Ga-68-DOTANOC PET/CT scan- role in clinical management with advantage over conventional imaging in patients of neuroendocrine tumors — ASN Events
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  3. Ga-68-DOTANOC PET/CT scan- role in clinical management with advantage over conventional imaging in patients of neuroendocrine tumors

Ga-68-DOTANOC PET/CT scan- role in clinical management with advantage over conventional imaging in patients of neuroendocrine tumors (#62)

Deepa Singh 1 , Mudalsha Ravina 1 , Narvesh Kumar 1 , Deepanksha Datta 1 , Sanjay Gambhir 1
  1. Nuclear Medicine, SGPGI, Lucknow, UP, India

Objective: Neuroendocrine tumors are rare, heterogeneous, slow-growing neoplasm with characteristic of somatostatin receptors expression, which forms basis of Ga-68-DOTANOC PET/CT imaging. Aim of study was to assess role of Ga-68-DOTANOC PET/CT in clinical management of NET patients and correlation with conventional imaging.

Methods: PET/CT was performed in 69 patients with known/suspected NETs on basis of conventional imaging, tumor markers or histopathology. Qualitative & semi-quantitative parameters were used for scan evaluation, results were compared with conventional imaging and patients were followed to see clinical management.

Result: Total 69 patients were included out of these, 18- GEP NET; 8- thyroid carcinoma; 2- lung carcinoma; 7- pheochromocytoma; 7-  paraganglioma; 11- neuroblastoma; 8- ectopic cushing; 2- occult; 1- MEN I; 1- VHL and 4- others. PET/CT demonstrated SSTRs expressing lesions in 52/69 patients. PET/CT was concordant with conventional imaging in 28/69 patients and discordant in 36/69 patients. Among discordant patients, disease was upstaged- 32 patients and down staged- 3 patients. Among patients with raised tumor markers (39/69 patients), PET positive- 29 patients, showed strong agreement between PET/CT & tumor markers (Kappa =0.8). PET/CT localized primary tumor- 4 patients (2- ectopic cushing syndrome; 1- paraganglioma; 1- neuroblastoma). The mean duration of follow-up after PET was 27 months (range 5-37months). Clinical management following PET/CT: surgery- 11 patients; PRRNT- 3 patients; surgery than PRRNT- 1 patient; cold SST analogues- 3 patients; chemotherapy- 2 patients; surgery than chemotherapy- 1 patient; same treatment- 13 patients; no further treatment- 13 patients, 15 patients died (1 after surgery) and 8 loss to follow-up. Among 13 patients who underwent surgery: histopathologically positive- 10 patients and negative- 3 patients.

Conclusion: Our study revealed sensitivity & specificity of Ga-68-DOTANOC PET/CT in primary tumor localization, stage modification and therapy monitoring >90% (p<0.05) after consideration of combined clinical, imaging, HPE and follow up as reference standard.