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J Clin Endocrinol Metab. 2017 May 1;102(5):1486-1494. doi: 10.1210/jc.2016-3732.

Functional Imaging in the Follow-Up of Enteropancreatic Neuroendocrine Tumors: Clinical Usefulness and Indications.

Author information

1
Digestive and Liver Diseases Unit, Sant'Andrea Hospital, 00189 Rome, Italy.
2
Department of Hepatology and Gastroenterology, Charité Universitätsmedizin, 13353 Berlin, Germany.
3
Department of Gastroenterology, University Hospital, 35043 Marburg, Germany.
4
Department of Radiology, Sant'Andrea Hospital, 00189 Rome, Italy.
5
Division of Nuclear Medicine, Sant'Andrea Hospital, 00189 Rome, Italy.
6
Department of Nuclear Medicine, Campus Virchow-Klinikum, Charité Universitätsmedizin, 13353 Berlin, Germany.
7
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University, 8036 Graz Austria.
8
Division of Nuclear Medicine, Department of Radiology, Medical University, 8036 Graz Austria.
9
Pancreatic Surgery Unit, Vita-Salute University, San Raffaele Hospital Istituto di Ricovero e Cura a Carattere Scientifico, 20132 Milan, Italy.

Abstract

Context:

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.

Objective:

Investigate the role of FITs after diagnosis of metastatic enteropancreatic NETs, identifying patients who might benefit from these exams.

Design:

Multicenter retrospective analysis of metastatic enteropancreatic NETs.

Setting:

Analysis of imaging tests performed between January 1995 and December 2015 in Rome, Berlin, Milan, Marburg, or Graz.

Subjects:

One hundred forty-three patients with metastatic pancreatic NETs and small intestine NETs, at least 2-year follow-up, and positive FITs.

Interventions:

Patients had received CT every 6 months (unless clinical conditions and tumor behavior required shorter intervals) and FIT every 12 months.

Main Outcome Measures:

Clinical usefulness of FITs, defined as changes in patient management (indication to biopsy, medical therapy, surgery, or further imaging tests) due only to FITs.

Results:

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).

Conclusions:

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.

PMID:
28324047
DOI:
10.1210/jc.2016-3732
[Indexed for MEDLINE]

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