title: Role of Combined 68Ga-DOTATOC and 18F-FDG Positron Emission Tomography/Computed Tomography in the Diagnostic Workup of Pancreas Neuroendocrine Tumors: Implications for Managing Surgical Decisions.
abstract: Ga-DOTATOC (Ga) positron emission tomography (PET)/computed tomography (CT) is recommended in the workup of pancreas neuroendocrine tumors (PanNETs); evidence suggests that F-FDG (F) PET/CT can also provide prognostic information. Aims of this study were to assess the role of combined Ga- and F-PET/CT in the evaluation of grade (G) 1-2 PanNETs and to test the correlation between F-PET/CT positivity and tumor grade.
  
  
  
  Preoperative Ga- and F-PET/CT of 35 patients with surgically resected G1-2 PanNETs were evaluated. For grading, the 2010 World Health Organization Classification was used; an ancillary analysis with Ki67 cutoffs at 5% to 20% was conducted. Correlation between F-PET/CT positivity (SUVmax > 3.5) and grade was assessed.
  
  
  
  Of 35 PanNETs, 28.6% and 71.4% were G1 and G2 as per World Health Organization. Ga-PET/CT showed high sensitivity (94.3%) in detecting G1-2 PanNETs. F-PET/CT was positive in 20% and 76% G1 and G2 tumors (P = 0.002). F-PET/CT identified G2 PanNETs with high positive predictive value (PPV, 90.5%). F-PET/CT correlated with tumor grade also in the ancillary analysis (P = 0.009).
  
  
  
  The high sensitivity of Ga-PET/CT in NET detection is known. The high PPV of F-PET/CT in the identification of G2 forms suggests its potential role in PanNETs prognostication and risk stratification.
authors.affiliation: From the *Department of Oncology, Comprehensive Cancer Center, G.B. Rossi University Hospital of Verona; †Department of Nuclear Medicine, Sacro Cuore Don Calabria Hospital, Negrar; ‡Hepato-Biliary and Pancreas Unit, Pederzoli Hospital, Peschiera; Departments of §Pancreatic Surgery, ∥Radiology, ¶Internal Medicine, #Hepatobiliary Surgery, and **Pathology, Comprehensive Cancer Center, G.B. Rossi University Hospital of Verona, Verona, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Cingarlini
authors.forename: Silvia
authors.initials: S
authors.lastname: Ortolani
authors.forename: Matteo
authors.initials: M
authors.lastname: Salgarello
authors.forename: Giovanni
authors.initials: G
authors.lastname: Butturini
authors.forename: Anna
authors.initials: A
authors.lastname: Malpaga
authors.forename: Veronica
authors.initials: V
authors.lastname: Malfatti
authors.forename: Mirko
authors.initials: M
authors.lastname: DʼOnofrio
authors.forename: Maria Vittoria
authors.initials: MV
authors.lastname: Davì
authors.forename: Paola
authors.initials: P
authors.lastname: Vallerio
authors.forename: Andrea
authors.initials: A
authors.lastname: Ruzzenente
authors.forename: Paola
authors.initials: P
authors.lastname: Capelli
authors.forename: Elia
authors.initials: E
authors.lastname: Citton
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Grego
authors.forename: Chiara
authors.initials: C
authors.lastname: Trentin
authors.forename: Riccardo
authors.initials: R
authors.lastname: De Robertis
authors.forename: Aldo
authors.initials: A
authors.lastname: Scarpa
authors.forename: Claudio
authors.initials: C
authors.lastname: Bassi
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Tortora
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery; D015282:Octreotide / Q000031:analogs & derivatives; D009942:Organometallic Compounds; D010179:Pancreas / Q000000981:diagnostic imaging* / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D057234:Preoperative Period; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: C499142:Ga(III)-DOTATOC; D009942:Organometallic Compounds; D019788:Fluorodeoxyglucose F18; D015282:Octreotide