title: 18F-fluorodihydroxyphenylalanine vs other radiopharmaceuticals for imaging neuroendocrine tumours according to their type.
abstract: 6-Fluoro-((18)F)-L-3,4-dihydroxyphenylalanine (FDOPA) is an amino acid analogue for positron emission tomography (PET) imaging which has been registered since 2006 in several European Union (EU) countries and by several pharmaceutical firms. Neuroendocrine tumour (NET) imaging is part of its registered indications. NET functional imaging is a very competitive niche, competitors of FDOPA being two well-established radiopharmaceuticals for scintigraphy, (123)I-metaiodobenzylguanidine (MIBG) and (111)In-pentetreotide, and even more radiopharmaceuticals for PET, including fluorodeoxyglucose (FDG) and somatostatin analogues. Nevertheless, there is no universal single photon emission computed tomography (SPECT) or PET tracer for NET imaging, at least for the moment. FDOPA, as the other PET tracers, is superior in diagnostic performance in a limited number of precise NET types which are currently medullary thyroid cancer, catecholamine-producing tumours with a low aggressiveness and well-differentiated carcinoid tumours of the midgut, and in cases of congenital hyperinsulinism. This article reports on diagnostic performance and impact on management of FDOPA according to the NET type, emphasising the results of comparative studies with other radiopharmaceuticals. By pooling the results of the published studies with a defined standard of truth, patient-based sensitivity to detect recurrent medullary thyroid cancer was 70 % [95 % confidence interval (CI) 62.1-77.6] for FDOPA vs 44 % (95 % CI 35-53.4) for FDG; patient-based sensitivity to detect phaeochromocytoma/paraganglioma was 94 % (95 % CI 91.4-97.1) for FDOPA vs 69 % (95 % CI 60.2-77.1) for (123)I-MIBG; and patient-based sensitivity to detect midgut NET was 89 % (95 % CI 80.3-95.3) for FDOPA vs 80 % (95 % CI 69.2-88.4) for somatostatin receptor scintigraphy with a larger gap in lesion-based sensitivity (97 vs 49 %). Previously unpublished FDOPA results from our team are reported in some rare NET, such as small cell prostate cancer, or in emerging indications, such as metastatic NET of unknown primary (CUP-NET) or adrenocorticotropic hormone (ACTH) ectopic production. An evidence-based strategy in NET functional imaging is as yet affected by a low number of comparative studies. Then the suggested diagnostic trees, being a consequence of the analysis of present data, could be modified, for some indications, by a wider experience mainly involving face-to-face studies comparing FDOPA and (68)Ga-labelled peptides.
authors: Department of Nuclear Medicine, Comenius University & St. Elisabeth Institute, Bratislava, Slovakia. sona.balogova@tnn.aphp.fr
authors: Sona
authors: S
authors: Balogova
authors: Jean-Noël
authors: JN
authors: Talbot
authors: Valérie
authors: V
authors: Nataf
authors: Laure
authors: L
authors: Michaud
authors: Virginie
authors: V
authors: Huchet
authors: Khaldoun
authors: K
authors: Kerrou
authors: Françoise
authors: F
authors: Montravers
mesh_terms: D019797:3-Iodobenzylguanidine / Q000494:pharmacology; D001984:Bronchial Neoplasms / Q000000981:diagnostic imaging; D015266:Carcinoma, Merkel Cell / Q000000981:diagnostic imaging; D004295:Dihydroxyphenylalanine / Q000031:analogs & derivatives / Q000494:pharmacology; D019788:Fluorodeoxyglucose F18 / Q000494:pharmacology; D005710:Gallium Radioisotopes / Q000494:pharmacology; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging; D064847:Multimodal Imaging; D009362:Neoplasm Metastasis; D018358:Neuroendocrine Tumors / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D015282:Octreotide / Q000031:analogs & derivatives / Q000494:pharmacology; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D017481:Receptors, Somatostatin / Q000378:metabolism; D012008:Recurrence; D012680:Sensitivity and Specificity; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging*; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D005710:Gallium Radioisotopes; D019275:Radiopharmaceuticals; D017481:Receptors, Somatostatin; D019788:Fluorodeoxyglucose F18; C043437:fluorodopa F 18; D019797:3-Iodobenzylguanidine; D004295:Dihydroxyphenylalanine; D015282:Octreotide; C106246:Edotreotide