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Clin Endocrinol (Oxf). 2019 May 8. doi: 10.1111/cen.14008. [Epub ahead of print]

The Clinical Impact of [68 Ga]-DOTATATE PET/CT for the Diagnosis and Management of Ectopic Adrenocorticotropic Hormone - Secreting Tumours.

Author information

1
Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan.
2
Faculty of Medicine Siriraj Hospital, Division of Endocrinology and Metabolism, Mahidol University, Bangkok, Thailand.
3
Division of Endocrinology, Diabetes, Metabolism & Nutrition, Mayo Clinic, Rochester, Michigan.
4
Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
5
Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan.
6
Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
7
Department of Pharmacology, University of Michigan, Ann Arbor, Michigan.

Abstract

OBJECTIVES:

Localization of ectopic ACTH-secreting tumours causing Cushing syndrome (ECS) is essential for clinical management, yet often difficult. [68 Ga]-DOTATATE PET/CT ([68 Ga]-DOTA-(Tyr3 )-octreotate)] is an FDA-approved high-resolution diagnostic tool for imaging neuroendocrine tumours. Data on the clinical utility of [68 Ga]-DOTATATE in patients with ECS, however, are scarce. The objectives of this study were to determine the efficacy for ECS localization and the clinical benefit of [68 Ga]-DOTATATE imaging.

METHOD:

We conducted a retrospective review of all cases with ECS evaluated with [68 Ga]-DOTATATE from November 2016 through October 2018 at three referral centres. The clinical benefit of [68 Ga]-DOTATATE was based on detection of new tumours and resultant changes in management.

RESULTS:

Over the study period, 28 patients with ECS underwent [68 Ga]-DOTATATE: 17 for identification of the primary tumour and 11 during follow-up. [68 Ga]-DOTATATE identified the suspected primary ECS in 11/17 patients (65%). Of these, nine patients underwent surgery: eight with confirmed ECS (5 bronchial, 1 thymic, 1 pancreatic and 1 metastatic neuroendocrine tumour of unknown primary origin) and one patient with a false-positive scan (adrenal gland). Of the 11 patients with ECS who underwent [68 Ga]-DOTATATE evaluation during follow-up, the study led to changes in clinical management in 7/11 (64%) patients.

CONCLUSIONS:

[68 Ga]-DOTATATE is sensitive in detecting primary and metastatic ECS, often identifies occult tumours after conventional imaging, and impacts clinical care in the majority of patients.

KEYWORDS:

CT; Cushing syndrome; [68Ga]-DOTATATE PET; ectopic ACTH secretion; somatostatin receptor; tumour localization

PMID:
31066920
DOI:
10.1111/cen.14008

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