Abstract
Purpose
Pulmonary carcinoid (PC) tumors are rare neoplasms of the lung with good prognosis but diagnosis may be demanding since there is no exclusive modality alone to clearly differentiate a PC tumor. The purpose of this study is to establish the diagnostic features of somatostatin receptor scintigraphy (SRS), comparatively (where available) with 18FDG PET/CT (PET/CT) correlated with histopathologic findings.
Methods
Twenty-one patients who underwent SRS with 111In-octreotide and were diagnosed as having PC tumors were retrospectively studied. Thirteen patients were performed PET/CT. Primary tumour size, Ki-67 indexes, image analysis data of SRS and PET/CT including maximum standardized uptake values (SUVmax) together with false negative, false positive, true positive and true negative lesions were documented and discussed.
Results
Eleven (52.4 %) patients were typical (TC) and 10 (47.6 %) were atypical carcinoids (AC) with mean Ki-67 indexes of 2.1 and 24 %, respectively. Patients underwent SRS for solitary pulmonary nodule (SPN) characterization (n = 12) and determination of disease extension (n = 9). Overall sensitivity and specificity of SRS in the detection of primary tumour, lymph nodes (LN) and distant metastasis (DM) were 76 and 97 %, respectively, whereas, positive and negative predictive values were 95 and 86 %. PET/CT was performed for determining disease spread (n = 3) and metabolic characterization (n = 10) of SPNs. Mean SUVmax in the primary pulmonary lesion in TCs and ACs were 2.9 ± 0.8 and 7.9 ± 5.4, respectively. Nodal involvement (n = 5) and DM (n = 3) were also detected. Sensitivity and specificity of PET/CT in the detection of primary tumour, LNs and DM were 85 and 89.4 %, respectively.
Conclusion
SRS is useful in the diagnosis and monitoring of PC tumors when incorporated with 18FDG PET/CT as a primary staging tool particularly in the determination of disease spread.
Similar content being viewed by others
References
Travis WD. Pathology of lung cancer. Clin Chest Med. 2011;32:669–92.
Travis WD, Brambilla E, Muller-Hermelink HK, Harris CC. Tumours of the lung, pleura, thymus and heart. Lyon: IARC Press; 2004.
Beasley MB, Thunnissen FB, Brambilla E, Hasleton P, Steele R, Hammar SP, et al. Pulmonary atypical carcinoid: predictors of survival in 106 cases. Hum Pathol. 2000;31:1255–65.
Gustafsson BI, Kidd M, Chan A, Malfertheiner MV, Modlin IM. Bronchopulmonary neuroendocrine tumours. Cancer. 2008;113:5–21.
Bertino EM, Confer PD, Colonna JE, Ross P, Otterson GA. Pulmonary neuroendocrine/carcinoid tumors: a review article. Cancer. 2009;115:4434–41.
Erasmus JJ, McAdams HP, Patz EF Jr, Coleman RE, Ahuja V, Goodman PC. Evaluation of primary pulmonary carcinoid tumors using FDG PET. AJR. 1998;170:1369–73.
Daniels CE, Lowe VJ, Aubry MC, Allen MS, Jett JR. The utility of fluorodeoxyglucose positron emission tomography in the evaluation of carcinoid tumors presenting as pulmonary nodules. Chest. 2007;131:255–60.
Wartski M, Alberini JL, Leroy-Ladurie F, De Montpreville V, Nguyen C, Corone C, et al. Typical and atypical bronchopulmonary carcinoid tumors on FDG PET/CT imaging. Clin Nucl Med. 2004;29:752–3.
Volante M, Bozzalla-Cassione F, Papotti M. Somatostatin receptors and their interest in diagnostic pathology. Endocr Pathol. 2004;15:275–91.
Righi L, Volante M, Tavaglione V, Billè A, Daniele L, Angusti T, et al. Somatostatin receptor tissue distribution in lung neuroendocrine tumours: a clinicopathologic and immunohistochemical study of 218 ‘clinically aggressive’ cases. Ann Oncol. 2010;21:548–55.
Belhocine T, Foidart J, Rigo P, Najjar F, Thiry A, Quatresooz P, et al. Fluorodeoxyglucose positron emission tomography and somatostatin receptor scintigraphy for diagnosing and staging carcinoid tumours: correlations with the pathological indexes p53 and Ki-67. Nucl Med Commun. 2002;23:727–34.
Laitinen KLJ, Soini Y, Mattila J, Paakko P. Atypical bronchopulmonary carcinoids show a tendency toward increased apoptotic and proliferative activity. Cancer. 2000;88:1590–8.
Yellin A, Zwas ST, Rozenman J, Simansky DA, Goshen E. Experience with somatostatin receptor scintigraphy in the management of pulmonary carcinoid tumors. Isr Med Assoc J. 2005;7:712–6.
Buchmann I, Henze M, Engelbrecht S, Buchmann I, Henze M, Engelbrecht S, et al. Comparison of 68 Ga-DOTATOC PET and 111In-DTPAOC (OctreoScan) SPECT in patients with neuroendocrine tumours. Eur J Nucl Med Mol Imaging. 2007;34:1617–26.
Kayani I, Bomanji JB, Groves A, Conway G, Gacinovic S, Win T, et al. Functional imaging of neuroendocrine tumors with combined PET/CT using 68 Ga-DOTATATE (DOTA-DPhe(1), Tyr(3)-octreotate) and 18F-FDG. Cancer. 2008;112:2447–55.
Gabriel M, Decristoforo C, Kendler D, Dobrozemsky G, Heute D, Uprimny C, et al. 68Ga-DOTATyr3-octreotide PET in neuroendocrine tumors: comparison with somatostatin receptor scintigraphy and CT. J Nucl Med. 2007;48:508–18.
Jindal T, Kumar A, Venkitaraman B, Dutta R, Kumar R. Role of (68)Ga-DOTATOC PET/CT in the evaluation of primary pulmonary carcinoids. Intern Med. 2010;25:386–91.
Cloran FJ, Banks KP, Song WS, Kim Y, Bradley YC. Limitations of dual time point PET in the assessment of lung nodules with low FDG avidity. Lung Cancer. 2010;68:66–71.
Chong S, Lee KS, Chung MJ, Han J, Kwon OJ, Kim TS. Neuroendocrine tumors of the lung: clinical, pathologic, and imaging findings. Radiographics. 2006;26:41–57. (discussion 57–58).
Krüger S, Buck AK, Blumstein NM, Pauls S, Schelzig H, Kropf C, et al. Use of integrated FDG PET/CT imaging in pulmonary carcinoid tumours. J Intern Med. 2006;260:545–50.
Binderup T, Knigge U, Loft A, Mortensen J, Pfeifer A, Federspiel B, et al. Functional imaging of neuroendocrine tumors: a head-to-head comparison of somatostatin receptor scintigraphy, 123I-MIBG scintigraphy, and 18F-FDG PET. J Nucl Med. 2010;51:704–12.
Kayani I, Conry BG, Groves AM, Win T, Dickson J, Caplin M, et al. A comparison of 68 Ga-DOTATATE and 18F-FDG PET/CT in pulmonary neuroendocrine tumors. J Nucl Med. 2009;50:1927–32.
Jindal T, Kumar A, Venkitaraman B, Meena M, Kumar R, Malhotra A, et al. Evaluation of the role of [18F]FDG PET/CT and [68 Ga]DOTATOC-PET/CT in differentiating typical and atypical pulmonary carcinoids. Cancer Imaging. 2011;11:70–5.
Reubi JC, Waser B, Schaer JC, Laissue JA. Somatostatin receptor sst1–sst5 expression in normal and neoplastic human tissues using receptor autoradiography with subtype-selective ligands. Eur J Nucl Med. 2001;28:836–46.
Vanhagen PM, Krenning EP, Reubi JC, Kwekkeboom DJ, Bakker WH, Mulder AH, et al. Somatostatin analogue scintigraphy in granulomatous diseases. Eur J Nucl Med. 1994;21:497–502.
Ferolla P, Faggiano A, Avenia N, Milone F, Masone S, Giampaglia F, et al. Epidemiology of non gastroenteropancreatic (neuro)endocrine tumours. Clin Endocrinol. 2007;66:1–6.
Ferguson MK, Landreneau RJ, Hazelrigg SR, Altorki NK, Naunheim KS, Zwischenberger JB, et al. Long-term outcome after resection for bronchial carcinoid tumors. Eur J Cardiothorac Surg. 2000;18:156–61.
Filosso PL, Rena O, Donati G, Casadio C, Ruffini E, Papalia E, et al. Bronchial carcinoid tumours: surgical management and long-term outcome. J Thorac Cardiovasc Surg. 2002;123:303–9.
Harpole DH, Feldman JM, Buchanan S, Young WG, Wolfe WG. Bronchial carcinoid tumours: a retrospective analysis of 126 patients. Ann Thorac Surg. 1992;54:50–5.
Modlin IM, Sandor A. An analysis of 8305 cases of carcinoid tumors. Cancer. 1997;79:813–29.
Fink G, Krelbaum T, Yellin A, Bendayan D, Saute M, Glazer M, et al. Pulmonary carcinoid: presentation, diagnosis, and outcome in 142 cases in Israel and review of 640 cases from the literature. Chest. 2001;119:1647–51.
Skuladottir H, Hirsch FR, Hansen HH, Olsen JH. Pulmonary neuroendocrine tumors: incidence and prognosis of histological subtypes. A population-based study in Denmark. Lung Cancer. 2002;37:127–35.
Schrevens L, Vansteenkiste J, Deneffe G, De Leyn P, Verbeken E, Vandenberghe T, et al. Clinical-radiological presentation and outcome of surgically treated pulmonary carcinoid tumours: a long-term single institution experience. Lung Cancer. 2004;43:39–45.
Thomas CF Jr, Tazelaar HD, Jett JR. Typical and atypical pulmonary carcinoids: outcome in patients presenting with regional lymph node involvement. Chest. 2001;119:1143–50.
Garin E, Le Jeune F, Devillers A, Cuggia M, de Lajarte-Thirouard AS, et al. Predictive value of 18F-FDG PET and somatostatin receptor scintigraphy in patients with metastatic endocrine tumors. J Nucl Med. 2009;50:858–64.
Abgral R, Leboulleux S, Déandreis D, Aupérin A, Lumbroso J, Dromain C, et al. Performance of (18)fluorodeoxyglucose-positron emission tomography and somatostatin receptor scintigraphy for high Ki67 (≥10 %) well-differentiated endocrine carcinoma staging. J Clin Endocrinol Metab. 2011;96:665–71.
Vilar E, Salazar R, Pérez-García J, Cortes J, Oberg K, Tabernero J. Chemotherapy and role of the proliferation marker Ki-67 in digestive neuroendocrine tumors. Endocr Relat Cancer. 2007;14:221–32.
Binderup T, Knigge U, Loft A, Federspiel B, Kjaer A. 18F-fluorodeoxyglucose positron emission tomography predicts survival of patients with neuroendocrine tumors. Clin Cancer Res. 2010;16:978–85.
Conflict of interest
The authors declare no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kuyumcu, S., Adalet, I., Sanli, Y. et al. Somatostatin receptor scintigraphy with 111In-octreotide in pulmonary carcinoid tumours correlated with pathological and 18FDG PET/CT findings. Ann Nucl Med 26, 689–697 (2012). https://doi.org/10.1007/s12149-012-0628-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12149-012-0628-x