%20of%2068Ga-DOTA-TATE%20in%20S4%20liver%20with.JPG "(A). Picture of the focus of pathological accumulation (metastasis) of 68Ga-DOTA-TATE in S4 liver with dimensions of 14mm with SUV=8.5. (B). Focal hyper fixation (primary focus) of 68Ga-DOTA-TATE in the distal parts of the tail of the pancreas with dimensions of 28*17mm with SUV=6.9")
Tinatin Rizaeva, Daniyar
Shahanov, Shafee Ur Rehman, Kudaibergen Osmonaliev, Nurlan Mannapuulu ,
Meder Melisbekov, and Damir Abibillaev, from the institute Russia. wrote a
Research Article about, PET-CT in Neuroendocrine Tumors of Unknown Primary:
Case Insights and Review. Entitled, The role of Pet-Ct in neuroendocrine tumors
without an identified primary focus: A case report and review. This research
paper published by the, International Journal of Biosciences (IJB). an open
access scholarly research journal on Biosciences. under the affiliation of
the International Network For Natural Sciences | INNSpub. an open
access multidisciplinary research journal publisher.
Abstract
Neuroendocrine tumors
are a rare group of heterogeneous tumors, mostly developed in the
gastrointestinal and respiratory tract. These tumors show overexpression
of somatostatin receptors on the cell membrane, in which type 2 SSTRs are more
common. Functional imaging techniques are using for the NETs diagnosis
and treatment. In this case a patient with neuroendocrine tumor (NET) without
primary focus was admitted to the hospital due to recurrent episodes of
cholecystitis. During diagnostic investigation incidentally anechoic foci in
the patient’s liver were detected and pathological examination of this foci
showed that it’s a metastasis of neuroendocrine tumor. The patient was
previously investigated for the primary focus identification of NET, but no
significant outcome was found. Hence, we used SSTR-based PET/CT scan
68Ga-DOTA-peptides, which showed the primary focus of NET in the tail of
pancreas. Therefore, we concluded that the PET/CT scan 68Ga-DOTA-TATE showed
significant outcome with identification of tumor localization.
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Introduction
Between 9% and 19% of patients with neuroendocrine tumors (NETs) present with metastatic disease with an unknown primary tumor site (Wedin et al., 2024). Localization of the primary tumor is highly relevant in the management of this patient population because complete resection of the primary tumor and metastases is the treatment goal for patients with well-differentiated NET metastases (Huang et al., 2024). Even if the metastases are not completely resectable, debulking surgery can improve symptom control in patients with endocrine symptoms and may improve survival (Ghabra et al., 2024; Søreide et al., 2024).
The standard imaging for staging
of NETs includes CT and MRI as well as somatostatin receptor scintigraphy
(Marcus et al., 2024). CT and MRI are limited for evaluation of primary small
bowel NETs; somatostatin receptor imaging with 111In-octreotide (Octreoscan;
Mallinckrodt Pharmaceuticals) also shows limited detectability, with only 37%
of small bowel primary NETs detected preoperatively with 111In-octreotide
(Marcus et al., 2024). More recently, somatostatin receptor imaging with
positron emitters has been developed using 68Ga (a generator product with a
half-life of 68 min) and DOTA as chelator. The most widely studied
68GaDOTA-octreotide analogs for PET imaging are 68Ga-DOTA-TATE, 68Ga-DOTA-TOC,
and 68GaDOTA-NOC (Han et al., 2024). All of these radiopharmaceuticals have
higher affinity than 111In-octreotide for the somatostatin receptor subtype 2,
the primary target in NETs, and are more sensitive than 111In-octreotide in the
detection of NET lesions (Di Franco et al., 2024; Raynor and Kempf, 2024). The
objective of this study was to evaluate the accuracy of 68Ga-DOTA-TOC and 68Ga-DOTA-TATE
PET/CT imaging in the localization of the site of the unknown primary tumor in
patients with metastatic.
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