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Limited role of carbidopa-assisted 18F-FDOPA PET/CT in patients with sporadic non-functional gastroduodenal neuroendocrine neoplasms

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Abstract

Objective

To evaluate 18F-fluorodihydroxyphenylalanine (18F-FDOPA) positron emission tomography/computed tomography (PET/CT) after carbidopa premedication to localize sporadic, well-differentiated, nonfunctioning gastroduodenal neuroendocrine neoplasms (NENs).

Methods

Ten patients undergoing staging carbidopa-assisted 18F-FDOPA PET/CT before endoscopic or surgical resection of gastroduodenal NENs were retrospectively selected. Preoperative imaging work up also included CT, magnetic resonance imaging (MRI), and somatostatin receptor scintigraphy (SRS) single-photon emission computed tomography/computed tomography (SPECT/CT) in ten, six, and eight patients, respectively. Histopathological diagnosis of primary NEN was the diagnostic standard of truth. Metastatic spread was defined as the presence of histologically proven nodal, visceral, and/or bone metastases.

Results

Tumors were located in the duodenal bulb in five patients, in descending duodenum in three, and in the gastric fundus in two. Three patients presented with both lymph nodes and distant metastases, and two with exclusive lymphatic spread. CT and MRI detected primary tumor in one out of ten and three out of six patients, respectively. SRS failed to detect intestinal NEN in all cases. 18F-FDOPA PET/CT detected four primary NENs (one gastric and three duodenal tumors) and was false negative in six patients. NENs missed by 18F-FDOPA PET/CT were smaller than 10 mm in two cases and measured about 30 mm in three patients. The remaining tumor was detected only on blind endoscopic biopsy. Among patients who underwent both 18F-FDOPA PET/CT and SRS, three presented discordant results for primary tumor detection (PET/CT positive/SRS negative) and five showed concordant negative studies. 18F-FDOPA PET/CT correctly identified all three patients with both nodal and visceral metastatic disease and failed to detect lymph node metastases in both N+ M0 patients.

Conclusions

18F-FDOPA PET/CT is not sufficiently accurate for localization of primary well-differentiated nonfunctioning sporadic gastroduodenal NENs. 18F-FDOPA PET/CT’s value for the assessment of visceral and lymph node metastases needs to be clarified in multicenter trials including a larger number of patients.

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Authors and Affiliations

  1. Biophysics and Nuclear Medicine, University Hospitals of Strasbourg-Hautepierre, 1, Avenue Molière, 67098, Strasbourg Cedex, France

    Alessio Imperiale & Mehdi Helali

  2. Faculty of Medicine, University of Strasbourg, CNRS, IPHC, UMR 7178, Strasbourg, France

    Alessio Imperiale

  3. Pathology, University Hospitals of Strasbourg, Strasbourg University, Strasbourg, France

    Gerlinde Averous

  4. Nuclear Medicine, La Timone University Hospital, Aix-Marseille University, Marseille, France

    David Taieb

  5. European Center for Research in Medical Imaging, Aix-Marseille University, Marseille, France

    David Taieb

  6. General, Digestive, and Endocrine Surgery, IRCAD-IHU, University of Strasbourg, Strasbourg, France

    Patrick Pessaux

  7. Internal Medicine, Diabetes and Metabolic Disorders, University Hospitals of Strasbourg, Strasbourg University, Strasbourg, France

    Bernard Goichot

  8. Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Hospitals of Strasbourg, Strasbourg University, Strasbourg, France

    Pietro Addeo & Philippe Bachellier

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  1. Alessio Imperiale
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Correspondence to Alessio Imperiale.

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All the authors (AI, GA, MH, DT, PP, BG, PA, PB) declare that they have no conflict of interest in the present manuscript.

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Informed consent was obtained from all individual participants included in the study.

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Imperiale, A., Averous, G., Helali, M. et al. Limited role of carbidopa-assisted 18F-FDOPA PET/CT in patients with sporadic non-functional gastroduodenal neuroendocrine neoplasms. Ann Nucl Med 33, 697–707 (2019). https://doi.org/10.1007/s12149-019-01378-1

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  • DOI: https://doi.org/10.1007/s12149-019-01378-1

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