Eric Ouvrard1, Louis De Mestier2, Caroline Boursier3, Boumediene Lachachi4, Nicolas Sahakian5, Elodie Chevalier3, Nidaa Mikail6, Josefina Carullo1, Aurélie Bando-Delaunay6, Thomas Walter7, Gabriel G Malouf8, Pietro Addeo9, Gilles Poncet10, Frederic Sebag11, Rachida Lebtahi6, Bernard Goichot12, David Taïeb5, Alessio Imperiale1. 1. Nuclear Medicine and Molecular Imaging, Institut de Cancérologie Strasbourg Europe (ICANS), France. 2. Université de Paris, Dept. of Pancreatology and Digestive Oncology, Beaujon Hospital (APHP), France. 3. Nuclear Medicine, University Hospital of Nancy, France. 4. Nuclear Medicine, Hospices Civils de Lyon, France. 5. Nuclear Medicine, La Timone University Hospital, Aix-Marseille University, France. 6. ENETS Centre of Excellence, Beaujon Hospital (APHP), Clichy, Université de Paris, France. 7. Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, Université Lyon 1, France. 8. Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), France. 9. Hepato-Pancreato-Biliary Surgery and Liver transplantation, University Hospitals of Strasbourg, France. 10. Digestive and Oncologic Surgery, Edouard-Herriot University Hospital, France. 11. Endocrine Surgery, Conception University Hospital, Aix-Marseille University, France. 12. Internal Medicine, Diabetes and Metabolic Disorders, University Hospitals of Strasbourg, France.
Abstract
To compare the respective value of 68Ga-DOTATOC and 18F-DOPA PET/CT for initial staging or pre-surgical work-up of patients with small intestine neuroendocrine tumors (SiNET). Methods: This is a retrospective, multicenter, non-interventional investigation involving 53 non-operated SiNET patients who underwent both 68Ga-DOTATOC and 18F-DOPA PET/CT within a 6-months interval without therapeutic intervention or change between the two PET/CT studies. Detection rate (DR %) was calculated according to per-region and per-lesion analyses. Sensitivity for primary tumor detection was assessed in 37 operated patients taking surgical results (76 SiNET) as diagnostic gold standard. Results: Each of 68Ga-DOTATOC PET/CT and 18F-DOPA PET/CT individually identified at least one primary SiNET in 92% (34/37) of the patients. Tumor intestinal multifocality was confirmed by histology in 8 patients. 68Ga-DOTATOC and 18F-DOPA PET/CT were concordant positive for tumor multifocality in 5, discordant positive in 2, and concordant negative in 1 case. DR % for subdiaphragmatic nodal metastases on per-region-based analysis was 91 % and 98 % for 68Ga-DOTATOC and 18F-DOPA PET/CT, respectively (P = 0.18). 18F-DOPA PET/CT detected a higher number of abnormal subdiaphragmatic nodes (P = 0.009). Regarding mesenteric nodes only, 18F-DOPA PET/CT detected more positive regions (P = 0.005) and nodal lesions (P = 0.003) than 68Ga-DOTATOC PET/CT, including nodes located at the origin of mesenteric vessels. For detection of distant metastases, 68Ga-DOTATOC and 18F-DOPA PET/CT performed equally on a per-region-based analysis. As compared to 68Ga-DOTATOC, 18F-DOPA PET/CT detected more hepatic (p<0.001), peritoneal (p<0.001), and lung metastases (p<0.001). Conclusion: 18F-DOPA PET/CT detects more lesions than 68Ga-DOTATOC PET/CT in studied patients. Their respective role should be discussed in terms of disease staging and treatment selection.
To compare the respective value of 68Ga-DOTATOC and 18F-DOPA PET/CT for initial staging or pre-surgical work-up of patients with small intestine neuroendocrine tumors (SiNET). Methods: This is a retrospective, multicenter, non-interventional investigation involving 53 non-operated SiNET patients who underwent both 68Ga-DOTATOC and 18F-DOPA PET/CT within a 6-months interval without therapeutic intervention or change between the two PET/CT studies. Detection rate (DR %) was calculated according to per-region and per-lesion analyses. Sensitivity for primary tumor detection was assessed in 37 operated patients taking surgical results (76 SiNET) as diagnostic gold standard. Results: Each of 68Ga-DOTATOC PET/CT and 18F-DOPA PET/CT individually identified at least one primary SiNET in 92% (34/37) of the patients. Tumor intestinal multifocality was confirmed by histology in 8 patients. 68Ga-DOTATOC and 18F-DOPA PET/CT were concordant positive for tumor multifocality in 5, discordant positive in 2, and concordant negative in 1 case. DR % for subdiaphragmatic nodal metastases on per-region-based analysis was 91 % and 98 % for 68Ga-DOTATOC and 18F-DOPA PET/CT, respectively (P = 0.18). 18F-DOPA PET/CT detected a higher number of abnormal subdiaphragmatic nodes (P = 0.009). Regarding mesenteric nodes only, 18F-DOPA PET/CT detected more positive regions (P = 0.005) and nodal lesions (P = 0.003) than 68Ga-DOTATOC PET/CT, including nodes located at the origin of mesenteric vessels. For detection of distant metastases, 68Ga-DOTATOC and 18F-DOPA PET/CT performed equally on a per-region-based analysis. As compared to 68Ga-DOTATOC, 18F-DOPA PET/CT detected more hepatic (p<0.001), peritoneal (p<0.001), and lung metastases (p<0.001). Conclusion: 18F-DOPA PET/CT detects more lesions than 68Ga-DOTATOC PET/CT in studied patients. Their respective role should be discussed in terms of disease staging and treatment selection.