Value of the68Ga-DOTATATE PET-CT in the diagnosis of endometriosis. A pilot study.
OBJECTIVE
The non-invasive diagnosis of endometriosis remains challenging. Recent data suggested that somatostatin might be involved in its pathogenesis. High sensitive visualization of somatostatin receptors expression is possible using PET-CT imaging after the administration of a68Ga-labeled somatostatin analog (DOTATATE) that will bind to the somatostatin receptor sub-types 2 and 5. The aim of the present study was to assess the usefulness of68Ga-DOTATATE PET-CT in the diagnosis of endometriosis.


METHODS
This is a prospective, single center pilot study. A pre operative68Ga-DOTATATE PET-CT was performed in all of the patients who presented with suspected endometriosis and who were scheduled for a laparoscopy. Surgical endometriosis staging and histopathological analysis, including somatostatin receptors SST1, 2 and 5 immunohistochemistry (IHC) of removed specimens, were confronted to the results of the68Ga-DOTATATE PET-CT.


RESULTS
12 patients were included in this study.68Ga-DOTATATE PET-CT performed pre operatively showed increased pathologic uptake in four patients with a deep infiltrating endometriosis (DIE) recto-vaginal lesion and in another patient with an adenomyoma. Expression of SST1, 2 and 5 receptors in surgical specimens was confirmed by IHC in these five lesions. Neither superficial peritoneal endometriosis, nor ovarian endometrioma were found to show an increased pathologic uptake on68Ga-DOTATATE PET-CT. IHC analysis confirmed that SST1, 2, and 5 receptors were not present in these lesions.


CONCLUSIONS
The results observed in this small size series of patients seem to confirm expression of somatostatin receptors only in recto-vaginal DIE and focal adenomyosis lesions. The usefulness of68Ga-DOTATATE PET-CT in the diagnosis of this entity is uncertain. Future research should concentrate on studying the role of somatostatin in the pathogenesis of DIE.
Department of Obstetrics and Gynaecology, CHU St Pierre, Université Libre de Bruxelles, 1000 Brussels, Belgium. Electronic address: maxime_fastrez@stpierre-bru.be.
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Fastrez
Department of Nuclear Medicine, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium.
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Artigas
Department of Pathology, CHU St Pierre & Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium.
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Sirtaine
Department of Nuclear Medicine, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium.
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Wimana
Department of Obstetrics and Gynaecology, CHU St Pierre, Université Libre de Bruxelles, 1000 Brussels, Belgium.
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Caillet
Department of Obstetrics and Gynaecology, CHU St Pierre, Université Libre de Bruxelles, 1000 Brussels, Belgium.
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Rozenberg
Department of Nuclear Medicine, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium.
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Flamen
D000328:Adult; D004715:Endometriosis / Q000000981:diagnostic imaging* / Q000473:pathology; D005240:Feasibility Studies; D005260:Female; D005710:Gallium Radioisotopes / Q000493:pharmacokinetics*; D006801:Humans; D009942:Organometallic Compounds / Q000493:pharmacokinetics*; D010865:Pilot Projects; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D011446:Prospective Studies; D017481:Receptors, Somatostatin / Q000378:metabolism*; D014621:Vagina / Q000000981:diagnostic imaging
D005710:Gallium Radioisotopes; D009942:Organometallic Compounds; D017481:Receptors, Somatostatin; C513399:gallium Ga 68 dotatate
(68)Ga-DOTATATE; Adenomyosis; Endometriosis; Immunohistochemistry; Positron-Emission Tomography; Somatostatin