Functional Imaging in the Follow-Up of Enteropancreatic Neuroendocrine Tumors: Clinical Usefulness and Indications.
Functional imaging tests (FITs) detecting somatostatin receptor expression [i.e., somatostatin receptor scintigraphy, 68Ga-DOTA positron emission tomography/computed tomography (CT)] have a pivotal role in the diagnosis of neuroendocrine tumors (NETs), although their indication during follow-up still needs to be clarified.



Investigate the role of FITs after diagnosis of metastatic enteropancreatic NETs, identifying patients who might benefit from these exams.



Multicenter retrospective analysis of metastatic enteropancreatic NETs.



Analysis of imaging tests performed between January 1995 and December 2015 in Rome, Berlin, Milan, Marburg, or Graz.



One hundred forty-three patients with metastatic pancreatic NETs and small intestine NETs, at least 2-year follow-up, and positive FITs.



Patients had received CT every 6 months (unless clinical conditions and tumor behavior required shorter intervals) and FIT every 12 months.



Clinical usefulness of FITs, defined as changes in patient management (indication to biopsy, medical therapy, surgery, or further imaging tests) due only to FITs.



FITs affected management in 73.4% of patients, mostly when G2 vs G1 [odds ratio (OR), 2.40; 95% confidence interval (CI), 1.09 to 5.27; P = 0.03]. Changes were observed in a 12-month time frame especially with pancreatic NETs vs small intestine NETs (OR, 2.89; 95% CI, 1.09 - 7.67; P = 0.03) or metastases since diagnosis vs developed during follow-up (OR, 4.00; 95% CI, 1.43 to 11.17; P < 0.01).



FITs used in addition to CT in the follow-up of stage IV enteropancreatic NETs improve patient management (especially for G2 tumors). Follow-up program should be tailored according to tumor features.
Digestive and Liver Diseases Unit, Sant'Andrea Hospital, 00189 Rome, Italy.
Elettra
E
Merola
Department of Hepatology and Gastroenterology, Charité Universitätsmedizin, 13353 Berlin, Germany.
Marianne E
ME
Pavel
Digestive and Liver Diseases Unit, Sant'Andrea Hospital, 00189 Rome, Italy.
Francesco
F
Panzuto
Digestive and Liver Diseases Unit, Sant'Andrea Hospital, 00189 Rome, Italy.
Gabriele
G
Capurso
Digestive and Liver Diseases Unit, Sant'Andrea Hospital, 00189 Rome, Italy.
Noemi
N
Cicchese
Department of Gastroenterology, University Hospital, 35043 Marburg, Germany.
Anja
A
Rinke
Department of Gastroenterology, University Hospital, 35043 Marburg, Germany.
Thomas M
TM
Gress
Department of Radiology, Sant'Andrea Hospital, 00189 Rome, Italy.
Elsa
E
Iannicelli
Division of Nuclear Medicine, Sant'Andrea Hospital, 00189 Rome, Italy.
Daniela
D
Prosperi
Division of Nuclear Medicine, Sant'Andrea Hospital, 00189 Rome, Italy.
Patrizia
P
Pizzichini
Department of Nuclear Medicine, Campus Virchow-Klinikum, Charité Universitätsmedizin, 13353 Berlin, Germany.
Vikas
V
Prasad
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University, 8036 Graz Austria.
Patrizia
P
Kump
Division of Nuclear Medicine, Department of Radiology, Medical University, 8036 Graz Austria.
Rainer
R
Lipp
Pancreatic Surgery Unit, Vita-Salute University, San Raffaele Hospital Istituto di Ricovero e Cura a Carattere Scientifico, 20132 Milan, Italy.
Stefano
S
Partelli
Pancreatic Surgery Unit, Vita-Salute University, San Raffaele Hospital Istituto di Ricovero e Cura a Carattere Scientifico, 20132 Milan, Italy.
Massimo
M
Falconi
Department of Hepatology and Gastroenterology, Charité Universitätsmedizin, 13353 Berlin, Germany.
Bertram
B
Wiedenmann
Digestive and Liver Diseases Unit, Sant'Andrea Hospital, 00189 Rome, Italy.
Gianfranco
G
Delle Fave
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007414:Intestinal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D007421:Intestine, Small / Q000000981:diagnostic imaging; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D018358:Neuroendocrine Tumors / Q000000981:diagnostic imaging* / Q000556:secondary; D009942:Organometallic Compounds; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D010534:Peritoneal Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D000072078:Positron Emission Tomography Computed Tomography; D019275:Radiopharmaceuticals; D012189:Retrospective Studies
D009942:Organometallic Compounds; D019275:Radiopharmaceuticals; C513399:gallium Ga 68 dotatate