Limited Value of Ga‐68‐DOTATOC‐PET‐CT in Routine Screening of Patients with Multiple Endocrine Neoplasia Type 1

• DOI: 10.1007/s00268-017-3907-9
• Publication Date: 2017-01-30T15:56:45Z
• Authors: Max B. Albers; Damiano Librizzi; Caroline L. Lopez; Jerena Manoharan; Jonas C. Apitzsch; Emily P. Slater; Carmen Bollmann; Peter H. Kann; Detlef K. Bartsch
• Keywords: Adult; Male; Middle Aged; Octreotide; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Positron Emission Tomography Computed Tomography; Multiple Endocrine Neoplasia Type 1; Humans; Female; Radiopharmaceuticals; Aged

AbstractBackgroundRoutine screening is recommended for patients with multiple endocrine neoplasia type 1 (MEN1) to enable early detection and treatment of associated neuroendocrine neoplasms (NEN). Gallium68‐DOTATOC‐Positron emission tomography combined with computed tomography (Ga‐68‐DOTATOC‐PET‐CT) is a very sensitive and specific imaging technique for the detection of sporadic neuroendocrine tumors. The present study evaluated the value of Ga‐68‐DOTATOC‐PET‐CT in routine screening of patients with MEN1.MethodsBetween January 2014 and March 2016, all MEN1 patients underwent Ga‐68‐DOTATOC‐PET‐CT in addition to conventional imaging (computed tomography of the thorax, magnetic resonance imaging of the abdomen and pituitary, endoscopic ultrasonography). The diagnostic yield of conventional imaging and Ga‐68‐DOTATOC‐PET‐CT was prospectively documented and compared, and treatment changes caused by the addition of Ga‐68‐DOTATOC‐PET‐CT were recorded.ResultsConventional imaging detected 145 NENs, mainly pancreaticoduodenal NENs (n = 117, 81%), in 31 of 33 MEN1 patients. Ga‐68‐DOTATOC‐PET‐CT detected 55 NENs in 23 of the 33 patients (p = 0.0001). Ninety (62%) NENs detected by conventional imaging were missed by DOTATOC‐PET‐CT. The majority of missed lesions were pNEN (n = 68; 74%). The sensitivity of Ga‐68‐DOTATOC‐PET‐CT for NENs <5, 5–9, 10–19 and ≥20 mm was 0, 29, 81 and 100%, respectively. However, Ga‐68‐DOTATOC‐PET‐CT detected more liver and lymph node metastases in patients with known metastatic disease, which did not lead to a change of patients’ management. In one patient (3%), Ga‐68‐DOTATOC‐PET‐CT was the only imaging modality that detected a small intestine NEN and led to potentially curative surgery.ConclusionGa‐68‐DOTATOC‐PET‐CT cannot be recommended for routine screening of MEN1 patients. It might provide important additional information in patients with suspected or known metastatic disease.