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Cockburn KC, Toumi Z, Mackie A, Julyan P. Radioguided Surgery for Gastroenteropancreatic Neuroendocrine Tumours: a Systematic Literature Review. J Gastrointest Surg 2021; 25:3244-3257. [PMID: 34506015 PMCID: PMC8654712 DOI: 10.1007/s11605-021-05115-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 08/07/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Radioguided surgery (RGS) for gastroenteropancreatic neuroendocrine tumours (GEP-NETs) has been suggested as a way to improve intraoperative lesion detection. This systematic literature review of reports of the use of RGS for GEP-NETs was performed to determine if there is a benefit. METHODS A literature search was conducted using Google Scholar and PubMed, and snowballing from any relevant literature. Full-text studies were included if they were published in the English language and reported outcomes of RGS on human subjects with GEP-NETs. Qualitative data synthesis was performed. RESULTS Twenty-six papers including a total of 209 patients were included. The tracers used were predominantly indium-111 pentetreotide, gallium-68 DOTA-peptides, and technetium-99m EDDA/HYNIC-peptides. Heterogeneous protocols make comparisons difficult, but most papers reported a benefit from the use of RGS in tumours in the gastrointestinal tract; utility in localisation of pancreatic tumours was less clear. Time between tracer administration and operation varied: from 16 h to 8 days with indium-111, 0-24 h with technetium-99m, and 19-193 min with gallium-68. Eight teams reported the thresholding technique used for discrimination-four used a ratio, four statistical methods, and one looked at the sensitivity and specificity of different cut-offs. Six teams performed follow-up of 24 patients (three pancreas, eight gastrinoma, 13 gastrointestinal tract) for between 3 months and 3 years. Two patients relapsed (one pancreas, one gastrinoma) between 6 and 12 months post-surgery. CONCLUSIONS RGS appears to aid in localisation of gastrointestinal NETs, but the benefit is more equivocal in pancreatic NETs. Further work into outcomes is warranted.
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Affiliation(s)
- Katrina Clair Cockburn
- Northern Medical Physics and Clinical Engineering, County Durham and Darlington NHS Foundation Trust, Hollyhurst Road, Darlington, DL3 6HX, UK.
| | - Zaher Toumi
- Department of General Surgery, County Durham and Darlington NHS Foundation Trust, Hollyhurst Road, Darlington, DL3 6HX, UK
| | - Alison Mackie
- Northern Medical Physics and Clinical Engineering, County Durham and Darlington NHS Foundation Trust, Hollyhurst Road, Darlington, DL3 6HX, UK
| | - Peter Julyan
- Department of Nuclear Medicine, The Christie Hospital NHS Foundation Trust, Manchester, UK
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Bertani E, Collamati F, Colandrea M, Faccini R, Fazio N, Ferrari ME, Fischetti M, Fumagalli Romario U, Funicelli L, De Simoni M, Mancini-Terracciano C, Mirabelli R, Morganti S, Papi S, Pisa E, Solfaroli-Camillocci E, Spada F, Cremonesi M, Grana CM. First Ex Vivo Results of β --Radioguided Surgery in Small Intestine Neuroendocrine Tumors with 90Y-DOTATOC. Cancer Biother Radiopharm 2021; 36:397-406. [PMID: 33601932 DOI: 10.1089/cbr.2020.4487] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: In neuroendocrine tumor (NET), complete surgery could better the prognosis. Radioguided surgery (RGS) with β--radioisotopes is a novel approach focused on developing a new probe that, detecting electrons and operating with low background, provides a clearer delineation of the lesions with low radiation exposition for surgeons. As a first step to validate this procedure, ex vivo specimens of tumors expressing somatostatin receptors, as small intestine neuroendocrine tumor (SI-NET), were tested. Materials and Methods: SI-NET presents a high uptake of a beta-emitting radiotracer, 90Y-DOTATOC. Five SI-NET patients were enrolled after performing a 68Ga-DOTATOC positron emission tomography/computed tomography (CT) and a CT enterography; 24 h before surgery, they received 5 mCi of 90Y-DOTATOC. Results: Surgery was performed as routine. Tumors and surrounding tissue were sectioned in different samples and examined ex vivo with the beta-detecting probe. All the tumor samples showed high counts of radioactivity that was up to a factor of 18 times higher than the corresponding cutoff value, with a sensitivity of 96% and a specificity of 100%. Conclusions: These first ex vivo RGS tests showed that this probe can discriminate very effectively between tumor and healthy tissues by the administration of low activities of 90Y-DOTATOC, allowing more precise surgery.
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Affiliation(s)
- Emilio Bertani
- Division of Digestive Surgery, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | | | - Marzia Colandrea
- Division of Nuclear Medicine, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Riccardo Faccini
- Sezione di Roma, Istituto Nazionale di Fisica Nucleare, Roma, Italy.,Dipartimento di Fisica, Università di Roma Sapienza, Roma, Italy
| | - Nicola Fazio
- Division of Gastrointestinal and Neuroendocrine Tumors Medical Treatment, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Mahila E Ferrari
- Medical Physics, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Marta Fischetti
- Sezione di Roma, Istituto Nazionale di Fisica Nucleare, Roma, Italy.,Dipartimento di Scienze di Base Applicate per l'Ingegneria, Sapienza Università di Roma, Roma, Italy
| | | | - Luigi Funicelli
- Division of Radiology, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Micol De Simoni
- Sezione di Roma, Istituto Nazionale di Fisica Nucleare, Roma, Italy.,Dipartimento di Fisica, Università di Roma Sapienza, Roma, Italy
| | - Carlo Mancini-Terracciano
- Sezione di Roma, Istituto Nazionale di Fisica Nucleare, Roma, Italy.,Dipartimento di Fisica, Università di Roma Sapienza, Roma, Italy
| | - Riccardo Mirabelli
- Sezione di Roma, Istituto Nazionale di Fisica Nucleare, Roma, Italy.,Dipartimento di Fisica, Università di Roma Sapienza, Roma, Italy
| | - Silvio Morganti
- Sezione di Roma, Istituto Nazionale di Fisica Nucleare, Roma, Italy
| | - Stefano Papi
- Division of Nuclear Medicine, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Eleonora Pisa
- Division of Pathology, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Elena Solfaroli-Camillocci
- Sezione di Roma, Istituto Nazionale di Fisica Nucleare, Roma, Italy.,Scuola di specializzazione in Fisica Medica, Sapienza Università di Roma, Roma, Italy
| | - Francesca Spada
- Division of Gastrointestinal and Neuroendocrine Tumors Medical Treatment, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Marta Cremonesi
- Medical Physics, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Chiara M Grana
- Division of Nuclear Medicine, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
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Wang YZ, Diebold A, Boudreaux P, Raines D, Campeau R, Anthony L, Woltering E. Surgical Treatment Options for Rectal Carcinoid Cancer: LocalversusLow Radical Excision. Am Surg 2020. [DOI: 10.1177/000313481408000120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Yi-Zarn Wang
- New Orleans Louisiana Neuroendocrine Tumor Specialists (NOLANETS), Ochsner Clinic Foundation, Ochsner Medical Center-Kenner, Kenner, Louisiana; the Departments of
- Surgery
| | - Anne Diebold
- New Orleans Louisiana Neuroendocrine Tumor Specialists (NOLANETS), Ochsner Clinic Foundation, Ochsner Medical Center-Kenner, Kenner, Louisiana; the Departments of
- Surgery
| | - Philip Boudreaux
- New Orleans Louisiana Neuroendocrine Tumor Specialists (NOLANETS), Ochsner Clinic Foundation, Ochsner Medical Center-Kenner, Kenner, Louisiana; the Departments of
- Surgery
| | - Daniel Raines
- New Orleans Louisiana Neuroendocrine Tumor Specialists (NOLANETS), Ochsner Clinic Foundation, Ochsner Medical Center-Kenner, Kenner, Louisiana; the Departments of
- Medicine, and
| | - Richard Campeau
- New Orleans Louisiana Neuroendocrine Tumor Specialists (NOLANETS), Ochsner Clinic Foundation, Ochsner Medical Center-Kenner, Kenner, Louisiana; the Departments of
- Radiology, Louisiana State University Health Science Center, New Orleans, Louisiana; and
| | - Lowell Anthony
- Department of Medicine, The University of Kentucky, Lexington, Kentucky
| | - Eugene Woltering
- New Orleans Louisiana Neuroendocrine Tumor Specialists (NOLANETS), Ochsner Clinic Foundation, Ochsner Medical Center-Kenner, Kenner, Louisiana; the Departments of
- Surgery
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Howe JR, Cardona K, Fraker DL, Kebebew E, Untch BR, Wang YZ, Law CH, Liu EH, Kim MK, Menda Y, Morse BG, Bergsland EK, Strosberg JR, Nakakura EK, Pommier RF. The Surgical Management of Small Bowel Neuroendocrine Tumors: Consensus Guidelines of the North American Neuroendocrine Tumor Society. Pancreas 2017; 46:715-731. [PMID: 28609357 PMCID: PMC5502737 DOI: 10.1097/mpa.0000000000000846] [Citation(s) in RCA: 236] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Small bowel neuroendocrine tumors (SBNETs) have been increasing in frequency over the past decades, and are now the most common type of small bowel tumor. Consequently, general surgeons and surgical oncologists are seeing more patients with SBNETs in their practices than ever before. The management of these patients is often complex, owing to their secretion of hormones, frequent presentation with advanced disease, and difficulties with making the diagnosis of SBNETs. Despite these issues, even patients with advanced disease can have long-term survival. There are a number of scenarios which commonly arise in SBNET patients where it is difficult to determine the optimal management from the published data. To address these challenges for clinicians, a consensus conference was held assembling experts in the field to review and discuss the available literature and patterns of practice pertaining to specific management issues. This paper summarizes the important elements from these studies and the recommendations of the group for these questions regarding the management of SBNET patients.
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Affiliation(s)
- James R Howe
- From the *Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA; †Department of Surgery, Winship Cancer Institute of Emory University, Atlanta, GA; ‡Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA; §Endocrine Oncology Branch, National Cancer Institute, Bethesda, MD; ∥Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY; ¶Department of Surgery, LSU Health Sciences Center, New Orleans, LA; #Department of Surgery, University of Toronto, Sunnybrook Health Sciences Center, Toronto, Canada; **Rocky Mountain Cancer Center, Denver, CO; ††Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; ‡‡Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA; §§Department of Radiology, H. Lee Moffitt Cancer Center, University of South Florida, Tampa, FL; ∥∥Department of Medicine, University of California San Francisco, San Francisco, CA; ¶¶Department of Medicine, H. Lee Moffitt Cancer Center, University of South Florida, Tampa, FL; ##Department of Surgery, University of California San Francisco, San Francisco, CA; and ***Department of Surgery, Oregon Health & Science University, Portland, OR
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Wang YZ, Beyer DT, Hall M. Obturator Canal Lymph Node Metastasis from Rectal Carcinoid Tumors: Total Mesorectal Excision May Be Insufficient. J Gastrointest Surg 2016; 20:1247-52. [PMID: 27000128 DOI: 10.1007/s11605-016-3128-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/07/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Optimal surgical treatment for small early rectal carcinoids is controversial. Large tumors (greater than 2 cm) and those with imaging evidence of lymph node metastasis are generally treated by low anterior resection (LAR) with total mesorectal excision (TME). We first observed and reported that midgut carcinoid with extensive mesenteric lymphadenopathy often develops alternated lymphatic drainage pathways. We hypothesize that rectal carcinoids have the same potential to develop alternated lymphatic pathways outside the mesorectal envelope, which allows tumor deposits to be missed by traditional TME. METHODS Twenty-two consecutive rectal carcinoid surgical patient charts were reviewed to determine if alternated lymphatic drainage occurred and resulted in extra-mesorectal metastasis. We attempted to identify any risk factor(s) that may lead to developing such alternated lymphatic drainage pathways. RESULTS Thirteen patients underwent initial LAR with TME (13/22, 59 %) and nine underwent a staged debulking for locoregional residual disease or regional/distant metastasis after previous resection (9/22, 41 %). Fourteen (14/22, 64 %) underwent radio-guided surgery in attempt to achieve a higher level of pelvic/distant metastatic disease detection and debulking. Six patients (6/22, 27 %) had obturator canal lymph node metastases confirmed histologically. CONCLUSIONS Based on our study, at least 27 % of rectal carcinoid patients may have extra-mesorectal metastasis that would be missed by the traditional TME. Radio-guided surgery can identify and remove such metastasis. The effect of having such extra-mesorectal metastasis and its surgical removal on long-term survival has yet to be determined.
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Affiliation(s)
- Yi-Zarn Wang
- Department of Surgery, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, Room 747, New Orleans, LA, 70112, USA.
| | - David T Beyer
- Department of Surgery, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, Room 747, New Orleans, LA, 70112, USA
| | - Michael Hall
- Department of Surgery, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, Room 747, New Orleans, LA, 70112, USA
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Sadowski SM, Millo C, Neychev V, Aufforth R, Keutgen X, Glanville J, Alimchandani M, Nilubol N, Herscovitch P, Quezado M, Kebebew E. Feasibility of Radio-Guided Surgery with ⁶⁸Gallium-DOTATATE in Patients with Gastro-Entero-Pancreatic Neuroendocrine Tumors. Ann Surg Oncol 2015; 22 Suppl 3:S676-82. [PMID: 26350374 DOI: 10.1245/s10434-015-4857-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Surgery is the only definitive therapy for gastro-entero-pancreatic neuroendocrine tumors (GEPNETs), and achieving complete tumor resection is an important prognostic factor. Radiopharmaceuticals such as (68)Ga-DOTA peptides have been developed that offer superior accuracy for localization of GEPNETs. The study aim was to determine the feasibility of radio-guided surgery (RGS) using (68)Ga-DOTATATE in patients with primary and recurrent GEPNETs. METHODS Fourteen patients with GEPNETs were enrolled onto a prospective study to determine the feasibility of RGS with (68)Ga-DOTATATE. Findings from preoperative imaging, intraoperative exploration, RGS, and pathology were analyzed. RESULTS The median decay corrected target count rate was 172.6 (range 28.15-2341) for tumors, with a tumor-to-background ratio (TBR) of 4.46 (range 1.6-43.56). The median lesion size was 1.55 (range 0.5-15) cm. There was no significant correlation between preoperative imaging maximum standardized uptake value (SUVmax) of the lesions and TBR (Spearman r = - 0.01, p = 0.9), TBR and tumor size (Spearman r = 0.29, p = 0.14), and SUVmax and tumor size (Spearman r = 0.22, p = 0.28). The probe showed correct identification for gastric and small intestine neuroendocrine tumor (NET), including lymph node metastasis in 17 (81.0 %) of 21 cases, with a median TBR of 3.5 (1.6-40.2). For pancreatic NETs and lymph node metastasis, 16 (66.7 %) of 24 were correctly identified by RGS. CONCLUSIONS Our study shows that RGS with (68)Ga-DOTATATE is feasible and correctly confirms bowel NETs and metastatic mesenteric lymph nodes. Further studies are needed to determine the benefit of RGS with (68)Ga-DOTATATE.
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Affiliation(s)
- Samira M Sadowski
- Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Corina Millo
- Positron Emission Tomography Department, Warren Grant Magnusson Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Vladimir Neychev
- Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Rachel Aufforth
- Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Xavier Keutgen
- Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Joanne Glanville
- Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Meghna Alimchandani
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Naris Nilubol
- Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter Herscovitch
- Positron Emission Tomography Department, Warren Grant Magnusson Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Martha Quezado
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Electron Kebebew
- Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
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8
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García-Talavera P, Ruano R, Rioja ME, Cordero JM, Razola P, Vidal-Sicart S. [Radioguided surgery in neuroendocrine tumors. A review of the literature]. Rev Esp Med Nucl Imagen Mol 2014; 33:358-65. [PMID: 25107596 DOI: 10.1016/j.remn.2014.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 07/08/2014] [Accepted: 07/09/2014] [Indexed: 11/26/2022]
Abstract
Radioguided surgery can be a useful technique in the localization of neuroendocrine tumors. It detects more and smaller lesions compared to pre-surgical imaging and intraoperative digital palpation by the surgeon. It detects residual lesions and also indicates the shortest access route to the lesion. Nevertheless, its use has not become widespread because of technical difficulties. There is a limited number of published series, a lack of standardized protocol because of the great variability regarding type of radiopharmaceutical, dose of radiotracer, timing between injection and surgery. In this paper, we review these issues, describing the experience of different authors in diverse tumors.
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Affiliation(s)
- P García-Talavera
- Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valladolid, Valladolid, España.
| | - R Ruano
- Servicio de Medicina Nuclear, Hospital Clínico Universitario de Salamanca, Salamanca, España
| | - M E Rioja
- Servicio de Medicina Nuclear, Hospital Universitario Ramón y Cajal, Madrid, España
| | - J M Cordero
- Servicio de Medicina Nuclear, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - P Razola
- Servicio de Medicina Nuclear, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - S Vidal-Sicart
- Servicio de Medicina Nuclear, Hospital Clínic de Barcelona, Barcelona, España
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KleinJan GH, Bunschoten A, Brouwer OR, van den Berg NS, Valdés-Olmos RA, van Leeuwen FWB. Multimodal imaging in radioguided surgery. Clin Transl Imaging 2013. [DOI: 10.1007/s40336-013-0039-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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