New types of localization methods for adrenocorticotropic hormone-dependent Cushing’s syndrome

Senanayake, Russell; Gillett, Daniel; MacFarlane, James; Meulen, Merel Van de; Powlson, Andrew S; Koulouri, Olympia; Casey, Ruth; Bashari, Waiel; Gurnell, Mark

doi:10.1016/j.beem.2021.101513

Cited by 21 publications

(54 citation statements)

References 89 publications

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“…There was a predominance of TC over AC (and LCNEC) and of female over male patients, consistent with epidemiologic data in the literature concerning these tumour types [ 5 , 37 , 38 ]. Interestingly, in 2 of the 51 patients that underwent surgical resection after the SSTR PET/CT, the diagnosis of PC was made during screening in the context of increased ACTH secretion, consistent with the recent literature evaluating the role of SSTR PET/CT in the detection of ectopic ACTH-secreting tumours [ 39 , 40 ].…”

Section: Discussionsupporting

confidence: 75%

“…ACs had moderate uptake of [ 18 F]FDG and high [ 68 Ga]Ga-DOTATOC uptake. The combined use of [ 18 F]FDG and [ 68 Ga]Ga-DOTATOC PET/CT reveals different uptake patterns in various bronchial tumours Ambrosini [ 24 ] 2009 11 -DOTANOC [ 68 Ga]Ga-DOTANOC PET/CT provided additional information in 9 of 11 patients compared to conventional imaging, leading to changes in the clinical management of 3 of these 9 patients Kayani [ 39 ] 2009 18 -DOTATATE Typical bronchial carcinoids showed higher and more selective uptake of [ 68 Ga]Ga-DOTATATE than of [ 18 F]FDG. Atypical carcinoids and higher grades had less [ 68 Ga]Ga-DOTATATE avidity but were [ 18 F]FDG-avid Jindal [ 43 ] 2011 20 -DOTATOC TCs had a lower [ 18 F]FDG and a higher [ 68 Ga]Ga-DOTATOC uptake compared with ACs.…”

Section: Discussionmentioning

confidence: 99%

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Value of [68Ga]Ga-somatostatin receptor PET/CT in the grading of pulmonary neuroendocrine (carcinoid) tumours and the detection of disseminated disease: single-centre pathology-based analysis and review of the literature

Deleu

Laenen²,

Decaluwé

et al. 2022

EJNMMI Res

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Background Although most guidelines suggest performing a positron emission tomography/computed tomography (PET/CT) with somatostatin receptor (SSTR) ligands for staging of pulmonary carcinoid tumours (PC), only a limited number of studies have evaluated the role of this imaging tool in this specific patient population. The preoperative differentiation between typical carcinoid (TC) and atypical carcinoid (AC) and the extent of dissemination (N/M status) are crucial factors for treatment allocation and prognosis of these patients. Therefore, we performed a pathology-based retrospective analysis of the value of SSTR PET/CT in tumour grading and detection of nodal and metastatic involvement of PC and compared this with the previous literature and with [18F]FDG PET/CT in a subgroup of patients. Methods SSTR PET/CT scans performed between January 2007 and May 2020 in the context of PC were included. If available, [18F]FDG PET/CT images were also evaluated. The maximum standardized uptake (SUVmax) values of the primary tumour, of the pathologically examined hilar and mediastinal lymph node stations, as well as of the distant metastases, were recorded. Tumoural SUVmax values were related to the tumour type (TC versus AC) for both SSTR and [18F]FDG PET/CT in diagnosing and differentiating both tumour types. Nodal SUVmax values were compared to the pathological status (N+ versus N−) to evaluate the diagnostic accuracy of SSTR PET/CT in detecting lymph node involvement. Finally, a mixed model analysis of all pathologically proven distant metastatic lesions was performed. Results A total of 86 SSTR PET/CT scans performed in 86 patients with PC were retrospectively analysed. [18F]FDG PET/CT was available in 46 patients. Analysis of the SUVmax values in the primary tumour showed significantly higher SSTR uptake in TC compared with AC (median SUVmax 18.4 vs 3.8; p = 0.003) and significantly higher [18F]FDG uptake in AC compared to TC (median SUVmax 5.4 vs 3.5; p = 0.038). Receiver operating characteristic (ROC) curve analysis resulted in an area under the curve (AUC) of 0.78 for the detection of TC on SSTR PET/CT and of 0.73 for the detection of AC on [18F]FDG PET/CT. A total of 267 pathologically evaluated hilar and mediastinal lymph node stations were analysed. ROC analysis of paired SSTR/[18F]FDG SUVmax values for the detection of metastasis of TC in 83 lymph node stations revealed an AUC of 0.91 for SSTR PET/CT and of 0.74 for [18F]FDG PET/CT (difference 0.17; 95% confidence interval − 0.03 to 0.38; p = 0.10). In a sub-cohort of 10 patients with 12 distant lesions that were pathologically examined due to a suspicious aspect on SSTR PET/CT, a positive predictive value (PPV) of 100% was observed. Conclusion Our findings confirm the higher SSTR ligand uptake in TC compared to AC and vice versa for [18F]FDG uptake. More importantly, we found a good diagnostic performance of SSTR PET/CT for the detection of hilar and mediastinal lymph node metastases of TC. Finally, a PPV of 100% for SSTR PET/CT was found in a small sub-cohort of patients with pathologically investigated distant metastatic lesions. Taken together, SSTR PET/CT has a very high diagnostic value in the TNM assessment of pulmonary carcinoids, particularly in TC, which underscores its position in European guidelines.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Value of [68Ga]Ga-somatostatin receptor PET/CT in the grading of pulmonary neuroendocrine (carcinoid) tumours and the detection of disseminated disease: single-centre pathology-based analysis and review of the literature

Deleu

Laenen²,

Decaluwé

et al. 2022

EJNMMI Res

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show abstract

“…The 68 Ga isotope, if it can be generated locally via a cyclotron, or 64 Cu, which has a longer 12.7-hour half-life and can be centrally produced, may be used as alternative DOTATATE, DOTATOC, or DOTANOC conjugates. 88…”

Section: Introductionmentioning

confidence: 99%

Consensus on diagnosis and management of Cushing's disease: a guideline update

Fleseriu

Auchus

Bancos

et al. 2021

The Lancet Diabetes & Endocrinology

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483

538

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“…[5,37,38] Interestingly, in 2 of the 51 patients that underwent surgical resection after the SSTR PET/CT, the diagnosis of PC was made during screening in the context of increased ACTH secretion, consistent with recent literature evaluating the role of SSTR PET/CT in the detection of ectopic ACTH-secreting tumours. [39,40] The role of PET/CT in the assessment of the tumour biology of PC was con rmed based on a signi cantly higher SSTR ligand and lower [ 18 F]FDG uptake in TC compared to AC. Moreover, a high sensitivity of 80% of SSTR PET/CT in detecting regional lymph node metastases was found.…”

Section: Discussionmentioning

confidence: 99%

Value of [68Ga]Ga-Somatostatin Receptor PET/CT in the Grading of Pulmonary Neuroendocrine (Carcinoid) Tumours and the Detection of Disseminated Disease: Single Center Pathology-Based Analysis and Review of the Literature

Deleu

Laenen²,

Decaluwé

et al. 2022

Preprint

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Background Although most guidelines suggest performing a positron emission tomography/computed tomography (PET/CT) with somatostatin receptor (SSTR) ligands for staging of pulmonary carcinoid tumours (PC), only a limited number of studies have evaluated the role of this imaging tool in this specific patient population. The preoperative differentiation between typical carcinoid (TC) and atypical carcinoid (AC) and the extent of dissemination (N/M status) are crucial factors for treatment allocation and prognosis of these patients. Therefore we performed a retrospective analysis to assess the value of SSTR PET/CT in the tumour grading and the detection of lymph node involvement and distant metastases of PC with histopathology as gold standard, and compared this to [18F]FDG PET/CT in a subgroup of patients and to previous literature with group sizes of mostly 20-30 patients. Methods SSTR PET/CT scans performed between January 2007 and May 2020 in the context of PC were included. If available, [18F]FDG PET/CT images were also evaluated. The maximum standardized uptake (SUVmax) values of the primary tumour, of the pathologically examined hilar and mediastinal lymph nodes, as well as of the distant metastases, were recorded. Tumoural SUVmax values were related to the tumour type (TC versus AC) for both SSTR and [18F]FDG PET/CT in diagnosing and differentiating both tumour types. Nodal SUVmax values were compared to the pathological status (N+ versus N−) to evaluate the diagnostic accuracy of SSTR PET/CT in detecting lymph node involvement. Finally, a mixed model analysis of all pathologically proven distant metastatic lesions was performed. Results A total of 86 SSTR PET/CT scans performed in 86 patients with PC were retrospectively analyzed. [18F]FDG PET/CT was available in 46 patients. Analysis of the SUVmax values in the primary tumour showed significantly higher SSTR uptake in TC compared with AC (median SUVmax 18.4 vs 3.8; p=0.003) and significantly higher [18F]FDG uptake in AC compared to TC (median SUVmax 5.4 vs 3.5; p=0.038). Receiver operating characteristic (ROC) curve analysis resulted in an area under the curve (AUC) of 0.78 for the detection of TC on SSTR PET/CT and of 0.73 for the detection of AC on [18F]FDG PET/CT. A total of 267 pathologically evaluated hilar and mediastinal lymph nodes were analyzed. ROC analysis of paired SSTR/[18F]FDG SUVmax values for the detection of metastasis of TC in 83 lymph nodes revealed an AUC of 0.91 for SSTR PET/CT and of 0.74 for [18F]FDG PET/CT (difference 0.17; 95% confidence interval: -0.03 to 0.38; p = 0.10). In a sub-cohort of 10 patients with 12 lesions suspicious for distant metastases on SSTR PET/CT that were investigated with biopsies, a positive predictive value (PPV) of 100% was observed. Conclusion Our findings confirm the higher SSTR ligand uptake in TC compared to AC and vice versa for the [18F]FDG uptake. More importantly, we found a good diagnostic performance of SSTR PET/CT for the detection of hilar and mediastinal lymph node metastases of TC. Finally, a PPV of 100% for SSTR PET/CT was found in a small sub-cohort of patients with pathologically investigated distant metastatic lesions. Taken together, SSTR PET/CT has a very high diagnostic value in the TNM assessment of pulmonary carcinoids, particularly in TC, which underscores its position in European guidelines.

show abstract

New types of localization methods for adrenocorticotropic hormone-dependent Cushing’s syndrome

Cited by 21 publications

References 89 publications

Value of [68Ga]Ga-somatostatin receptor PET/CT in the grading of pulmonary neuroendocrine (carcinoid) tumours and the detection of disseminated disease: single-centre pathology-based analysis and review of the literature

Value of [68Ga]Ga-somatostatin receptor PET/CT in the grading of pulmonary neuroendocrine (carcinoid) tumours and the detection of disseminated disease: single-centre pathology-based analysis and review of the literature

Consensus on diagnosis and management of Cushing's disease: a guideline update

Value of [68Ga]Ga-Somatostatin Receptor PET/CT in the Grading of Pulmonary Neuroendocrine (Carcinoid) Tumours and the Detection of Disseminated Disease: Single Center Pathology-Based Analysis and Review of the Literature

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