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Head-to-head comparison of 68Ga-DOTATATE PET/CT and 18F-FDG PET/CT in localizing tumors with ectopic adrenocorticotropic hormone secretion: a prospective study

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Localizing the source of ectopic adrenocorticotropic hormone secretion (EAS) is challenging. This study compared the diagnostic value of 68Ga-DOTATATE PET/CT and 18F-FDG PET/CT in tumors with EAS.

Methods

Thirty-six patients with a suspicion of EAS were enrolled to undergo both 68Ga-DOTATATE PET/CT and 18F-FDG PET/CT within 4 weeks for comparison. Twenty-three underwent surgical resection or biopsy. Immunohistochemical staining for SSTR2 and Ki-67 was performed to correlate with 68Ga-DOTATATE uptake and 18F-FDG uptake, respectively.

Results

EAS tumors were observed in 20/23 patients. Among the 20 patients with histologically proven EAS tumors, 68Ga-DOTATATE PET/CT correctly identified the tumor in 15 (75.0%), with an SUVmax ranging from 1.4 to 20.7 (6.7 ± 5.5). 18F-FDG PET/CT correctly identified the tumor in 12 (60.0%) patients, with an SUVmax ranging from 1.8 to 10.0 (4.0 ± 2.1). Moreover, 68Ga-DOTATATE PET/CT unmasked the sources of EAS in 6 patients with negative 18F-FDG uptake, and 18F-FDG PET/CT unmasked the sources in 3 patients with negative 68Ga-DOTATATE uptake, resulting in EAS tumors being identified in 18 (90%) patients by combining 68Ga-DOTATATE PET/CT and 18F-FDG PET/CT.

Conclusions

68Ga-DOTATATE PET/CT and 18F-FDG PET/CT are complementary in localizing and discriminating the source of EAS. 68Ga-DOTATATE PET/CT combined with 18F-FDG PET/CT had higher detection rate than each alone.

Trial registration

68Ga-DOTATATE PET/CT in Neuroendocrine Tumors (NCT04041882)

URL of registry

https://clinicaltrials.gov/ct2/show/NCT04041882

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Funding

This study was supported by the Chinese Academy of Medical Science Innovation Fund for Medical Sciences (2019-I2M-1-001 and 2016-I2M-1-011), the Chinese Academy of Medical Science Clinical and Translational Medicine Research Foundation (2019XK320032), the National Natural Science Foundation of China (81871392), and the Capital Health Development Scientific Research Project (2018-1-4011).

Author information

Author notes

  1. Qingxing Liu and Jie Zang contributed equally to this work.

Authors and Affiliations

  1. Department of Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China

    Qingxing Liu, Jie Zang & Zhaohui Zhu

  2. Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China

    Qingxing Liu, Jie Zang & Zhaohui Zhu

  3. Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China

    Yingying Yang & Lin Lu

  4. Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China

    Qing Ling, Huanwen Wu & Pengyan Wang

Authors
  1. Qingxing Liu
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  2. Jie Zang
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Corresponding authors

Correspondence to Lin Lu or Zhaohui Zhu.

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Ethics approval

Ethical approval was obtained from the Institute Review Board of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, and this study was conducted in accordance with the principles of the Declaration of Helsinki.

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

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Liu, Q., Zang, J., Yang, Y. et al. Head-to-head comparison of 68Ga-DOTATATE PET/CT and 18F-FDG PET/CT in localizing tumors with ectopic adrenocorticotropic hormone secretion: a prospective study. Eur J Nucl Med Mol Imaging 48, 4386–4395 (2021). https://doi.org/10.1007/s00259-021-05370-8

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  • DOI: https://doi.org/10.1007/s00259-021-05370-8

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