title: The role of 68Ga-DOTATATE PET/CT in suspected neuroendocrine tumors.
abstract: In patients with suspected but yet not localized neuroendocrine tumors (NETs), early diagnosis or reliable exclusion is crucial for optimal individual prognosis and therapy. Despite recourse to several imaging modalities, the definite diagnosis of NET can be challenging. Therefore, we tested (68)Ga-DOTATATE PET/CT as a tool for improved diagnosis in a cohort of patients with suspected, nonlocalized NET.
  
  
  METHODS
  (68)Ga-DOTATATE PET/CT recordings were obtained in 104 consecutive patients meeting at least one of the following criteria: clinical suspicion of NET (n = 70), elevated blood levels of tumor markers (n = 49), and image-based suspicion of NET (n = 53). The presence of NET was validated by histopathology (n = 49) or clinical follow-up of 107 ± 59 wk (n = 55).
  
  
  RESULTS
  In 36 of 104 patients (35%), NET was histologically verified, most frequently located in the small bowel (10/36), pancreas (8/36), lung (5/36), and stomach (2/36). Twelve patients had tumors of nonneuroendocrine origin, and 7 patients had benign tumors. (68)Ga-DOTATATE PET/CT identified NET in 29 of the 36 cases and excluded the presence of a NET in 61 of the 68 non-NET patients, indicating a sensitivity of 81% and specificity of 90%. The PET/CT gave a false-positive result in 7 patients and a false-negative in another 7 patients, indicating positive and negative predictive values of 81% and 90%, respectively, and an accuracy of 87%. Chromogranin A levels were significantly higher in both PET-positive patients (1,841 vs. 342 ng/mL; P < 0.05) and patients with verified NET (2,214 vs. 524 ng/mL; P < 0.05).
  
  
  CONCLUSIONS
  In patients with suspected NETs due to clinical symptoms, elevated levels of tumor markers, or indeterminate tumors suggestive of NET, (68)Ga-DOTATATE PET/CT is highly accurate, thus supporting its use in clinical routine diagnostics.
authors.affiliation: Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany. Alexander.Haug@med.uni-muenchen.de
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Haug
authors.forename: Ramona
authors.initials: R
authors.lastname: Cindea-Drimus
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Auernhammer
authors.forename: Martin
authors.initials: M
authors.lastname: Reincke
authors.forename: Björn
authors.initials: B
authors.lastname: Wängler
authors.forename: Christopher
authors.initials: C
authors.lastname: Uebleis
authors.forename: Gerwin P
authors.initials: GP
authors.lastname: Schmidt
authors.forename: Burkhard
authors.initials: B
authors.lastname: Göke
authors.forename: Peter
authors.initials: P
authors.lastname: Bartenstein
authors.forename: Marcus
authors.initials: M
authors.lastname: Hacker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D053379:Chromogranin A / Q000378:metabolism; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D018358:Neuroendocrine Tumors / Q000000981:diagnostic imaging*; D009942:Organometallic Compounds / Q000378:metabolism; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D053379:Chromogranin A; D009942:Organometallic Compounds; C513399:gallium Ga 68 dotatate