Value of somatostatin receptor scintigraphy: a prospective study in gastrinoma of its effect on clinical management.
OBJECTIVE
Recently [111In-DTPA-D-Phe1]-octreotide was approved for somatostatin receptor scintigraphy (SRS) of gastroenteropancreatic tumors. SRS and other tumor localization methods can be time consuming, expensive, and involve patient inconvenience. The role of SRS in comparison to other tumor localization modalities remains undefined because the relative effects of these methods on management have not been studied. The aim of this study was to determine whether SRS alters clinical management in Zollinger-Ellison syndrome.


METHODS
One hundred twenty-two consecutive patients were studied prospectively. Each patient was assigned to one of five different clinical categories. Conventional imaging studies (ultrasonography, computerized tomography, magnetic resonance image, angiography, and bone scan) were performed, and the management was proposed. SRS was then performed. Clinical management was reassessed, and whether SRS altered management was determined based on six criteria.


RESULTS
SRS was superior to any single imaging study. SRS altered management in 47% overall and in 22%-60% of patients in the five different clinical categories. Primary tumor localization and clarification of equivocal localization results from conventional studies were the principal reasons for altering management. SRS was equally useful in patients with or without metastatic liver disease.


CONCLUSIONS
Because of the ability of SRS to alter clinical management combined with its superior sensitivity, high specificity, simplicity, and cost-effectiveness, SRS should be the initial imaging modality for patients with gastrinomas.
Termanini
B
B
Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA.
Gibril
F
F
Reynolds
J C
JC
Doppman
J L
JL
Chen
C C
CC
Stewart
C A
CA
Sutliff
V E
VE
Jensen
R T
RT
D000328:Adult; D000368:Aged; D000792:Angiography; D001842:Bone and Bones / Q000000981:diagnostic imaging; D005260:Female; D015408:Gastrinoma / Q000000981:diagnostic imaging* / Q000378:metabolism* / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism* / Q000628:therapy; D011446:Prospective Studies; D011877:Radionuclide Imaging; D017481:Receptors, Somatostatin / Q000378:metabolism*; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
D017481:Receptors, Somatostatin