Feasibility of Radio-Guided Surgery with ⁶⁸Gallium-DOTATATE in Patients with Gastro-Entero-Pancreatic Neuroendocrine Tumors.
BACKGROUND
Surgery is the only definitive therapy for gastro-entero-pancreatic neuroendocrine tumors (GEPNETs), and achieving complete tumor resection is an important prognostic factor. Radiopharmaceuticals such as (68)Ga-DOTA peptides have been developed that offer superior accuracy for localization of GEPNETs. The study aim was to determine the feasibility of radio-guided surgery (RGS) using (68)Ga-DOTATATE in patients with primary and recurrent GEPNETs.


METHODS
Fourteen patients with GEPNETs were enrolled onto a prospective study to determine the feasibility of RGS with (68)Ga-DOTATATE. Findings from preoperative imaging, intraoperative exploration, RGS, and pathology were analyzed.


RESULTS
The median decay corrected target count rate was 172.6 (range 28.15-2341) for tumors, with a tumor-to-background ratio (TBR) of 4.46 (range 1.6-43.56). The median lesion size was 1.55 (range 0.5-15) cm. There was no significant correlation between preoperative imaging maximum standardized uptake value (SUVmax) of the lesions and TBR (Spearman r = - 0.01, p = 0.9), TBR and tumor size (Spearman r = 0.29, p = 0.14), and SUVmax and tumor size (Spearman r = 0.22, p = 0.28). The probe showed correct identification for gastric and small intestine neuroendocrine tumor (NET), including lymph node metastasis in 17 (81.0 %) of 21 cases, with a median TBR of 3.5 (1.6-40.2). For pancreatic NETs and lymph node metastasis, 16 (66.7 %) of 24 were correctly identified by RGS.


CONCLUSIONS
Our study shows that RGS with (68)Ga-DOTATATE is feasible and correctly confirms bowel NETs and metastatic mesenteric lymph nodes. Further studies are needed to determine the benefit of RGS with (68)Ga-DOTATATE.
Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Samira M
SM
Sadowski
Positron Emission Tomography Department, Warren Grant Magnusson Clinical Center, National Institutes of Health, Bethesda, MD, USA.
Corina
C
Millo
Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Vladimir
V
Neychev
Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Rachel
R
Aufforth
Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Xavier
X
Keutgen
Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Joanne
J
Glanville
Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Meghna
M
Alimchandani
Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Naris
N
Nilubol
Positron Emission Tomography Department, Warren Grant Magnusson Clinical Center, National Institutes of Health, Bethesda, MD, USA.
Peter
P
Herscovitch
Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Martha
M
Quezado
Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. kebebewe@mail.nih.gov.
Electron
E
Kebebew
D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007124:Immunoenzyme Techniques; D007414:Intestinal Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D018358:Neuroendocrine Tumors / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D009942:Organometallic Compounds / Q000493:pharmacokinetics*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D049268:Positron-Emission Tomography / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics*; D061089:Radiotherapy, Image-Guided / Q000379:methods*; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D014018:Tissue Distribution; D014057:Tomography, X-Ray Computed / Q000379:methods
D014408:Biomarkers, Tumor; D009942:Organometallic Compounds; D019275:Radiopharmaceuticals; C513399:gallium Ga 68 dotatate