title: Limited Value of Ga-68-DOTATOC-PET-CT in Routine Screening of Patients with Multiple Endocrine Neoplasia Type 1.
abstract: Routine screening is recommended for patients with multiple endocrine neoplasia type 1 (MEN1) to enable early detection and treatment of associated neuroendocrine neoplasms (NEN). Gallium68-DOTATOC-Positron emission tomography combined with computed tomography (Ga-68-DOTATOC-PET-CT) is a very sensitive and specific imaging technique for the detection of sporadic neuroendocrine tumors. The present study evaluated the value of Ga-68-DOTATOC-PET-CT in routine screening of patients with MEN1.
  
  
  
  Between January 2014 and March 2016, all MEN1 patients underwent Ga-68-DOTATOC-PET-CT in addition to conventional imaging (computed tomography of the thorax, magnetic resonance imaging of the abdomen and pituitary, endoscopic ultrasonography). The diagnostic yield of conventional imaging and Ga-68-DOTATOC-PET-CT was prospectively documented and compared, and treatment changes caused by the addition of Ga-68-DOTATOC-PET-CT were recorded.
  
  
  
  Conventional imaging detected 145 NENs, mainly pancreaticoduodenal NENs (n = 117, 81%), in 31 of 33 MEN1 patients. Ga-68-DOTATOC-PET-CT detected 55 NENs in 23 of the 33 patients (p = 0.0001). Ninety (62%) NENs detected by conventional imaging were missed by DOTATOC-PET-CT. The majority of missed lesions were pNEN (n = 68; 74%). The sensitivity of Ga-68-DOTATOC-PET-CT for NENs <5, 5-9, 10-19 and ≥20 mm was 0, 29, 81 and 100%, respectively. However, Ga-68-DOTATOC-PET-CT detected more liver and lymph node metastases in patients with known metastatic disease, which did not lead to a change of patients' management. In one patient (3%), Ga-68-DOTATOC-PET-CT was the only imaging modality that detected a small intestine NEN and led to potentially curative surgery.
  
  
  
  Ga-68-DOTATOC-PET-CT cannot be recommended for routine screening of MEN1 patients. It might provide important additional information in patients with suspected or known metastatic disease.
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, University Hospital of Giessen and Marburg, Philipps University of Marburg, Marburg, Germany. max.b.albers@gmail.com.
authors.forename: Max B
authors.initials: MB
authors.lastname: Albers
authors.affiliation: Department of Nuclear Medicine, University Hospital of Giessen and Marburg, Philipps University of Marburg, Marburg, Germany.
authors.forename: Damiano
authors.initials: D
authors.lastname: Librizzi
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, University Hospital of Giessen and Marburg, Philipps University of Marburg, Marburg, Germany.
authors.forename: Caroline L
authors.initials: CL
authors.lastname: Lopez
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, University Hospital of Giessen and Marburg, Philipps University of Marburg, Marburg, Germany.
authors.forename: Jerena
authors.initials: J
authors.lastname: Manoharan
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital of Giessen and Marburg, Philipps University of Marburg, Marburg, Germany.
authors.forename: Jonas C
authors.initials: JC
authors.lastname: Apitzsch
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, University Hospital of Giessen and Marburg, Philipps University of Marburg, Marburg, Germany.
authors.forename: Emily P
authors.initials: EP
authors.lastname: Slater
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, University Hospital of Giessen and Marburg, Philipps University of Marburg, Marburg, Germany.
authors.forename: Carmen
authors.initials: C
authors.lastname: Bollmann
authors.affiliation: Division of Endocrinology, University Hospital of Giessen and Marburg, Philipps University of Marburg, Marburg, Germany.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Kann
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, University Hospital of Giessen and Marburg, Philipps University of Marburg, Marburg, Germany.
authors.forename: Detlef K
authors.initials: DK
authors.lastname: Bartsch
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018761:Multiple Endocrine Neoplasia Type 1 / Q000000981:diagnostic imaging*; D015282:Octreotide / Q000031:analogs & derivatives*; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D019275:Radiopharmaceuticals
chemical_list: D019275:Radiopharmaceuticals; D015282:Octreotide; C106246:Edotreotide