Functional imaging in the follow-up of enteropancreatic neuroendocrine tumors: Clinical usefulness and indications

E Merola, ME Pave, F Panzuto, G Capurso, N Cicchese, A Rinke, TM Gress, E Iannicelli, D Prosperi, P Pizzichini, V Prasad, P Kump, R Lipp, S Partelli, M Falconi, B Wiedenmann, Gianfranco Delle Fave

Research output: Contribution to journalArticle

Abstract

Context: 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. Objective: Investigate the role of FITs after diagnosis of metastatic enteropancreatic NETs, identifying patients who might benefit from these exams. Design: Multicenter retrospective analysis of metastatic enteropancreatic NETs. Setting: Analysis of imaging tests performed between January 1995 and December 2015 in Rome, Berlin, Milan, Marburg, or Graz. Subjects: One hundred forty-three patients with metastatic pancreatic NETs and small intestine NETs, at least 2-year follow-up, and positive FITs. Interventions: Patients had received CT every 6 months (unless clinical conditions and tumor behavior required shorter intervals) and FIT every 12 months. Main Outcome Measures: Clinical usefulness of FITs, defined as changes in patient management (indication to biopsy, medical therapy, surgery, or further imaging tests) due only to FITs. Results: 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 especiallywith 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). Conclusions: 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 featur es. (J Clin Endocrinol Metab 102: 1486-1494, 2017). © 2017 Endocrine Society.
Original languageEnglish
Pages (from-to)1486-1494
Number of pages9
JournalJournal of Clinical Endocrinology and Metabolism
Volume102
Issue number5
DOIs
Publication statusPublished - 2017

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    Merola, E., Pave, ME., Panzuto, F., Capurso, G., Cicchese, N., Rinke, A., Gress, TM., Iannicelli, E., Prosperi, D., Pizzichini, P., Prasad, V., Kump, P., Lipp, R., Partelli, S., Falconi, M., Wiedenmann, B., & Delle Fave, G. (2017). Functional imaging in the follow-up of enteropancreatic neuroendocrine tumors: Clinical usefulness and indications. Journal of Clinical Endocrinology and Metabolism, 102(5), 1486-1494. https://doi.org/10.1210/jc.2016-3732