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Hope TA, Bergsland EK, Bozkurt MF, Graham M, Heaney AP, Herrmann K, Howe JR, Kulke MH, Kunz PL, Mailman J, May L, Metz DC, Millo C, O'Dorisio S, Reidy-Lagunes DL, Soulen MC, Strosberg JR. Appropriate Use Criteria for Somatostatin Receptor PET Imaging in Neuroendocrine Tumors. J Nucl Med 2017; 59:66-74. [PMID: 29025982 DOI: 10.2967/jnumed.117.202275] [Citation(s) in RCA: 186] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 10/06/2017] [Indexed: 02/06/2023] Open
Affiliation(s)
- Thomas A Hope
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia .,American College of Radiology, Reston, Virginia
| | - Emily K Bergsland
- American Society of Clinical Oncology, Alexandria, Virginia.,North American Neuroendocrine Tumor Society, Albany, New York
| | | | - Michael Graham
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | | | - Ken Herrmann
- European Association of Nuclear Medicine, Vienna, Austria
| | - James R Howe
- North American Neuroendocrine Tumor Society, Albany, New York.,Society of Surgical Oncology, Rosemont, Illinois
| | - Matthew H Kulke
- American Society of Clinical Oncology, Alexandria, Virginia.,North American Neuroendocrine Tumor Society, Albany, New York.,National Comprehensive Cancer Network, Fort Washington, Pennsylvania
| | - Pamela L Kunz
- American Society of Clinical Oncology, Alexandria, Virginia.,North American Neuroendocrine Tumor Society, Albany, New York.,National Comprehensive Cancer Network, Fort Washington, Pennsylvania
| | | | | | - David C Metz
- North American Neuroendocrine Tumor Society, Albany, New York.,American Gastroenterological Association, Bethesda, Maryland; and
| | - Corina Millo
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | - Sue O'Dorisio
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia.,American Society of Clinical Oncology, Alexandria, Virginia.,North American Neuroendocrine Tumor Society, Albany, New York
| | - Diane L Reidy-Lagunes
- American Society of Clinical Oncology, Alexandria, Virginia.,North American Neuroendocrine Tumor Society, Albany, New York
| | - Michael C Soulen
- North American Neuroendocrine Tumor Society, Albany, New York.,Society of Interventional Oncology, Washington, DC
| | - Jonathan R Strosberg
- American Society of Clinical Oncology, Alexandria, Virginia.,North American Neuroendocrine Tumor Society, Albany, New York
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Clift AK, Faiz O, Al-Nahhas A, Bockisch A, Liedke MO, Schloericke E, Wasan H, Martin J, Ziprin P, Moorthy K, Frilling A. Role of Staging in Patients with Small Intestinal Neuroendocrine Tumours. J Gastrointest Surg 2016; 20:180-8; discussion 188. [PMID: 26394880 DOI: 10.1007/s11605-015-2953-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 09/14/2015] [Indexed: 01/31/2023]
Abstract
Small bowel neuroendocrine tumours are the commonest malignancy arising in the small intestine and have substantially increased in incidence in recent decades. Patients with small bowel neuroendocrine tumours commonly develop lymph node and/or distant metastases. Here, we examine the role of staging in 84 surgically treated patients with small bowel neuroendocrine tumours, comparing diagnostic information yielded from morphological, functional and endoscopic modalities. Furthermore, we correlate pre-operative staging with intra-operative findings in a sub-cohort of 20 patients. The vast majority of patients had been histologically confirmed to have low-grade (Ki-67 <2%) disease; however, lymph node and distant metastases were observed in 74 (88.1%) and 51 (60.7%) of patients at presentation, respectively. Liver metastases were evident in 48 (57.1%) patients, with solely peritoneal and bone metastases observed in 2 (2.4%) and 1 (1.2%) patients, respectively. Forty patients (47.6%) received multimodal treatment. In our sub-cohort analysis, pre-operative imaging understaged disease in 14/20 (70%) when compared with intra-operative findings. In patients with multifocal primary tumours and miliary liver metastases, no imaging modality was able to detect entire disease spread. Overall, presently available imaging modalities heavily underestimate disease stage, with meticulous intra-operative abdominal examination being superior to any imaging technology. Multimodal treatment has an important role in prolonging survival.
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Affiliation(s)
- Ashley Kieran Clift
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0HS, UK
| | - Omar Faiz
- Department of Surgery, St. Mark's Hospital, London, UK
| | - Adil Al-Nahhas
- Department of Nuclear Medicine, Imperial College London, London, UK
| | - Andreas Bockisch
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Marc Olaf Liedke
- Department of Surgery, Westkuesten Klinikum Heide, Heide, Germany
| | - Erik Schloericke
- Department of Surgery, Westkuesten Klinikum Heide, Heide, Germany
| | - Harpreet Wasan
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0HS, UK
| | - John Martin
- Department of Gastroenterology, Imperial College London, London, UK
| | - Paul Ziprin
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0HS, UK
| | - Krishna Moorthy
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0HS, UK
| | - Andrea Frilling
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0HS, UK.
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