title: Clinical utility of indigenously formulated single-vial lyophilized HYNIC-TOC kit in evaluating Gastro-entero Pancreatic neuro endocrine tumours.
abstract: OBJECTIVE
  The objective of this study was to evaluate the performance and utility of (99m)Tc HYNIC-TOC planar scintigraphy and SPECT/CT in the diagnosis, staging and management of gastroenteropancreatic neuroendocrine tumors (GPNETs).
  
  
  METHODS
  22 patients (median age, 46 years) with histologically proven gastro- entero- pancreatic NETs underwent (99m)Tc HYNIC-TOC whole body scintigraphy and regional SPECT/CT as indicated. Scanning was performed after injection of 370-550 MBq (10-15 mCi) of (99m)Tc HYNIC-TOC intravenously. Images were evaluated by two experienced nuclear medicine physicians both qualitatively as well as semi quantitatively (tumor to background and tumor to normal liver ratios on SPECT -CT images). Results of SPECT/CT were compared with the results of conventional imaging. Histopathology results and follow-up somatostatin receptor scintigraphy with (99m)Tc HYNIC TOC or conventional imaging with biochemical markers were considered to be the reference standards.
  
  
  RESULTS
  (99m)Tc HYNIC TOC showed sensitivity and specificity of 87.5% and 85.7%, respectively, for primary tumor and 100% and 86% for metastases. It was better than conventional imaging modalities for the detection of both primary tumor (P<0.001) and metastases (P<0.0001). It changed the management strategy in 6 patients (31.8%) and supported management decisions in 8 patients (36.3%).
  
  
  CONCLUSIONS
  (99m)Tc HYNIC TOC SPECT/CT appears to be a highly sensitive and specific modality for the detection and staging of GPNETs. It is better than conventional imaging for the evaluation of GPNETs and can have a significant impact on patient management and planning further therapeutic options.
authors.affiliation: Nuclear Medicine Department, Kovai Medical Center and Hospital, India.
authors.forename: Ajit S
authors.initials: AS
authors.lastname: Shinto
authors.affiliation: Nuclear Medicine Department, Kovai Medical Center and Hospital, India.
authors.forename: K
authors.initials: K
authors.lastname: Kamaleshwaran
authors.affiliation: Nuclear Medicine Department, Kovai Medical Center and Hospital, India.
authors.forename: K
authors.initials: K
authors.lastname: Vyshak
authors.affiliation: Nuclear Medicine Department, Kovai Medical Center and Hospital, India.
authors.forename: Natarajan
authors.initials: N
authors.lastname: Sudhakar
authors.affiliation: Isotope Applications & Radiopharmaceuticals Division, Bhabha Atomic Research Centre, Mumbai, India.
authors.forename: Sharmila
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: Isotope Applications & Radiopharmaceuticals Division, Bhabha Atomic Research Centre, Mumbai, India.
authors.forename: Aruna
authors.initials: A
authors.lastname: Korde
authors.affiliation: Isotope Applications & Radiopharmaceuticals Division, Bhabha Atomic Research Centre, Mumbai, India.
authors.forename: Grace
authors.initials: G
authors.lastname: Samuel
authors.affiliation: Isotope Applications & Radiopharmaceuticals Division, Bhabha Atomic Research Centre, Mumbai, India.
authors.forename: Madhav
authors.initials: M
authors.lastname: Mallia
keywords: HYNIC TOC; Neuroendocrine tumor; SPECT CT