Somatostatin-receptor scintigraphy in the management of gastroenteropancreatic tumors.
OBJECTIVE
This study evaluates the diagnostic and therapeutic implications of somatostatin-receptor scintigraphy in the management of patients with proven or high clinical suspicion of gastroenteropancreatic endocrine tumors.


METHODS
Forty-one patients were studied by planar and tomographic imaging at 4 h and 24 h after 111In-pentetreotide injection. Scintigraphic findings were compared with computed tomography, and in several patients also with ultrasound, angiography, biopsy, and/or surgery, when performed.


RESULTS
Among 23 patients with carcinoid tumor, three of nine primary tumors were initially identified by scintigraphy. Unsuspected mesenteric metastases found on scintigraphy in three patients led to octreotide treatment. Scintigraphic detection of multiple metastases in a patient with thyroid metastasis of bronchial carcinoid spared her an unnecessary total thyroidectomy. Among 18 patients with 19 islet-cell tumors, scintigraphy detected three of five insulinomas, whereas computed tomography identified only one. Receptor positivity in an islet-cell tumor (vipoma?) with no metastases on the scan led to surgical removal of the primary tumor. Receptor-positive metastases of gastrinoma (two of three patients), glucagonoma (two of three patients), and parathyroid hormone-related peptide-producing tumor (one patient) led to octreotide treatment. Nonvisualization of metastases of a glucovipoma led to chemotherapy.


CONCLUSIONS
Somatostatin-receptor scintigraphy contributes to the management of patients with gastroenteropancreatic tumors in the following ways: 1) localization of a primary occult tumor, allowing surgical removal; 2) staging of the disease for optimal therapy-surgical excision or systemic treatment; and 3) identification of receptor status of the metastases for octreotide treatment or chemotherapy.
Krausz
Y
Y
Department of Nuclear Medicine, Hadassah University Hospital, Jerusalem, Israel.
Bar-Ziv
J
J
de Jong
R B
RB
Ish-Shalom
S
S
Chisin
R
R
Shibley
N
N
Glaser
B
B
D007516:Adenoma, Islet Cell / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D002276:Carcinoid Tumor / Q000000981:diagnostic imaging* / Q000556:secondary; D005260:Female; D015408:Gastrinoma / Q000000981:diagnostic imaging; D005935:Glucagonoma / Q000000981:diagnostic imaging; D006801:Humans; D007078:Ileal Neoplasms / Q000000981:diagnostic imaging*; D007205:Indium Radioisotopes; D007340:Insulinoma / Q000000981:diagnostic imaging; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D008297:Male; D008643:Mesentery; D008875:Middle Aged; D018761:Multiple Endocrine Neoplasia Type 1; D009362:Neoplasm Metastasis / Q000000981:diagnostic imaging; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging*; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging; D010534:Peritoneal Neoplasms / Q000000981:diagnostic imaging; D011877:Radionuclide Imaging; D017481:Receptors, Somatostatin; D013004:Somatostatin / Q000031:analogs & derivatives; D013005:Somatostatinoma / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed
D007205:Indium Radioisotopes; D017481:Receptors, Somatostatin; D013004:Somatostatin; C081788:pentetreotide