Radioguided Surgery for Gastroenteropancreatic Neuroendocrine Tumours: a Systematic Literature Review

Abstract

Background Radioguided surgery (RGS) for gastroenteropancreatic neuroendocrine tumours (GEP-NETs) has been suggested as a way to improve intraoperative lesion detection. This systematic literature review of reports of the use of RGS for GEP-NETs was performed to determine if there is a benefit. Methods A literature search was conducted using Google Scholar and PubMed, and snowballing from any relevant literature. Full-text studies were included if they were published in the English language and reported outcomes of RGS on human subjects with GEP-NETs. Qualitative data synthesis was performed. Results Twenty-six papers including a total of 209 patients were included. The tracers used were predominantly indium-111 pentetreotide, gallium-68 DOTA-peptides, and technetium-99m EDDA/HYNIC-peptides. Heterogeneous protocols make comparisons difficult, but most papers reported a benefit from the use of RGS in tumours in the gastrointestinal tract; utility in localisation of pancreatic tumours was less clear. Time between tracer administration and operation varied: from 16 h to 8 days with indium-111, 0–24 h with technetium-99m, and 19–193 min with gallium-68. Eight teams reported the thresholding technique used for discrimination—four used a ratio, four statistical methods, and one looked at the sensitivity and specificity of different cut-offs. Six teams performed follow-up of 24 patients (three pancreas, eight gastrinoma, 13 gastrointestinal tract) for between 3 months and 3 years. Two patients relapsed (one pancreas, one gastrinoma) between 6 and 12 months post-surgery. Conclusions RGS appears to aid in localisation of gastrointestinal NETs, but the benefit is more equivocal in pancreatic NETs. Further work into outcomes is warranted.

Intraoperative Radioguided Localization of an Occult Neuroendocrine Tumor of the Ileum

“…In summary, a preoperative IV administration of 99m Tc-HYNICTOC enabled RGS, facilitating the identification and resection of the primary tumor (C). [1][2][3][4][5][6][7][8]…”

“…Postoperative pathology confirmed the radioactive tissue to be a well-differentiated neuroendocrine tumor of the ileum, G2 (3 mitosis/10 HPF, MIB1: 1%). In summary, a preoperative IV administration of 99m Tc-HYNICTOC enabled RGS, facilitating the identification and resection of the primary tumor ( C ) 1–8 …”

Tracers in Gastric Cancer Surgery

“…Technetium-99m (99mTc) antimony sulfur colloid, 99mTc tin colloid, and 99mTc sulfur colloid are preferentially selected [ 102 ]. Applications of Indium-111 penetreotide and positron-emitting gallium-68-DOTA-peptides in surgeries of gastroenteropancreatic neuroendocrine tumors have also been reported [ 103 ]. Similar to carbon nanoparticles, radioactive tracers tend to migrate to the SLNs within 2 h and stay there for more than 20 h thanks to the phagocytosis of macrophages [ 104 ].…”

Theranostics bei gut bis mäßig differenzierten GEP-NEN

“…In einigen Berichten konnte auch die OP-Zeit verkürzt werden. Nachweise für darüber hinausgehende Verbesserungen der klinischen Ergebnisse sind jedoch noch begrenzt [32]. Angesichts der heterogenen Natur und unterschiedlichen Aggressivität vieler neuroendokriner Tumoren erfordert dies eine langfristige Nachbeobachtung.…”