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Pape UF, Perren A, Niederle B, Gross D, Gress T, Costa F, Arnold R, Denecke T, Plöckinger U, Salazar R, Grossman A. ENETS Consensus Guidelines for the management of patients with neuroendocrine neoplasms from the jejuno-ileum and the appendix including goblet cell carcinomas. Neuroendocrinology 2012; 95:135-56. [PMID: 22262080 DOI: 10.1159/000335629] [Citation(s) in RCA: 269] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Ulrich-Frank Pape
- Division of Hepatology and Gastroenterology, Department of Internal Medicine, Campus Virchow-Klinikum, Berlin, Germany.
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102
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Striated muscle as implantation site for transplanted pancreatic islets. J Transplant 2011; 2011:352043. [PMID: 22174984 PMCID: PMC3235886 DOI: 10.1155/2011/352043] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 09/20/2011] [Indexed: 01/27/2023] Open
Abstract
Islet transplantation is an attractive treatment for selected patients with brittle type 1 diabetes. In the clinical setting, intraportal transplantation predominates. However, due to extensive early islet cell death, the quantity of islets needed to restore glucose homeostasis requires in general a minimum of two donors. Moreover, the deterioration of islet function over time results in few insulin-independent patients after five-year followup. Specific obstacles to the success of islet transplantation include site-specific concerns for the liver such as the instant blood mediated inflammatory reaction, islet lipotoxicity, low oxygen tension, and poor revascularization, impediments that have led to the developing interest for alternative implantation sites over recent years. Within preclinical settings, several alternative sites have now been investigated and proven favorable in various aspects. Muscle is considered a very promising site and has physiologically properties and technical advantages that could make it optimal for islet transplantation.
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Kitano M, Millo C, Rahbari R, Herscovitch P, Gesuwan K, Webb RC, Venkatesan AM, Phan GQ, Hughes MS, Libutti SK, Nilubol N, Linehan WM, Kebebew E. Comparison of 6-18F-fluoro-L-DOPA, 18F-2-deoxy-D-glucose, CT, and MRI in patients with pancreatic neuroendocrine neoplasms with von Hippel-Lindau disease. Surgery 2011; 150:1122-8. [PMID: 22136831 PMCID: PMC3293369 DOI: 10.1016/j.surg.2011.09.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 09/16/2011] [Indexed: 10/14/2022]
Abstract
INTRODUCTION There are limited data on the utility of 6-(18)F-fluoro-l-3,4-dihydroxyphenylalanine ((18)F-DOPA) and (18)F-2-deoxy-d-glucose ((18)F-FDG) in the workup of patients with pancreatic neuroendocrine tumors (PNETs). The aim of our study was to determine the accuracy of (18)F-DOPA and (18)F-FDG to detect PNETs in patients with von Hippel-Lindau disease (vHL). METHODS We studied prospectively 69 patients with a diagnosis of vHL and pancreatic lesion(s) using computed tomography (CT), magnetic resonance imaging (MRI), (18)F-FDG, and (18)F-DOPA. Clinical, genetic, and laboratory characteristics were analyzed to determine association with imaging study results. RESULTS In sum, 40 patients underwent evaluation by all 4 modalities; 98 PNETs and 55 PNETs were identified on CT and MRI, respectively. Only 11 of the 98 lesions (11%) were positive on (18)F-DOPA and 45 of the 98 (46%) lesions were positive on (18)F-FDG. There were 13 (18)F-DOPA and 26 (18)F-FDG avid extrapancreatic lesions. One patient underwent resection of an (18)F-DOPA avid extrapancreatic lesion in the lung, with pathology demonstrating a NET. There was no association between (18)F-DOPA and (18)F-FDG avidity and tumor size, age, gender, vHL mutation, or serum chromogranin A level. CONCLUSION (18)F-FDG and MRI may be adjuncts to CT in identifying PNETs and metastatic disease. (18)F-DOPA has limited value in identifying PNETs in patients with vHL, but may be useful for identifying extrapancreatic NET lesions.
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Affiliation(s)
- Mio Kitano
- Endocrine Oncology Section, Surgery Branch, National Cancer Institute, National Institutes of Health, CRC, 10 Center Drive, Bethesda, MD 20892
| | - Corina Millo
- Endocrine Oncology Section, Surgery Branch, National Cancer Institute, National Institutes of Health, CRC, 10 Center Drive, Bethesda, MD 20892
| | - Reza Rahbari
- Endocrine Oncology Section, Surgery Branch, National Cancer Institute, National Institutes of Health, CRC, 10 Center Drive, Bethesda, MD 20892
| | - Peter Herscovitch
- Endocrine Oncology Section, Surgery Branch, National Cancer Institute, National Institutes of Health, CRC, 10 Center Drive, Bethesda, MD 20892
| | - Krisana Gesuwan
- Endocrine Oncology Section, Surgery Branch, National Cancer Institute, National Institutes of Health, CRC, 10 Center Drive, Bethesda, MD 20892
| | - Richard C. Webb
- Endocrine Oncology Section, Surgery Branch, National Cancer Institute, National Institutes of Health, CRC, 10 Center Drive, Bethesda, MD 20892
| | - Aradhana M. Venkatesan
- Endocrine Oncology Section, Surgery Branch, National Cancer Institute, National Institutes of Health, CRC, 10 Center Drive, Bethesda, MD 20892
| | - Giao Q. Phan
- Endocrine Oncology Section, Surgery Branch, National Cancer Institute, National Institutes of Health, CRC, 10 Center Drive, Bethesda, MD 20892
| | - Marybeth S. Hughes
- Endocrine Oncology Section, Surgery Branch, National Cancer Institute, National Institutes of Health, CRC, 10 Center Drive, Bethesda, MD 20892
| | - Steven K. Libutti
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Greene Medical Arts Pavilion, 4th Floor, 3400 Bainbridge Avenue, Bronx, NY 10467
| | - Naris Nilubol
- Endocrine Oncology Section, Surgery Branch, National Cancer Institute, National Institutes of Health, CRC, 10 Center Drive, Bethesda, MD 20892
| | - W. Marston Linehan
- Urology Oncology Section, National Cancer Institute, National Institutes of Health, CRC, 10 Center Drive, Bethesda, MD 20892
| | - Electron Kebebew
- Endocrine Oncology Section, Surgery Branch, National Cancer Institute, National Institutes of Health, CRC, 10 Center Drive, Bethesda, MD 20892
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104
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Kauhanen S, Schalin-Jäntti C, Seppänen M, Kajander S, Virtanen S, Schildt J, Lisinen I, Ahonen A, Heiskanen I, Väisänen M, Arola J, Korsoff P, Ebeling T, Sane T, Minn H, Välimäki MJ, Nuutila P. Complementary roles of 18F-DOPA PET/CT and 18F-FDG PET/CT in medullary thyroid cancer. J Nucl Med 2011; 52:1855-63. [PMID: 22052128 DOI: 10.2967/jnumed.111.094771] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
UNLABELLED Serum calcitonin and carcinoembryonic antigen (CEA) are markers of recurrent or persistent disease in medullary thyroid cancer (MTC). However, conventional imaging often fails to localize metastatic disease. Our aim was to compare fluorine-labeled dihydroxyphenylalanine ((18)F-DOPA) and (18)F-FDG PET/CT with multidetector CT (MDCT) and MRI in recurrent or persistent MTC. METHODS Nineteen MTC patients with increased calcitonin or CEA on follow-up (mean ± SD, 93 ± 91 mo; range, 4-300 mo) after primary therapy were prospectively imaged with 4 techniques: (18)F-DOPA PET/CT, (18)F-FDG PET/CT, MDCT, and MRI. Images were analyzed for pathologic lesions, which were surgically removed when possible. The correlation between the detection rate for each method and the calcitonin and CEA concentrations and histopathologic findings was investigated. RESULTS On the basis of histology and follow-up, one or more imaging methods accurately localized metastatic disease in 12 (63%) of 19 patients. The corresponding figures for (18)F-DOPA PET/CT, (18)F-FDG PET/CT, MDCT, and MRI were 11 (58%) of 19, 10 (53%) of 19, 9 (47%) of 19, and 10 (59%) of 17, respectively. Calcitonin and CEA correlated with (18)F-DOPA PET/CT (P = 0.0007 and P = 0.0263, respectively) and (18)F-FDG PET/CT findings (both P < 0.0001). In patients with an unstable calcitonin doubling time (n = 8), (18)F-DOPA and (18)F-FDG PET/CT were equally sensitive. In contrast, for patients with an unstable CEA doubling time (n = 4), (18)F-FDG PET/CT was more accurate. CONCLUSION For most MTC patients with occult disease, (18)F-DOPA PET/CT accurately detects metastases. In patients with an unstable calcitonin level, (18)F-DOPA PET/CT and (18)F-FDG PET/CT are complementary. For patients with an unstable CEA doubling time, (18)F-FDG PET/CT may be more feasible. MRI is sensitive but has the highest rate of false-positive results.
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Affiliation(s)
- Saila Kauhanen
- Turku PET Centre, Turku University Hospital, Turku, Finland.
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105
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Teunissen JJM, Kwekkeboom DJ, Valkema R, Krenning EP. Nuclear medicine techniques for the imaging and treatment of neuroendocrine tumours. Endocr Relat Cancer 2011; 18 Suppl 1:S27-51. [PMID: 22005114 DOI: 10.1530/erc-10-0282] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Nuclear medicine plays a pivotal role in the imaging and treatment of neuroendocrine tumours (NETs). Somatostatin receptor scintigraphy (SRS) with [(111)In-DTPA(0)]octreotide has proven its role in the diagnosis and staging of gastroenteropancreatic NETs (GEP-NETs). New techniques in somatostatin receptor imaging include the use of different radiolabelled somatostatin analogues with higher affinity and different affinity profiles to the somatostatin receptor subtypes. Most of these analogues can also be labelled with positron-emitting radionuclides that are being used in positron emission tomography imaging. The latter imaging modality, especially in the combination with computed tomography, is of interest because of encouraging results in terms of improved imaging quality and detection capabilities. Considerable advances have been made in the imaging of NETs, but to find the ideal imaging method with increased sensitivity and better topographic localisation of the primary and metastatic disease remains the ultimate goal of research. This review provides an overview of the currently used imaging modalities and ongoing developments in the imaging of NETs, with the emphasis on nuclear medicine and puts them in perspective of clinical practice. The advantage of SRS over other imaging modalities in GEP-NETs is that it can be used to select patients with sufficient uptake for treatment with radiolabelled somatostatin analogues. Peptide receptor radionuclide therapy (PRRT) is a promising new tool in the management of patients with inoperable or metastasised NETs as it can induce symptomatic improvement with all Indium-111, Yttrium-90 or Lutetium-177-labelled somatostatin analogues. The results that were obtained with [(90)Y-DOTA(0),Tyr(3)]octreotide and [(177)Lu-DOTA(0),Tyr(3)]octreotate are even more encouraging in terms of objective tumour responses with tumour regression and documented prolonged time to progression. In the largest group of patients receiving PRRT, treated with [(177)Lu-DOTA(0),Tyr(3)]octreotate, a survival benefit of several years compared with historical controls has been reported.
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Affiliation(s)
- Jaap J M Teunissen
- Department of Nuclear Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands.
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106
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Eriksson O, Alavi A. Imaging the islet graft by positron emission tomography. Eur J Nucl Med Mol Imaging 2011; 39:533-42. [PMID: 21932118 DOI: 10.1007/s00259-011-1928-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 08/22/2011] [Indexed: 10/17/2022]
Abstract
Clinical islet transplantation is being investigated as a permanent cure for type 1 diabetes mellitus (T1DM). Currently, intraportal infusion of islets is the favoured procedure, but several novel implantation sites have been suggested. Noninvasive longitudinal methodologies are an increasingly important tool for assessing the fate of transplanted islets, their mass, function and early signs of rejection. This article reviews the approaches available for islet graft imaging by positron emission tomography and progress in the field, as well as future challenges and opportunities.
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Affiliation(s)
- Olof Eriksson
- Preclinical PET Platform, Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden.
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107
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McConathy J, Yu W, Jarkas N, Seo W, Schuster DM, Goodman MM. Radiohalogenated nonnatural amino acids as PET and SPECT tumor imaging agents. Med Res Rev 2011; 32:868-905. [DOI: 10.1002/med.20250] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Jonathan McConathy
- Mallinckrodt Institute of Radiology; Washington University School of Medicine; St. Louis Missouri
| | - Weiping Yu
- Department of Radiology and Imaging Sciences; School of Medicine, Emory University; Atlanta Georgia
| | - Nachwa Jarkas
- Department of Radiology and Imaging Sciences; School of Medicine, Emory University; Atlanta Georgia
| | - Wonewoo Seo
- Department of Radiology and Imaging Sciences; School of Medicine, Emory University; Atlanta Georgia
| | - David M. Schuster
- Department of Radiology and Imaging Sciences; School of Medicine, Emory University; Atlanta Georgia
| | - Mark M. Goodman
- Department of Radiology and Imaging Sciences; School of Medicine, Emory University; Atlanta Georgia
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108
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Fiebrich HB, van Asselt SJ, Brouwers AH, van Dullemen HM, Pijl MEJ, Elsinga PH, Links TP, de Vries EGE. Tailored imaging of islet cell tumors of the pancreas amidst increasing options. Crit Rev Oncol Hematol 2011; 82:213-26. [PMID: 21704529 DOI: 10.1016/j.critrevonc.2011.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 04/10/2011] [Accepted: 05/19/2011] [Indexed: 02/07/2023] Open
Abstract
Pancreatic islet cell tumors are neuroendocrine tumors, which can produce hormones and can arise as part of multiple endocrine neoplasia type 1 or von-Hippel-Lindau-disease, two genetically well-defined hereditary cancer syndromes. Currently, technical innovation improves conventional and specific molecular imaging techniques. To organize the heterogeneous results described for the imaging of these tumors, we distinguished three indications (1) imaging of a patient with hormone hypersecretion, (2) search for a pancreatic primary in case of proven neuroendocrine cancer of unknown primary, and (3) screening of asymptomatic mutation carriers. We searched for publications on imaging of islet cell tumors between 1995 and January 2010 and defined a Level of Evidence (LOE) for the applicability of each technique. For each technique, data were analyzed in a Forest plot and arranged per imaging indication and tumor subtype. LOEs are weak for all imaging techniques. Analyses indicate a prominent role for endoscopic ultrasound for all three indications.
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Affiliation(s)
- Helle-Brit Fiebrich
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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109
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Fiebrich HB, de Jong JR, Kema IP, Koopmans KP, Sluiter W, Dierckx RAJO, Walenkamp AM, Links TP, Brouwers AH, de Vries EGE. Total 18F-dopa PET tumour uptake reflects metabolic endocrine tumour activity in patients with a carcinoid tumour. Eur J Nucl Med Mol Imaging 2011; 38:1854-61. [PMID: 21698413 PMCID: PMC3168742 DOI: 10.1007/s00259-011-1862-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 06/07/2011] [Indexed: 01/06/2023]
Abstract
Purpose Positron emission tomography (PET) using 6-[18F]fluoro-L-dihydroxyphenylalanine (18F-dopa) has an excellent sensitivity to detect carcinoid tumour lesions. 18F-dopa tumour uptake and the levels of biochemical tumour markers are mediated by tumour endocrine metabolic activity. We evaluated whether total 18F-dopa tumour uptake on PET, defined as whole-body metabolic tumour burden (WBMTB), reflects tumour load per patient, as measured with tumour markers. Methods Seventy-seven consecutive carcinoid patients who underwent an 18F-dopa PET scan in two previously published studies were analysed. For all tumour lesions mean standardised uptake values (SUVs) at 40% of the maximal SUV and tumour volume on 18F-dopa PET were determined and multiplied to calculate a metabolic burden per lesion. WBMTB was the sum of the metabolic burden of all individual lesions per patient. The 24-h urinary serotonin, urine and plasma 5-hydroxindoleacetic acid (5-HIAA), catecholamines (nor)epinephrine, dopamine and their metabolites, measured in urine and plasma, and serum chromogranin A served as tumour markers. Results All but 1 were evaluable for WBMTB; 74 patients had metastatic disease. 18F-dopa PET detected 979 lesions. SUVmax on 18F-dopa PET varied up to 29-fold between individual lesions within the same patients. WBMTB correlated with urinary serotonin (r = 0.51) and urinary and plasma 5-HIAA (r = 0.78 and 0.66). WBMTB also correlated with urinary norepinephrine, epinephrine, dopamine and plasma dopamine, but not with serum chromogranin A. Conclusion Tumour load per patient measured with 18F-dopa PET correlates with tumour markers of the serotonin and catecholamine pathway in urine and plasma in carcinoid patients, reflecting metabolic tumour activity.
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Affiliation(s)
- Helle-Brit Fiebrich
- Department of Medical Oncology, University Medical Centre Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
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Bushnell DL, Baum RP. Standard imaging techniques for neuroendocrine tumors. Endocrinol Metab Clin North Am 2011; 40:153-62, ix. [PMID: 21349416 DOI: 10.1016/j.ecl.2010.12.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Several diagnostic imaging techniques have been used successfully for evaluating patients with neuroendocrine tumors (NETs). These techniques include computed tomography (CT), magnetic resonance imaging, positron emission tomography/CT, single-photon emission CT (SPECT), and SPECT/CT. This article reviews the various imaging methods and their respective advantages and limitations for use in different types of NETs, in particular carcinoid tumors.
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Affiliation(s)
- David L Bushnell
- Division of Nuclear Medicine, Department of Radiology, University of Iowa Roy J. and Lucille A. Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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111
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Kao CHK, Hsu WL, Xie HL, Lin MC, Lan WC, Chao HY. GMP production of [18F]FDOPA and issues concerning its quality analyses as in USP “Fluorodopa F 18 Injection”. Ann Nucl Med 2011; 25:309-16. [DOI: 10.1007/s12149-010-0463-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 12/15/2010] [Indexed: 11/29/2022]
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112
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Abstract
Pancreatic endocrine tumors have been steadily growing in incidence and prevalence during the last two decades, showing an incidence of 4-5/1,000,000 population. They represent a heterogeneous group with very varying tumor biology and prognosis. About half of the patients present clinical symptoms and syndromes related to substances released from the tumors (Zollinger-Ellison syndrome, insulinoma, glucagonoma, etc) and the other half are so-called nonfunctioning tumors mainly presenting with symptoms such as obstruction, jaundice, bleeding, and abdominal mass. Ten percent to 15% of the pancreatic endocrine tumors are part of an inherited syndrome such as multiple endocrine neoplasia type 1 (MEN-1), von Hippel-Lindau (VHL), neurofibromatosis, or tuberousclerosis. The diagnosis is based on histopathology demonstrating neuroendocrine features such as positive staining for chromogranin A and specific hormones such as gastrin, proinsulin, and glucagon. Moreover, the biochemical diagnosis includes measurement of chromogranins A and B or specific hormones such as gastrin, insulin, glucagon, and vasoactive intestinal polypeptide (VIP) in the circulation. In addition to standard localization procedures, radiology (computed tomography [CT] scan, magnetic resonance imaging [MRI], ultrasound [US]), somatostatin receptor scintigraphy, and most recently positron emission tomography with specific isotopes such as (11)C-5 hydroxytryptamin ((11)C-5-HTP), fluorodopa and (68)Ga-1,4,7,10-tetra-azacyclododecane-N,N',N″,N‴-tetra-acetic acid (DOTA)-octreotate are performed. Surgery is still one of the cornerstones in the management of pancreatic endocrine tumors, but curative surgery is rarely obtained in most cases because of metastatic disease. Debulking and other cytoreductive procedures might facilitate systemic treatment. Cytotoxic drugs, biological agents, such as somatostatin analogs, alpha interferons, mammalian target of rapamycin (mTOR) inhibitors and tyrosine kinase inhibitors are routinely used. Tumor-targeted radioactive treatment is available in many centres in Europe and is effective in patients with tumors that express high content of somatostatin receptors type 2 and 5. In the future, treatment will be based on tumor biology and molecular genetics with the aim of so-called personalized medicine.
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Affiliation(s)
- Kjell Oberg
- Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
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113
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Abstract
Neuroendocrine tumors (NET) are a heterogeneous group of tumors that arise from neuroendocrine cells. These tumors may arise from various organs, including lung, thymus, thyroid, stomach, duodenum, small bowel, large bowel, appendix, pancreas, adrenal, and skin. Most are well differentiated and have the ability to produce biogenic amines and various hormones. NET usually occur sporadically but they also be associated with various familial syndromes. For the vast majority of NET, surgical resection is the treatment of choice whenever feasible. Localization of NET prior to surgery and for staging and follow-up relies on both anatomic and functional imaging modalities. In fact, the unique secretory characteristics of these tumors lend themselves to imaging by molecular imaging modalities, which can target specific metabolic pathways or receptors. Neuroendocrine cells have a variety of such target receptors and pathways for which radiopharmaceuticals have been developed, including [(123)I/(131)I]-metaiodobenzylguanidine (MIBG), [(111)In]pentetreotide, [(68)Ga] somatostatin analogs, [(18)F] fluorodeoxyglucose (FDG), [(11)C/(18)F] dihydroxyphenylalanine (DOPA), [(11)C] 5-hydroxytryptophan (5-HTP) (99m)Tc pentavalent dimercaptosuccinic acid ([(99m)Tc] (V) DMSA, and [(18)F] fluorodopamine (FDA). Here, we review the molecular imaging approaches for NET using various radiopharmaceuticals.
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Affiliation(s)
- Jorge A Carrasquillo
- Nuclear Medicine Service, Radiology Department Memorial Sloan-Kettering, New York, NY, USA.
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114
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Tan EH, Tan CH. Imaging of gastroenteropancreatic neuroendocrine tumors. World J Clin Oncol 2011; 2:28-43. [PMID: 21603312 PMCID: PMC3095463 DOI: 10.5306/wjco.v2.i1.28] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 10/20/2010] [Accepted: 10/27/2010] [Indexed: 02/06/2023] Open
Abstract
Imaging of gastroenteropancreatic neuroendocrine tumors can be broadly divided into anatomic and functional techniques. Anatomic imaging determines the local extent of the primary lesion, providing crucial information required for surgical planning. Functional imaging, not only determines the extent of metastatic disease spread, but also provides important information with regard to the biologic behavior of the tumor, allowing clinicians to decide on the most appropriate forms of treatment. We review the current literature on this subject, with emphasis on the strengths of each imaging modality.
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Affiliation(s)
- Eik Hock Tan
- Eik Hock Tan, Department of Nuclear Medicine and PET, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
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115
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Abstract
Neuroendocrine tumors (NET) have several distinct pathophysiological features that can be addressed by specific radiolabeled probes. An overview on the different radiopharmaceuticals that have been developed for positron emission tomography (PET) of NET are presented. The focus is on fluordeoxyglucose (F-18 FDG), biogenic amine precursors, somatostatin analogs, and hormone syntheses markers. Due to the highly specific tracers lacking any clear anatomical landmarking, the advantages of integrated functional and morphological imaging systems such as PET-CT are obvious. Based on the up to now published literature and one's own experience, it is concluded that amine precursors (e.g. fluor-dihydroxyphenylalanin and hydroxytryptophane) should be employed in most gastroenteropancreatic NET, whereas F-18 FDG should be preserved for more aggressive less-differentiated NETs. Hormone syntheses markers have up to now only been used in few centers and their broad clinical value remains uncertain. The different available somatostatin analogs are the most promising tracers, since they can improve dosimetry in cases where peptide receptor radiotherapies are planned. Of specific interest are the somatostatin analogs addressing several subtypes of the somatostatin receptor (e.g. DOTANOC) that allow detecting also subtypes not expressing the "classically" addressed subtype 2 and 5. Since NET have a high variety of different features, the individual diagnostic approach using PET or integrated PET-CT should be tailored, depending on the histological classification and the differentiation of the tumor.
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116
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Nikolaou A, Thomas D, Kampanellou C, Alexandraki K, Andersson LG, Sundin A, Kaltsas G. The value of 11C-5-hydroxy-tryptophan positron emission tomography in neuroendocrine tumor diagnosis and management: experience from one center. J Endocrinol Invest 2010; 33:794-9. [PMID: 20332708 DOI: 10.1007/bf03350344] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Many neuroendocrine tumors (NET) are small and may escape localization by conventional imaging techniques. In such cases, 11C-5-hydroxy-tryptophan (11C-5-HTP) positron emission tomography (PET) has been tested as an additional diagnostic tool. Nine patients with clinically, biochemically and/or histologically confirmed NET and negative computerized tomography (CT) or magnetic resonance imaging (MRI), and 111In-pentetreotide (Octreoscan) scintigraphy underwent imaging with 11C-5-HTP-PET/CT in order to: 1) detect the primary tumor lesion in three patients; 2) detect residual disease in two patients with appendiceal carcinoid, one with rectal carcinoid, one with midgut carcinoid, and one with ectopic ACTH secretion (EAS) due to residual pulmonary carcinoid; and 3) restage a patient with medullary thyroid carcinoma (MTC) and hepatic metastases. 11C-5-HTP-PET/CT detected lesions in the mediastinum in a patient with EAS due to a pulmonary carcinoid, further hepatic metastases in a patient with carcinoid syndrome (CS) from a NET of unknown primary, further hepatic metastases in the patient with MTC, and hepatic metastases in the patient with midgut carcinoid. The 11C-5-HTP-PET/CT findings contributed to radical cure of the patient with recurrent EAS, and pointed towards bilateral adrenalectomy in the patient with EAS without evident primary tumor. In addition, 11C-5- HTP-PET/CT directed towards combined surgical and medical treatment in the patient with CS and multiple rather than single hepatic metastases and in the patient with midgut carcinoid, and towards continuation of medical treatment in the patient with MTC. 11C-5-HTP-PET/CT is a useful imaging technique, providing additional information for the diagnosis, staging and decision-making regarding management of patients with NET.
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Affiliation(s)
- A Nikolaou
- Endocrine Unit, Department of Pathophysiology, National University of Athens, Mikras Asias 75, Athens, Greece
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117
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Miederer M, Weber MM, Fottner C. Molecular imaging of gastroenteropancreatic neuroendocrine tumors. Gastroenterol Clin North Am 2010; 39:923-35. [PMID: 21093764 DOI: 10.1016/j.gtc.2010.08.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Somatostatin-receptor scintigraphy has become an obligatory molecular imaging method in the management of patients with neuroendocrine tumors when metastatic disease is suspected. Using positron emission tomography and new somatostatin analogues, sensitivity of somatostatin receptor imaging has further increased. With a combination of morphologic imaging methods, such as hybrid imaging by PET/CT, this method represents the method of choice in many centers and efforts are under way to translate somatostatin receptor imaging onto a cellular level by endoscopic confocal microscopy. Other clinically relevant functional pathways in neuroendocrine tumors that are accessible by PET imaging are glucose metabolism and amine precursor uptake and decarboxylation.
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Affiliation(s)
- Matthias Miederer
- Department of Nuclear Medicine, University of Mainz, Langenbeckstr 1, Mainz 55131, Germany
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Measuring serotonin synthesis: from conventional methods to PET tracers and their (pre)clinical implications. Eur J Nucl Med Mol Imaging 2010; 38:576-91. [PMID: 21113591 PMCID: PMC3034914 DOI: 10.1007/s00259-010-1663-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Accepted: 11/01/2010] [Indexed: 12/20/2022]
Abstract
The serotonergic system of the brain is complex, with an extensive innervation pattern covering all brain regions and endowed with at least 15 different receptors (each with their particular distribution patterns), specific reuptake mechanisms and synthetic processes. Many aspects of the functioning of the serotonergic system are still unclear, partially because of the difficulty of measuring physiological processes in the living brain. In this review we give an overview of the conventional methods of measuring serotonin synthesis and methods using positron emission tomography (PET) tracers, more specifically with respect to serotonergic function in affective disorders. Conventional methods are invasive and do not directly measure synthesis rates. Although they may give insight into turnover rates, a more direct measurement may be preferred. PET is a noninvasive technique which can trace metabolic processes, like serotonin synthesis. Tracers developed for this purpose are α-[11C]methyltryptophan ([11C]AMT) and 5-hydroxy-L-[β-11C]tryptophan ([11C]5-HTP). Both tracers have advantages and disadvantages. [11C]AMT can enter the kynurenine pathway under inflammatory conditions (and thus provide a false signal), but this tracer has been used in many studies leading to novel insights regarding antidepressant action. [11C]5-HTP is difficult to produce, but trapping of this compound may better represent serotonin synthesis. AMT and 5-HTP kinetics are differently affected by tryptophan depletion and changes of mood. This may indicate that both tracers are associated with different enzymatic processes. In conclusion, PET with radiolabelled substrates for the serotonergic pathway is the only direct way to detect changes of serotonin synthesis in the living brain.
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Müssig K, Bares R, Erckenbrecht JF, Horger M. Multimodal imaging in functional endocrine pancreatic tumors. Expert Rev Endocrinol Metab 2010; 5:855-866. [PMID: 30780827 DOI: 10.1586/eem.10.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Endocrine pancreatic tumors, also known as pancreatic islet tumors, are rare entities of neuroendocrine origin that are located within the pancreas or in its close proximity. Approximately 50% of these tumors secrete biologically active substances that lead to the development of specific clinical syndromes. Once diagnosis has been established on the basis of clinical and laboratory findings, localization of the source of pathologic hormone secretion is warranted. Endocrine pancreatic tumor imaging comprises anatomical imaging modalities, such as ultrasound, computed tomography (CT) and MRI, as well as functional radiological studies, including arterial calcium stimulation with hepatic venous sampling, and functional nuclear medicine imaging modalities, such as scintigraphy and PET. The recent combination of high-resolution anatomic studies and functional imaging, such as PET/CT and single-photon emission CT/CT, allows excellent diagnostic evaluation of pancreatic islet cell tumors and has, therefore, especially high value. Given that none of these imaging methods are exclusively superior to the others, visualization of pancreatic islet cell tumors often requires the combination of different imaging modalities.
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Affiliation(s)
- Karsten Müssig
- a Department of Internal Medicine, Gastroenterology and Oncology, Florence Nightingale Hospital, Kaiserswerther Diakonie, Kreuzbergstr. 79, 40489 Düsseldorf, Germany
- d
| | - Roland Bares
- b Department of Nuclear Medicine, University Hospital of Tübingen, Otfried-Müller-Str. 14, 72076 Tübingen, Germany
| | - Joachim F Erckenbrecht
- a Department of Internal Medicine, Gastroenterology and Oncology, Florence Nightingale Hospital, Kaiserswerther Diakonie, Kreuzbergstr. 79, 40489 Düsseldorf, Germany
| | - Marius Horger
- c Department of Diagnostic Radiology, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
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Scherübl H, Jensen RT, Cadiot G, Stölzel U, Klöppel G. Neuroendocrine tumors of the small bowels are on the rise: Early aspects and management. World J Gastrointest Endosc 2010; 2:325-34. [PMID: 21160582 PMCID: PMC2998818 DOI: 10.4253/wjge.v2.i10.325] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 08/02/2010] [Accepted: 08/09/2010] [Indexed: 02/05/2023] Open
Abstract
Neuroendocrine tumors of the small bowel are on the rise. In the US they have increased by 300%-500% in the last 35 years. At the same time their prognosis is much improved. Today, most neuroendocrine tumors (NETs) of the duodenum are detected "incidentally" and therefore recognized at an early stage. Duodenal NETs which are well differentiated, not larger than 10 mm and limited to the mucosa/submucosa can be endoscopically resected. The management of duodenal NETs ranging between 10 and 20 mm needs an interdisciplinary discussion. Endoscopic ultrasound is the method of choice to determine tumor size and depth of infiltration. Surgery is recommended for well-differentiated duodenal NET tumors greater than 20 mm, for localized sporadic gastrinomas (of any size) and for localized poorly differentiated NE cancers. Surgery is recommended for any ileal NET. Advanced ileal NETs with a carcinoid syndrome are treated with long-acting somatostatin analogs. This treatment significantly improves (progression-free) survival in patients with metastatic NETs of the ileum. For optimal NET management, tumor biology, type, localization and stage of the neoplasm, as well as the patient's individual circumstances have to be taken into account.
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Affiliation(s)
- Hans Scherübl
- Hans Scherübl, Departments of Gastroenterology and Gastrointestinal Oncology, Vivantes Klinikum Am Urban, Berlin 10967, Germany
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Hicks RJ. Use of molecular targeted agents for the diagnosis, staging and therapy of neuroendocrine malignancy. Cancer Imaging 2010; 10 Spec no A:S83-91. [PMID: 20880795 PMCID: PMC2967140 DOI: 10.1102/1470-7330.2010.9007] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Imaging of neuroendocrine tumours (NET) poses significant challenges because of the heterogeneous biology of the tumours that are represented by this class of neoplasia. NET can range from benign lesions to highly aggressive cancers. Structural imaging techniques have suboptimal sensitivity in most published series and diagnosis is often delayed until metastatic disease is present. Current guidelines emphasise the importance of functional imaging for evaluating the extent of NET. The mainstay of this type of imaging has been somatostatin receptor scintigraphy (SRS) with [111In]diethylenetriaminepentaacetic acid-octreotide (Octreoscan™). Routine use of single-photon emission computed tomography (SPECT) and particularly of hybrid SPECT/computed tomography (CT) has significantly improved localisation of tumour sites and evaluation of somatostatin receptor (SSTR) expression, which is important for predicting the likelihood of response to somatostatin analogues (SSA). Positron emission tomography (PET) can also now be used for evaluating SSTR expression. There are a number of peptides that have been evaluated but [68Ga]tetraazocyclodecanetetraacetic acid (DOTA)-octreotate (GaTate) PET/CT, which has been shown to be significantly more sensitive for detecting small lesions than Octreoscan™, is now probably the preferred agent because high uptake in known sites of disease provides a diagnostic pair for assessing suitability of patients for [177Lu]DOTA-octreotate (LuTate) peptide receptor radionuclide therapy (PRRT). A range of other radiolabelled SSA has also been used for PRRT. Lesions without SSTR expression require alternative imaging and therapeutic strategies. Although fluorodeoxyglucose (FDG) uptake in low-grade NET is not generally increased relative to normal tissues, the loss of differentiation that often accompanies loss of SSTR expression may be associated with a significant increase in glycolytic metabolism and an accompanying improvement in the diagnostic sensitivity of FDG PET/CT. High FDG avidity is associated with a poorer prognosis but increases the likelihood of response to chemotherapy. Functioning tumours also require substrates for their secreted products. This can be exploited for NET imaging with amine precursor uptake being imaged using [18F]3,4-dihydrophenylalanine and serotonin-secreting tumours being sensitively detected using [11C]5-hydroxytryptamine. Both these agents are suitable for imaging with PET. [123I]meta-Iodo-benzyl-guanidine (MIBG) SPECT/CT may also be useful as a staging technique, particularly for NET of the sympathetic neuronal chain, and can identify patients who may be suitable for [131I]MIBG therapy. In the future, paradigms guided by clinical and biopsy features should allow personalised imaging paradigms aligned to therapeutic options.
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Affiliation(s)
- R J Hicks
- Departments of Medicine and Radiology, University of Melbourne, Centre for Cancer Imaging, Molecular Imaging and Targeted Therapeutics Laboratory, The Peter MacCallum Cancer Centre, East Melbourne, Australia.
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De Angelis CG, Crippa F. 5. Imaging techniques in diagnostic approaches. TUMORI JOURNAL 2010; 96:817-22. [DOI: 10.1177/030089161009600534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite the considerable technological advances in imaging modalities which have occurred over the last years, EUS remains one of the most reliable and accurate technique for the study of gastroenteropancreatic neuroendocrine tumors. More specifically, EUS can detect very small lesions, assess the local extent and lymph node involvement and biopsy the lesion for cytophatological confirmation (EUS-FNA). In addition, nuclear medicine imaging has a relevant role in the evaluation of NET. However, its performance depends on series of patient-specific features (lesion size and uptake, depth and other anatomic features; metabolic activity, receptor expression, affinity and vacancy, tissue specificity) and technical features (choice of tracer, administered dose, and physical half-life; instrument sensitivity, acquisition technique, reader experience). In particular, current data show that PET/CT has greater intrinsic resolution and sensitivity than SPECT or SPECT/CT images resulting in improved tumor detection. However, the PET tracer of choice has not yet been identified. 18F-FDG has proved to be useful as indicator of tumor aggressiveness rather than detection of extent of disease, and 68Ga-DOTA-TOC has demonstrated good results in clinical trials. 11C-5HTP has performed well in limited trials, but the 20-min half life of 11C precludes widespread availability. Better information concerning biodistribution and further comparative data of these agent in larger clinical trials are warranted. Free full text available at www.tumorionline.it
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Affiliation(s)
- Claudio G De Angelis
- GastroHepatology Department, San Giovanni Battista “Molinette” Hospital, University of Turin, Turin
| | - Flavio Crippa
- SS PET, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
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Veit-Haibach P, Schiesser M, Soyka J, Strobel K, Schaefer NG, Hesselmann R, Clavien PA, Hany TF. Clinical value of a combined multi-phase contrast enhanced DOPA-PET/CT in neuroendocrine tumours with emphasis on the diagnostic CT component. Eur Radiol 2010; 21:256-64. [DOI: 10.1007/s00330-010-1930-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 07/22/2010] [Accepted: 07/28/2010] [Indexed: 10/19/2022]
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Janson ET, Sørbye H, Welin S, Federspiel B, Grønbæk H, Hellman P, Mathisen Ø, Mortensen J, Sundin A, Thiis-Evensen E, Välimäki MJ, Öberg K, Knigge U. Nordic Guidelines 2010 for diagnosis and treatment of gastroenteropancreatic neuroendocrine tumours. Acta Oncol 2010; 49:740-56. [PMID: 20553100 DOI: 10.3109/0284186x.2010.492791] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The diagnostic work-up and treatment of patients with neuroendocrine tumours has undergone a major change during the last decade. New diagnostic possibilities and treatment options have been developed. These Nordic guidelines, written by a group with a major interest in the subject, summarises our current view on how to diagnose and treat these patients. The guidelines are meant to be useful in the daily practice for clinicians handling patients with neuroendocrine tumours.
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Frilling A, Sotiropoulos GC, Li J, Kornasiewicz O, Plöckinger U. Multimodal management of neuroendocrine liver metastases. HPB (Oxford) 2010; 12:361-79. [PMID: 20662787 PMCID: PMC3028577 DOI: 10.1111/j.1477-2574.2010.00175.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The incidence of neuroendocrine tumours (NET) has increased over the past three decades. Hepatic metastases which occur in up to 75% of NET patients significantly worsen their prognosis. New imaging techniques with increasing sensitivity enabling tumour detection at an early stage have been developed. The treatment encompasses a panel of surgical and non-surgical modalities. METHODS This article reviews the published literature related to management of hepatic neuroendocrine metastases. RESULTS Abdominal computer tomography, magnetic resonance tomography and somatostatin receptor scintigraphy are widely accepted imaging modalities. Hepatic resection is the only potentially curative treatment. Liver transplantation is justified in highly selected patients. Liver-directed interventional techniques and locally ablative measures offer effective palliation. Promising novel therapeutic options offering targeted approaches are under evaluation. CONCLUSIONS The treatment of neuroendocrine liver metastases still needs to be standardized. Management in centres of expertise should be strongly encouraged in order to enable a multidisciplinary approach and personalized treatment. Development of molecular prognostic factors to select treatment according to patient risk should be attempted.
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Affiliation(s)
- Andrea Frilling
- Department of Surgery and Cancer, Imperial College London, Hammersmith HospitalLondon, UK
| | | | - Jun Li
- Department of General, Visceral and Transplantation Surgery, University Hospital TübingenTübingen
| | - Oskar Kornasiewicz
- Department of Surgery and Cancer, Imperial College London, Hammersmith HospitalLondon, UK
| | - Ursula Plöckinger
- Interdisciplinary Centre for Metabolism: Endocrinology, Diabetes and Metabolism, Campus Virchow-Klinikum, Charité-Universitaetsmedizin BerlinBerlin, Germany
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Srirajaskanthan R, Kayani I, Quigley AM, Soh J, Caplin ME, Bomanji J. The Role of 68Ga-DOTATATE PET in Patients with Neuroendocrine Tumors and Negative or Equivocal Findings on 111In-DTPA-Octreotide Scintigraphy. J Nucl Med 2010; 51:875-82. [DOI: 10.2967/jnumed.109.066134] [Citation(s) in RCA: 241] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Binderup T, Knigge U, Loft A, Mortensen J, Pfeifer A, Federspiel B, Hansen CP, Højgaard L, Kjaer A. Functional imaging of neuroendocrine tumors: a head-to-head comparison of somatostatin receptor scintigraphy, 123I-MIBG scintigraphy, and 18F-FDG PET. J Nucl Med 2010; 51:704-12. [PMID: 20395333 DOI: 10.2967/jnumed.109.069765] [Citation(s) in RCA: 223] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
UNLABELLED Functional techniques are playing a pivotal role in the imaging of cancer today. Our aim was to compare, on a head-to-head basis, 3 functional imaging techniques in patients with histologically verified neuroendocrine tumors: somatostatin receptor scintigraphy (SRS) with (111)In-diethylenetriaminepentaacetic acid-octreotide, scintigraphy with (123)I-metaiodobenzylguanidine (MIBG), and (18)F-FDG PET. METHODS Ninety-six prospectively enrolled patients with neuroendocrine tumors underwent SRS, (123)I-MIBG scintigraphy, and (18)F-FDG PET on average within 40 d. The functional images were fused with low-dose CT scans for anatomic localization, and the imaging results were compared with the proliferation index as determined by Ki67. RESULTS The overall sensitivity of SRS, (123)I-MIBG scintigraphy, and (18)F-FDG PET was 89%, 52%, and 58%, respectively. Of the 11 SRS-negative patients, 7 were (18)F-FDG PET-positive, of which 3 were also (123)I-MIBG scintigraphy-positive, giving a combined overall sensitivity of 96%. SRS also exceeded (123)I-MIBG scintigraphy and (18)F-FDG PET based on the number of lesions detected (393, 185, and 225, respectively) and tumor subtypes. (123)I-MIBG scintigraphy was superior to (18)F-FDG PET for ileal neuroendocrine tumors, and (18)F-FDG PET was superior to (123)I-MIBG scintigraphy for pancreaticoduodenal neuroendocrine tumors. The sensitivity of (18)F-FDG PET (92%) exceeded that of both SRS (69%) and (123)I-MIBG scintigraphy (46%) for tumors with a proliferation index above 15%. CONCLUSION The overall sensitivity of (123)I-MIBG scintigraphy and (18)F-FDG PET was low compared with SRS. However, for tumors with a high proliferation rate, (18)F-FDG PET had the highest sensitivity. The results indicate that, although SRS should still be the routine method, (18)F-FDG PET provides complementary diagnostic information and is of value for neuroendocrine tumor patients with negative SRS findings or a high proliferation index.
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Affiliation(s)
- Tina Binderup
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen, Denmark
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Synthesis and evaluation of l-5-(2-[18F]fluoroethoxy)tryptophan as a new PET tracer. Appl Radiat Isot 2010; 68:303-8. [DOI: 10.1016/j.apradiso.2009.10.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 09/27/2009] [Accepted: 10/07/2009] [Indexed: 11/23/2022]
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Dudczak R, Traub-Weidinger T. PET and PET/CT in endocrine tumours. Eur J Radiol 2010; 73:481-93. [PMID: 20089377 DOI: 10.1016/j.ejrad.2009.12.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 12/15/2009] [Indexed: 10/19/2022]
Abstract
Functional information provided by PET tracers together with the superior image quality and the better data quantification by PET technology had a changing effect on the significance of nuclear medicine in medical issues. Recently introduced hybrid PET/CT systems together with the introduction of novel PET radiopharmaceuticals have contributed to the fact that nuclear medicine has become a growing diagnostic impact on endocrinology. In this review imaging strategies, different radiopharmaceuticals including the basic mechanism of their cell uptake, and the diagnostic value of PET and PET/CT in endocrine tumours except differentiated thyroid carcinomas will be discussed.
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Affiliation(s)
- Robert Dudczak
- Department of Nuclear Medicine, Medical University of Vienna, Austria.
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Naji M, Hodolic M, El-Refai S, Khan S, Marzola MC, Rubello D, Al-Nahhas A. Endocrine tumors: the evolving role of positron emission tomography in diagnosis and management. J Endocrinol Invest 2010; 33:54-60. [PMID: 19820296 DOI: 10.1007/bf03346550] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Endocrine tumors comprise a range of benign and malignant conditions that produce a spectrum of clinical symptoms and signs depending on the specific hormones they produce. The symptoms and presentations of these tumors are often independent of their size and location. Because of their expression of cell membrane receptors or production of specific types of hormones or peptides, endocrine tumors can be identified with functional radionuclide imaging much more readily compared to standard cross-sectional imaging. In recent years, 18F-fluoro-deoxy- D-glucose positron emission tomography (18F-FDG-PET) has emerged as a useful tool for diagnosing and assessing many tumors. In this review we describe how PET, using 18F-FDG and other radiopharmaceuticals can be useful in the diagnosis and management of a wide range of endocrine tumors.
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Affiliation(s)
- M Naji
- Department for Nuclear Medicine, Hammersmith Hospital, London, UK
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Bertino EM, Confer PD, Colonna JE, Ross P, Otterson GA. Pulmonary neuroendocrine/carcinoid tumors: a review article. Cancer 2009; 115:4434-41. [PMID: 19562772 DOI: 10.1002/cncr.24498] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Neuroendocrine tumors are a unique malignant neoplasm that can arise from the respiratory tree. Although well-differentiated bronchial neuroendocrine tumors (also called carcinoid tumors) are reported to account for approximately 25% of all neuroendocrine tumors, they represent only 1% to 2% of all lung cancers. The epidemiology, clinical behavior, and treatment of neuroendocrine carcinoid tumors differ significantly from other lung malignancies. In this article, the recent data regarding these tumors were reviewed with attention to the treatment modalities used. Although conventional cytotoxic therapy has not been reported to demonstrate much promise in this entity over the past 4 decades, newer molecular targeted agents including those that targeted angiogenesis and the mammalian target of rapamycin (mTOR) pathway have shown encouraging results in early phase trials for advanced carcinoid tumors.
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Affiliation(s)
- Erin M Bertino
- Department of Internal Medicine, Ohio State University College of Medicine, Columbus, Ohio, USA
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Abstract
Although 6-(18)F-fluoro-L-dopa ((18)F-FDOPA) has been available to study the striatal dopaminergic system for more than 2 decades, the full potential of the tracer was not realized before the introduction of (18)F-FDOPA PET and PET/CT to image a variety of neuroendocrine tumors (NETs) and pancreatic beta-cell hyperplasia. Together with receptor-based imaging, (18)F-FDOPA offers a formerly unforeseen means to assist in the management of NETs and infants with persistent hyperinsulinemic hyperplasia. Institutions with special expertise in surgical, oncologic, and radiologic therapeutic modalities for NETs derive the highest benefit from (18)F-FDOPA PET/CT. (18)F-FDOPA-guided therapy may add to NET control by ensuring maximal cytoreduction.
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Affiliation(s)
- Heikki Minn
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland.
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Chua S, Gnanasegaran G, Cook GJ. Miscellaneous Cancers (Lung, Thyroid, Renal Cancer, Myeloma, and Neuroendocrine Tumors): Role of SPECT and PET in Imaging Bone Metastases. Semin Nucl Med 2009; 39:416-30. [DOI: 10.1053/j.semnuclmed.2009.07.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Fiebrich HB, Brouwers AH, Kerstens MN, Pijl MEJ, Kema IP, de Jong JR, Jager PL, Elsinga PH, Dierckx RAJO, van der Wal JE, Sluiter WJ, de Vries EGE, Links TP. 6-[F-18]Fluoro-L-dihydroxyphenylalanine positron emission tomography is superior to conventional imaging with (123)I-metaiodobenzylguanidine scintigraphy, computer tomography, and magnetic resonance imaging in localizing tumors causing catecholamine excess. J Clin Endocrinol Metab 2009; 94:3922-30. [PMID: 19622618 DOI: 10.1210/jc.2009-1054] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
CONTEXT Catecholamine excess is rare, but symptoms may be life threatening. OBJECTIVE The objective of the study was to investigate the sensitivity of 6-[F-18]fluoro-l-dihydroxyphenylalanine positron emission tomography ((18)F-DOPA PET), compared with (123)I-metaiodobenzylguanidine ((123)I-MIBG) scintigraphy and computer tomography (CT)/magnetic resonance imaging (MRI) for tumor localization in patients with catecholamine excess. DESIGN AND SETTING All consecutive patients with catecholamine excess visiting the University Medical Center Groningen, Groningen, The Netherlands, between March 2003 and January 2008 were eligible. PATIENTS Forty-eight patients were included. The final diagnosis was pheochromocytoma in 40, adrenal hyperplasia in two, paraganglioma in two, ganglioneuroma in one, and unknown in three. MAIN OUTCOME MEASURES Sensitivities and discordancy between (18)F-DOPA PET, (123)I-MIBG, and CT or MRI were analyzed for individual patients and lesions. Metanephrines and 3-methoxytyramine in plasma and urine and uptake of (18)F-DOPA with PET were measured to determine the whole-body metabolic burden and correlated with biochemical tumor activity. The gold standard was a composite reference standard. RESULTS (18)F-DOPA PET showed lesions in 43 patients, (123)I-MIBG in 31, and CT/MRI in 32. Patient-based sensitivity for (18)F-DOPA PET, (123)I-MIBG, and CT/MRI was 90, 65, and 67% (P < 0.01 for (18)F-DOPA PET vs. both (123)I-MIBG and CT/MRI, P = 1.0 (123)I-MIBG vs. CT/MRI). Lesion-based sensitivities were 73, 48, and 44% (P < 0.001 for (18)F-DOPA PET vs. both (123)I-MIBG and CT/MRI, P = 0.51 (123)I-MIBG vs. CT/MRI). The combination of (18)F-DOPA PET with CT/MRI was superior to (123)I-MIBG with CT/MRI (93 vs. 76%, P < 0.001). Whole-body metabolic burden measured with (18)F-DOPA PET correlated with plasma normetanephrine (r = 0.82), urinary normetanephrine (r = 0.84), and metanephrine (r = 0.57). CONCLUSION To localize tumors causing catecholamine excess, (18)F-DOPA PET is superior to (123)I-MIBG scintigraphy and CT/MRI.
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Affiliation(s)
- Helle-Brit Fiebrich
- Department of Medical Oncology, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
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Koopmans KP, Neels ON, Kema IP, Elsinga PH, Links TP, de Vries EGE, Jager PL. Molecular imaging in neuroendocrine tumors: molecular uptake mechanisms and clinical results. Crit Rev Oncol Hematol 2009; 71:199-213. [PMID: 19362010 DOI: 10.1016/j.critrevonc.2009.02.009] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2007] [Revised: 02/16/2009] [Accepted: 02/25/2009] [Indexed: 12/20/2022] Open
Abstract
Neuroendocrine tumors can originate almost everywhere in the body and consist of a great variety of subtypes. This paper focuses on molecular imaging methods using nuclear medicine techniques in neuroendocrine tumors, coupling molecular uptake mechanisms of radiotracers with clinical results. A non-systematic review is presented on receptor based and metabolic imaging methods. Receptor-based imaging covers the molecular backgrounds of somatostatin, vaso-intestinal peptide (VIP), bombesin and cholecystokinin (CCK) receptors and their link with nuclear imaging. Imaging methods based on specific metabolic properties include meta-iodo-benzylguanide (MIBG) and dimercapto-sulphuric acid (DMSA-V) scintigraphy as well as more modern positron emission tomography (PET)-based methods using radio-labeled analogues of amino acids, glucose, dihydroxyphenylalanine (DOPA), dopamine and tryptophan. Diagnostic sensitivities are presented for each imaging method and for each neuroendocrine tumor subtype. Finally, a Forest plot analysis of diagnostic performance is presented for each tumor type in order to provide a comprehensive overview for clinical use.
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Affiliation(s)
- Klaas P Koopmans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen and University Medical Centre Groningen, 9700 RB Groningen, The Netherlands
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137
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Biermann M, Johnsen B, Sørbye H, Følling M, Sundin A, Bach-Gansmo T. [Positron emission tomography in neuroendocrine tumours]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2009; 129:1474-7. [PMID: 19690598 DOI: 10.4045/tidsskr.08.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Neuroendocrine tumours constitute a small group of malignancies; about 200 new patients are diagnosed in Norway annually. This article discusses problems associated with use of deoxyfluoroglucose (FDG) Positron Emission Tomography (PET) and other available options in patients with these conditions, as well as challenges related to introduction of new radiopharmaceutical agents. MATERIAL AND METHODS The article is based on review of literature in connection with development of new guidelines for nuclear medicine examinations, supplemented with literature identified through a non-systematic search of Pubmed. RESULTS A large proportion of these tumours grow slowly, and recent data show that 5-year survival is about 50 %. Neuroendocrine tumours are characterised by specific biochemical processes that enable tailoring of radiopharmaceutical agents for PET and consequently a more accurate diagnosis and improved follow-up of these patients. INTERPRETATION As for other cancer types, diagnostics and detection of metastases are an important factor for correct treatment of neuroendocrine tumours. PET with FDG is of limited use for patients with this condition. New specific radiopharmaceutical agents for PET may imply detection of 90 % of all such tumours.
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Affiliation(s)
- Martin Biermann
- Senter for nukleaermedisin/PET, Haukeland universitetssykehus og Institutt for kirurgiske fag Universitetet i Bergen, Bergen, Norway
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138
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Abstract
Multiple endocrine neoplasia type 1 (MEN 1) is an autosomal-dominant inherited tumor syndrome characterized by hyperplasia and/or tumors in the parathyroid glands, the pancreatic islets, the anterior pituitary and adrenal glands, as well as neuroendocrine tumors in the thymus, lungs and stomach, and tumors in nonendocrine tissues. In 1997, the responsible MEN1 gene was identified as a tumor-suppressor gene and its product was named menin. In this review, guidelines for early diagnosis, including MEN1 gene mutation analysis, and treatment, including periodic clinical monitoring, have been formulated, enabling improvement of life expectancy and quality of life. Identification of menin-interacting proteins has provided new insights into the function of menin, notably involving regulation of gene transcription related to proliferation and apoptosis, genome stability and DNA repair, and endocrine/metabolic homeostasis. In the near future, target-directed intervention may prevent or delay the onset of MEN 1-related tumors.
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Affiliation(s)
- Cornelis Jm Lips
- a University Medical Center Utrecht, Department of Internal Medicine, Wassenaarseweg 109, 2596 CN The Hague, The Netherlands.
| | - Koen Dreijerink
- b University Medical Center Utrecht, Department of Internal Medicine, F02.126, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Thera P Links
- c University Medical Center Groningen, Department of Internal Medicine, PO Box 30001, 9700 RB Groningen, The Netherlands.
| | - Jo Wm Höppener
- d Department of Metabolic and Endocrine Diseases, PO Box 85090, 3508 AB Utrecht.
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139
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Koornstra JJ, de Vries EGE, Porte RJ. Improvements in small bowel carcinoid diagnosis and staging: 18F-DOPA PET, capsule endoscopy and double balloon enteroscopy. Dig Liver Dis 2009; 41:e35-8. [PMID: 18606578 DOI: 10.1016/j.dld.2008.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Revised: 05/13/2008] [Accepted: 05/23/2008] [Indexed: 12/11/2022]
Abstract
Carcinoid tumours are rare, slow growing tumours, originating from cells of the neuroendocrine system. Staging of the disease is of paramount importance to determine the optimal treatment strategy but is notoriously difficult. A case of a 45-year-old male who presented with abdominal pain and flushes is presented. An abdominal computerised tomography-scan was performed which showed a solitary liver lesion, consisting of neuroendocrine tumour cells. Further staging with (18)F-DOPA PET, capsule endoscopy and double balloon enteroscopy revealed the localisation of the primary tumours in the small bowel, and the patient subsequently underwent surgery. The recent introduction of (18)F-DOPA PET, capsule endoscopy and double balloon enteroscopy in the diagnosis and staging of carcinoid tumours has made significant contributions to the management of this disease.
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Affiliation(s)
- J J Koornstra
- Department of Gastroenterology & Hepatology, University Medical Centre Groningen, University of Groningen, The Netherlands.
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140
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Fiebrich HB, Brouwers AH, Koopmans KP, de Vries EGE. Combining 6-fluoro-[18F]l-dihydroxyphenylalanine and [18F]fluoro-2-deoxy-d-glucose positron emission tomography for distinction of non-carcinoid malignancies in carcinoid patients. Eur J Cancer 2009; 45:2312-5. [PMID: 19477116 DOI: 10.1016/j.ejca.2009.04.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 04/29/2009] [Accepted: 04/30/2009] [Indexed: 11/25/2022]
Abstract
AIM Carcinoid patients frequently develop a second primary malignancy (SPM), which can deserve full treatment. Distinguishing a SPM from carcinoid lesions is therefore important. Differentiation can be achieved using the difference in uptake between different positron emission tomography (PET) tracers. METHODS AND RESULTS Between January 2005 and August 2008, 105 carcinoid patients were seen at the Department of Medical Oncology for treatment and follow-up. We identified 3 patients who presented with a new SPM in whom differentiation between carcinoid lesions and the SPM was guided by functional imaging of the catecholamine pathway with 6-fluoro-[(18)F]l-dihydroxyphenylalanine ((18)F-DOPA) PET and [(18)F]fluoro-2-deoxy-d-glucose ((18)F-FDG) PET as radiotracer for the glucose metabolism. All 3 patients had metastatic carcinoid disease and localised adenocarcinoma based on the PET-scans. For the adenocarcinoma they received curative treatment. CONCLUSION The difference in uptake between these PET techniques can be used for decision making when a primary or metastatic SPM is suspected.
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Affiliation(s)
- Helle-Brit Fiebrich
- Department of Medical Oncology, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
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141
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A review of molecular imaging studies reaching the clinical stage. Eur J Radiol 2009; 70:205-11. [DOI: 10.1016/j.ejrad.2009.01.049] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Accepted: 01/14/2009] [Indexed: 12/21/2022]
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142
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Montravers F, Kerrou K, Nataf V, Huchet V, Lotz JP, Ruszniewski P, Rougier P, Duron F, Bouchard P, Grangé JD, Houry S, Talbot JN. Impact of fluorodihydroxyphenylalanine-18F positron emission tomography on management of adult patients with documented or occult digestive endocrine tumors. J Clin Endocrinol Metab 2009; 94:1295-301. [PMID: 19141589 DOI: 10.1210/jc.2008-1349] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
CONTEXT AND OBJECTIVES Fluorodihydroxyphenylalanine-(18F) (FDOPA) positron emission tomography (PET) is a recent imaging modality used to localize endocrine tumors. This study was conducted to evaluate the impact of FDOPA-PET on the management of patients referred for carcinoid or noncarcinoid digestive tumors and the clinical relevance of the treatment decisions based on this examination. METHODS AND PATIENTS Between March 2002 and December 2006, 101 FDOPA-PET examinations were performed in 78 adult patients for follow-up of histologically documented carcinoid tumor of the ileum (23 patients) or noncarcinoid digestive tumor (26 patients) or to screen for occult digestive endocrine tumors (29 patients). More than one FDOPA-PET examination was performed in 12 patients. The impact of FDOPA PET was evaluated on a per-patient basis by means of a questionnaire completed by the referring physician, and the relevance of the treatment decision was assessed on the basis of follow-up data. RESULTS The survey response rate was 91% (71 of 78). The overall impact rate of FDOPA-PET on patient management was 25% (18 of 71). The greatest impact was observed for carcinoid tumors (50%: 11 of 22) and was clinically relevant in every case, followed by occult endocrine tumors (16%: four of 25), and was clinically relevant in three of the four cases, and noncarcinoid tumors (13%: 3 of 22), clinically relevant in only one case. CONCLUSION FDOPA-PET appears to be a major tool for the management of carcinoid tumors with excellent diagnostic performances and induced relevant changes in patient management. FDOPA-PET was less sensitive and less useful for the management of noncarcinoid tumors.
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Affiliation(s)
- Françoise Montravers
- Department of Nuclear Medicine, Tenon Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.
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143
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Abstract
Neuroendocrine carcinomas of unknown primary site are uncommon, diverse tumors with variable clinical behavior, predicted by tumor grade or differentiation. Most of these carcinomas probably arise from an occult/clinically undetectable primary site in one of several locations (bronchus, pancreas, stomach, colon, rectum and several other sites). Patients with these tumors are a subset of unknown primary carcinoma with relatively favorable prognoses. Low-grade or well-differentiated tumors are frequently indolent and cases should be managed similar to advanced carcinoid tumors. Targeted therapies may have a role in the treatment of low-grade tumors. The high-grade or poorly differentiated carcinomas, including small cell and large cell neuroendocrine tumors, are rapidly growing and aggressive but responsive to platinum-based combination chemotherapy. Poorly differentiated large cell neuroendocrine tumors, first reported in 1988, are usually not recognized by routine hematoxylin and eosin light microscopy but require immunohistochemical stains or electron microscopy for their diagnosis. A review of cytotoxic chemotherapy for patients with high-grade neuroendocrine carcinomas, including a series of 99 patients, revealed an overall response rate of 70%, with a 20% complete response rate. The median survival was 15 months, and a minority of patients (13%) had long-term survival. Tumor grade/differentiation currently is an important determinant of the management of these patients, and therapy in the future will be based on a more precise knowledge of the unique biology of these tumors.
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Affiliation(s)
- David R Spigel
- Sarah Cannon Research Institute, Tennessee Oncology, PLLC, Nashville, TN, USA.
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144
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Abstract
Radiolabeled tracers provide a functional imaging technique to identify neuroendocrine tumors, usually with greater sensitivity and specificity than anatomic imaging techniques such as computed tomography (CT), magnetic resonance imaging and ultrasound. Currently, there are several single-photon techniques available using either 123I-MIBG, 111In-DTPA-pentetreotide (Octreoscan®) or 99mTc-EDDA/HYNIC-tyr3-octreotate. 111In-DTPA-pentetreotide is most widely used. The best results are achieved with single-photon emission computed tomography/CT. Positron emission tomography (PET) and PET/CT are likely to provide further improvements in tumor detection, but there is, at the present time, no consensus on the choice of tracer. 18F-FDG, 68Ga-DOTA-TOC and 68Ga-DOTA-NOC, 18F-FP-Gluc-TOCA, 18F-FDOPA and 11C-5HTP (hydroxy tryptophan) are currently being evaluated. Early results and issues pertaining to availability are reviewed. The identification of the ‘best’ tracer will depend on multiple factors.
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Affiliation(s)
- Stanley J Goldsmith
- Radiology and Medicine, Weill Medical College of Cornell University, Director Nuclear Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, Starr 2–21, 525 East 68th Street, New York, NY 10065, USA
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145
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Abstract
BACKGROUND Surgery has become heavily dependent on accurate imaging in the assessment and treatment of suspected or confirmed intra-abdominal malignancy. Positron emission tomography-computed tomography (PET-CT) fuses uptake of a radiotracer combined with CT images to assess both functional tissue activity and anatomical detail. Since its introduction it has offered new ways of treating gastrointestinal cancers. METHODS The review analyses the present literature regarding the use of PET-CT in the assessment, diagnosis, staging and treatment of hepatobiliary malignancies. RESULTS PET-CT is widely used in pre-operative tumours staging for colorectal liver metastases. There is convincing data that it may also be applicable for neuroendocrine tumours, assessment of indeterminate pancreas lesions and clinical drug trials. PET-CT is of limited value in hepatocellular cancers, although new techniques in dual-tracer PET-CT may change this. CONCLUSION Knowledge of the strengths and limitations of PET-CT is important for all surgeons managing cancer of the hepatobiliary system. More clinical data are required on PET-CT, particularly its effect on long-term survival in PET-CT-staged patients undergoing resection.
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Affiliation(s)
- Ginseppe Garcea
- Department of Hepatobiliary and Upper Gastrointestinal Surgery, The Queen Elizabeth HospitalAdelaide, SA, Australia
| | - Seok Ling Ong
- Department of Hepatobiliary and Pancreatic Surgery, Leicester General HospitalLeicester, UK
| | - Guy J Maddern
- Department of Hepatobiliary and Upper Gastrointestinal Surgery, The Queen Elizabeth HospitalAdelaide, SA, Australia
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146
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Ilias I, Pacak K. A clinical overview of pheochromocytomas/paragangliomas and carcinoid tumors. Nucl Med Biol 2009; 35 Suppl 1:S27-34. [PMID: 18707631 DOI: 10.1016/j.nucmedbio.2008.04.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Revised: 04/23/2008] [Accepted: 04/23/2008] [Indexed: 01/02/2023]
Abstract
Pheochromocytomas/paragangliomas are rare tumors; most are sporadic. Biochemical proof of disease is better with measurement of plasma metanephrines and less cumbersome than determinations in urine; its implementation is expanding. Anatomical imaging with computed tomography or magnetic resonance imaging should be followed by functional (nuclear medicine) imaging: chromaffin tumor-specific methods are preferred. Treatment is surgical; for nonoperable disease other options are available. Overall 5-year survival is 50%. Carcinoid tumors derive from serotonin-producing enterochromaffin cells in the fore-, mid- or hindgut. Biochemical screening (and follow-up) is done with measurements of 5-hydroxyindoloacetic acid in urine. For most carcinoids, functional imaging is better than other modalities in localizing primary tumors. Surgery is the treatment of choice; nonresectable tumors are treated with somatostatin analogs or chemotherapy. Overall 5-year survival for patients with carcinoids is 67%.
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Affiliation(s)
- Ioannis Ilias
- Department of Endocrinology, E. Venizelou Hospital, Athens GR-11521, Greece.
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147
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Abstract
Carcinoid tumors are rare, slow-growing neuroendocrine tumors arising from the enterochromaffin cells disseminated throughout the gastrointestinal and bronchopulmonary systems. Though they have been traditionally classified based on embryologic site of origin, morphologic pattern, and silver affinity, newer classification systems have been developed to emphasize the considerable clinical and histopathologic variability of carcinoid tumors found within each embryologic site of origin. These neoplasms pose a diagnostic challenge because they are often innocuous at the time of presentation, emphasizing the need for a multidisciplinary diagnostic approach using biochemical analysis, standard cross-sectional imaging, and newer advances in nuclear medicine. Similarly, treatment of both primary and disseminated carcinoid disease reflects the need for a multidisciplinary approach, with surgery remaining the only curative modality. The prognosis for patients with these tumors is generally favorable; however, it can be quite variable and is related to the location of the primary tumor, extent of metastatic disease at initial presentation, and time of diagnosis.
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Affiliation(s)
- Scott N Pinchot
- Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI 53792, USA
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Affiliation(s)
- Ido P. Kema
- Department of Pathology and Laboratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Klaas-Pieter Koopmans
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Philip H. Elsinga
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Adrienne H. Brouwers
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Pieter L. Jager
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Elisabeth G.E. de Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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149
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Fiebrich HB, Brouwers AH, Links TP, de Vries EGE. Images in cardiovascular medicine: myocardial metastases of carcinoid visualized by 18F-dihydroxy-phenyl-alanine positron emission tomography. Circulation 2008; 118:1602-4. [PMID: 18838577 DOI: 10.1161/circulationaha.108.767111] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Helle-Brit Fiebrich
- Department of Medical Oncology, University Medical Center Groningen, Groningen, Netherlands
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150
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Kauhanen S, Seppänen M, Nuutila P. Premedication with carbidopa masks positive finding of insulinoma and beta-cell hyperplasia in [(18)F]-dihydroxy-phenyl-alanine positron emission tomography. J Clin Oncol 2008; 26:5307-8; author reply 5308-9. [PMID: 18854556 DOI: 10.1200/jco.2008.18.8581] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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