Prospective evaluation of ⁶⁸Ga‐DOTATATE PET/CT in limited disease neuroendocrine tumours and/or elevated serum neuroendocrine biomarkers

Abstract

Our study shows that Ga-DOTATATE PET/CT detected similar number of sites than combination of SRS, liver MRI and thoraco-abdominopelvic CT on region-based analysis. Ga-DOTATATE PET/CT missed half of primary lung carcinoids with ectopic Cushing's syndrome.

MANAGEMENT OF ENDOCRINE DISEASE: Cushing’s syndrome due to ectopic ACTH secretion: an expert operational opinion

“…A recent report, having included six new EAS cases, suggested that the sensitivity of 68 Ga -SSTR PET/CT for identifying ectopic ACTHsecreting lesions (including multiple metastases) was lower than previously reported, with a sensitivity of 64% as compared to 69% for CT (183). Our literature search, on the performance of 68 Ga -SSTR-PET/CT, identified 51 patients with possible occult and covert EAS at initial morphological imaging, assuming that the diagnosis of occult/covert EAS was based on variable imaging procedures across the studies (149,183,187,188,189,190): 68 Ga -SSTR PET/CT led to the discovery of the source of EAS in 29 out of 51 patients, indicating a sensitivity of only 57%. Despite its limitations, we consider that 68 Ga -SSTR PET/CT may be a useful complementary tool in the difficult context of occult EAS, but evaluation of its performance deserves additional studies, including a significantly larger number of unselected EAS patients.…”

“…In addition, published data indicates that 68 Ga-SSTR PET/CT offers better spatial resolution and anatomical detail than octreoscan and could therefore help to detect smaller tumors. In the general context of NETs, several studies suggest that 68 Ga -SSTR PET/CT is superior to octreoscan in detecting small NETs (188,189) and staging metastatic NETs (170). In the specific context of EAS, to our knowledge only one small head-to-head study (involving only five patients with EAS) directly compared the diagnostic performances of octreoscan and 68 Ga-SSTR PET/CT (188) (Fig.…”

“…Mifepristone has been used in the treatment of EAS for many years but evidence is based mainly on scarce isolated case reports (238,239). Apart from a few retrospective series (240), the published data are limited (188). In theory, mifepristone has certain advantages in the treatment of hypercortisolism related to EAS, including its rapid action and blockade of glucocorticoid receptor activation that is responsible for the clinical manifestations and, particularly, psychiatric symptoms of hypercortisolism (200,240).…”

Current Standards and Recent Advances in Biomarkers of Major Endocrine Tumors

“…Neuroendocrine carcinomas result from cells throughout the diffuse endocrine system ( The National Comprehensive Cancer Network [NCCN], 2018a ). Most common of these are well differentiated or carcinoid tumors, which are gastroenterohepatic and pulmonary in origin and exhibit a variety of symptoms ( Gabriel et al, 2018 ). Patients may present with symptoms associated with hormonal hypersecretion (“functional” tumors) or those that are asymptomatic are considered to have “non-functional” disease ( The National Comprehensive Cancer Network [NCCN], 2018a ).…”

“…Patients may present with symptoms associated with hormonal hypersecretion (“functional” tumors) or those that are asymptomatic are considered to have “non-functional” disease ( The National Comprehensive Cancer Network [NCCN], 2018a ). Furthermore, due to the sporadic and gradual nature of tumor growth, as well as their small size, the lesions can be difficult to detect ( Gabriel et al, 2018 ).…”