, respectively. The sensitivity in detecting liver metastasis, lymph nodes, bone metastasis, and primary lesion was 95%, 95%, 90%, and 93% for (68)Ga-DOTATATE and 40%, 28%, 28%, and 75% for (18)F-FDG, respectively. Statistically significant differences were found between grades 1-2, 2a-2b, and 1-2b with respect to (68)Ga-DOTATATE PET/CT as well as between 1-2a and 1-2b with respect to (18)F-FDG PET/CT. However, no statistical differences were found between 1 and 2a (P > 0.05) for (68)Ga-DOTATATE and 2a and 2b (P = 0.484) for (18)F-FDG. The impact of the combined (18)F-FDG and (68)Ga-DOTATATE PET/CT on the therapeutic decision was 59%.. Combined (68)Ga-DOTATATE and (18)F-FDG PET/CT is helpful in the individual therapeutic approach of GEPNETs and can overcome the shortcomings of histopathologic grading especially in intermediate-grade GEPNETs.

Topics: Adult; Aged; Female; Fluorodeoxyglucose F18; Humans; Image Processing, Computer-Assisted; Intestinal Neoplasms; Ki-67 Antigen; Male; Middle Aged; Multimodal Imaging; Neoplasm Metastasis; Neuroendocrine Tumors; Organometallic Compounds; Pancreatic Neoplasms; Positron-Emission Tomography; Prospective Studies; Sensitivity and Specificity; Stomach Neoplasms; Tomography, X-Ray Computed

Topics: Female; Fluorodeoxyglucose F18; Humans; Intestinal Neoplasms; Male; Neuroendocrine Tumors; Organometallic Compounds; Pancreatic Neoplasms; Positron-Emission Tomography; Stomach Neoplasms; Tomography, X-Ray Computed