Clinical Usefulness of 18F-Fluorodeoxyglucose Positron Emission Tomography in the Diagnostic Algorithm of Advanced Entero-Pancreatic Neuroendocrine Neoplasms

Published on Feb 1, 2018in Oncologist5.025
· DOI :10.1634/THEONCOLOGIST.2017-0278
Maria Rinzivillo14
Estimated H-index: 14
(Sapienza University of Rome),
Stefano Partelli43
Estimated H-index: 43
+ 11 AuthorsFrancesco Panzuto27
Estimated H-index: 27
(Sapienza University of Rome)
Background. The role of F-18-fluorodeoxyglucose positron emission tomography (F-18-FDG PET) in the diagnostic algorithm of entero-pancreatic neuroendocrine neoplasms (EP NENs) is unclear because most available data derive from heterogeneous populations in terms of tumor biology and disease status at time of examination. The aim of this study was to determine the ability of F-18-FDG PET to identify patients with more aggressive disease among those with advanced EP NENs.Subjects, Materials, and Methods. Patients with advanced EP NENs and known disease status (progressive disease [PD] or stable disease [SD]) according to imaging procedures, who received F-18-FDG PET and computed tomography scans during a time frame of 1 month, were included.Results. A total of 93 patients, including 69 patients with pancreatic NENs and 24 patients with small-intestine NENs, were included. At the time of study entry, 64 patients (68.8%) had PD, and the remaining 29 patients (31.2%) had SD. A total of 62 patients (66.7%) had positive F-18-FDG PET, whereas F-18-FDG PET was negative in the remaining 31 patients (33.3%). Overall, F-18-FDG PET sensitivity and specificity to detect PD were 90.6% and 86.2%, respectively, resulting in a diagnostic accuracy of 89.2%. A positive F-18-FDG PET was significantly associated with PD at the time of study entry (p<.0001 at multivariate analysis). Although a higher proportion of F-18-FDG PET-positive examinations were observed in patients with higher tumor grade (p=.01), 53.8% of patients with grade 1 neuroendocrine tumors (NETs) had positive F-18-FDG PET, and 37.5% of patients with grade 2 NETs had negative F-18-FDG PET. Overall survival was significantly shorter in F-18-FDG PET-positive patients (median: 60 months) in comparison with F-18-FDG PET-negative patients (median not reached; p=.008).Conclusion. F-18-FDG PET has a high diagnostic accuracy to identify progression of disease with unfavorable clinical outcome in patients with advanced EP NENs. Knowledge of disease status and G grading are key factors for physicians to better select patients for whom F-18-FDG PET is clinically useful.
📖 Papers frequently viewed together
10 Authors (Winand Van Rompaey, ..., Robin Vos)
95 Citations
98 Citations
#1Arvind Dasari (University of Texas MD Anderson Cancer Center)H-Index: 24
#2Chan Shen (University of Texas MD Anderson Cancer Center)H-Index: 17
Last. James C. Yao (University of Texas MD Anderson Cancer Center)H-Index: 74
view all 8 authors...
Importance The incidence and prevalence of neuroendocrine tumors (NETs) are thought to be rising, but updated epidemiologic data are lacking. Objective To explore the evolving epidemiology and investigate the effect of therapeutic advances on survival of patients with NETs. Design, Setting, and Participants A retrospective, population-based study using nationally representative data from the Surveillance, Epidemiology, and End Results (SEER) program was conducted to evaluate 64 971 patients with...
984 CitationsSource
Context: Functional imaging tests (FITs) detecting somatostatin receptor expression [i.e., somatostatin receptor scintigraphy, 68Ga-DOTA positron emission tomography/computed tomography (CT)] have a pivotal role in the diagnosis of neuroendocrine tumors (NETs), although their indication during follow-up still needs to be clarified. Objective: Investigate the role of FITs after diagnosis of metastatic enteropancreatic NETs, identifying patients who might benefit from these exams. Design: Multicen...
15 CitationsSource
#1Francesco Panzuto (Sapienza University of Rome)H-Index: 27
#2Elettra Merola (Sapienza University of Rome)H-Index: 9
Last. Gianfranco Delle Fave (Sapienza University of Rome)H-Index: 33
view all 14 authors...
Several risk factors predict clinical outcome in gastro-entero-pancreatic neuroendocrine neoplasms (GEP-NENs); however, the impact of their combination has not been investigated so far.A retrospective analysis of stage IV GEP-NENs was performed. Multivariate analysis for progression of disease (PD) was performed by Cox proportional hazards method to obtain a risk score. Area under the curve obtained by receiver operating characteristic analysis was used to assess the score performance. Progressi...
22 CitationsSource
#1Aurel Perren (University of Bern)H-Index: 74
#2Anne CouvelardH-Index: 69
Last. Staffan WelinH-Index: 24
view all 15 authors...
The European Neuroendocrine Tumor Society (ENETS) proposed standard of care guidelines for pathology in 2009. Since then, profound changes in the classification have been made, dividing neuroendocrine
87 CitationsSource
#1Sara CingarliniH-Index: 23
#2Silvia OrtolaniH-Index: 9
Last. Giampaolo TortoraH-Index: 83
view all 18 authors...
OBJECTIVES: Ga-DOTATOC (Ga) positron emission tomography (PET)/computed tomography (CT) is recommended in the workup of pancreas neuroendocrine tumors (PanNETs); evidence suggests that F-FDG (F) PET/CT can also provide prognostic information. Aims of this study were to assess the role of combined Ga- and F-PET/CT in the evaluation of grade (G) 1-2 PanNETs and to test the correlation between F-PET/CT positivity and tumor grade. METHODS: Preoperative Ga- and F-PET/CT of 35 patients with surgically...
23 CitationsSource
#1Bruno Niederle (Medical University of Vienna)H-Index: 72
#2Ulrich-Frank Pape (Charité)H-Index: 28
Last. Reza KianmaneshH-Index: 37
view all 15 authors...
216 CitationsSource
#1Marianne Pavel (Charité)H-Index: 52
#2Dermot O'Toole (Trinity College, Dublin)H-Index: 67
Last. Kjell Öberg (Uppsala University)H-Index: 116
view all 11 authors...
The goal of this paper is to update a more extensive review and guidelines paper published in 2012 [1] . Gen-erally, any pertinent update pertaining to the diagnosis and staging of individual prima ...
500 CitationsSource
#1Massimo Falconi (UniSR: Vita-Salute San Raffaele University)H-Index: 105
#2Barbro Eriksson (Uppsala University)H-Index: 77
Last. Robert T. Jensen (NIH: National Institutes of Health)H-Index: 122
view all 13 authors...
ENETS Consensus Guidelines Update for the Management of Patients with Functional Pancreatic Neuroendocrine Tumors and Non-Functional Pancreatic Neuroendocrine Tumors
551 CitationsSource
#2Svenja MatzkeH-Index: 1
Last. Harald SchremH-Index: 22
view all 9 authors...
Background This study strives to define prognostic models for outcome after surgery for malignant pancreatic neuroendocrine tumors. Methods Forty-one patients were included. Prognostic models for mortality and disease recurrence were developed with multivariate binary logistic regression. Results The proposed prognostic model for tumor recurrence risk after surgery in percentage (AUROC = 0.774, 95%CI = 0.611–0.937) is: Risk in % = Exp(Y)/(1 + Exp(Y)), with Y = −4.360 + (0.015 × tumor diameter in...
10 CitationsSource
#1Simona Grozinsky-Glasberg (HUJI: Hebrew University of Jerusalem)H-Index: 26
#2Haggi Mazeh (HUJI: Hebrew University of Jerusalem)H-Index: 25
Last. David J. Gross (HUJI: Hebrew University of Jerusalem)H-Index: 34
view all 3 authors...
Pancreatic neuroendocrine tumors (PNETs), also known as islet cell tumors, are rare neoplasms that arise in the endocrine tissues of the pancreas. Most of pancreatic NETs (50–75%) are nonfunctioning (not associated with a hormonal clinical syndrome); however, in up to one third they can secrete a variety of peptide hormones, including insulin, gastrin, glucagon, vasoactive intestinal peptide, somatostatin etc., resulting in rare but unique clinical syndromes. In this article, the clinical featur...
15 CitationsSource
Cited By20
#1Wenming Wu (Peking Union Medical College Hospital)H-Index: 11
#1Wei-wei Wu (Peking Union Medical College Hospital)H-Index: 4
view all 28 authors...
#1Jan Calissendorff (KI: Karolinska Institutet)H-Index: 19
#2Freja Bjellerup-Calissendorff (Uppsala University)
Last. Henrik Falhammar (KI: Karolinska Institutet)H-Index: 31
view all 5 authors...
Abstract Purpose: Neuroendocrine tumors of the pancreas (Pan-NETs) are usually hormonally inactive with a capacity to metastasize. Since Pan-NETs are rare, more knowledge is needed. Methods: We reviewed all patients' medical files with Pan-NET treated at a tertiary center (2006-2019). Grade 1 (G1) and grade 2 (G2) tumors were compared. The latter group was subdivided into a hypothetical G2a based on the proliferation index (3-9.9%) and G2b (10-19.9%). Results: We found 137 patients (76 females; ...
#1Divya Yadav (AIIMS: All India Institute of Medical Sciences)H-Index: 1
#2Rakesh Kumar (AIIMS, New Delhi)H-Index: 7
Last. Rakesh Kumar (AIIMS, New Delhi)H-Index: 72
view all 2 authors...
2-[18F]-fluoro-2-deoxyglucose (FDG) is the most commonly used radiotracer and provides valuable information about glucose metabolism. With the advent of newer receptor-based tracers in the management of hormonally active malignancies, the focus has been shifted from FDG. These tracers might be more specific than FDG because they target specific hormone receptors. But because FDG is widely available, this review discusses what information still can be harnessed from this workhorse of molecular im...
Purpose This study aims to identify in patients with neuroendocrine neoplasia (NEN) the potential correlation between FDG-PET findings and responses to everolimus therapy to identify predictors of long-term efficacy. Methods Retrospective analysis of patients with sporadic, advanced, progressive NEN treated with everolimus was performed based on the available data on FDG-PET patients obtained before commencing therapy. Data are expressed as the median (25-75th IQR). Risk factor analysis and surv...
#1Valentina Andreasi (UniSR: Vita-Salute San Raffaele University)H-Index: 8
#2Stefano Partelli (UniSR: Vita-Salute San Raffaele University)H-Index: 43
Last. Massimo Falconi (UniSR: Vita-Salute San Raffaele University)H-Index: 105
view all 6 authors...
The incidence gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) has dramatically risen over the last three decades, probably due to the increased detection of asymptomatic lesions. The diagnostic work-up for patients with suspected GEP-NENs is based on conventional imaging, endoscopy, pathology, and functional imaging, including 68Gallium-DOTATATE PET and 18F-FDG PET. The choice of the best treatment strategy should be based on the evaluation of tumor-related features and patient's char...
1 CitationsSource
#1Ludovica MagiH-Index: 3
#2Maria RinzivilloH-Index: 14
Last. Francesco PanzutoH-Index: 27
view all 3 authors...
Owing to the rarity and the biological and clinical heterogeneity of gastroenteropancreatic neuroendocrine neoplasia (GEP NEN), the management of these patients may be challenging for physicians. This review highlights the specific features of GEP NEN with particular attention on the role of Ki67 heterogeneity, the potential prognostic role of novel radiological techniques, and the clinical usefulness of functional imaging, including 68Ga-DOTA-SST PET/CT and 18F-FDG PET/CT. Understanding these s...
#1Marine PerrierH-Index: 3
#2Olivia Hentic (University of Paris)H-Index: 32
view all 7 authors...
#1Samira M. SadowskiH-Index: 24
Last. Gerlof D. Valk (UU: Utrecht University)H-Index: 40
view all 5 authors...
Metastatic duodenopancreatic neuro-endocrine tumors (dpNETs) are the most important disease-related cause of death in patients with multiple endocrine neoplasia type 1 (MEN1). Nonfunctioning pNETs (NF-pNETs) are highly prevalent in MEN1 and clinically heterogeneous. Therefore, management is controversial. Data on prognostic factors for risk stratification is limited. This systematic review aims to establish the current state of evidence regarding prognostic factors in MEN1-related NF-pNETs. We s...
7 CitationsSource
#1Asahi Sato (Kyoto University)H-Index: 6
#2Toshihiko Masui (Kyoto University)H-Index: 23
Last. Shinji Uemoto (Kyoto University)H-Index: 88
view all 10 authors...
BACKGROUND: Although (18) F-FDG-PET/CT is a widely used diagnostic tool for several malignancies, its efficacy in diagnosing pancreatic neuroendocrine tumors is reported to be controversial because of the short-term follow-up. METHODS: We retrospectively compared demographics and pathological features between (18) F-FDG-positive and -negative diseases. Additionally, we evaluated whether the avidity of (18) F-FDG-PET/CT affected earlier recurrence after curative treatment of non-functioning tumor...
1 CitationsSource