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The diagnostic and prognostic role of combined [18F]FDG and [68Ga]-DOTA-peptides PET/CT in primary pulmonary carcinoids: a multicentric experience

  • Nuclear Medicine
  • Published:
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Abstract

Objectives

In the present retrospective multicentric study, we combined [68Ga]-DOTA-peptides and [18F]FDG-PET/CT findings aiming to investigate their capability to differentiate typical (TC) and atypical pulmonary carcinoids (AC) and their prognostic role.

Methods

From three centers, 61 patients were retrospectively included. Based on a dual tracer combination we classified PET scans as score 1, [18F]FDG- and [68Ga]-DOTA-peptides negative; score 2, [68Ga]-DOTA-peptides positive and [18F]FDG-negative; score 3, [68Ga]-DOTA-peptides negative and [18F]FDG-positive; score 4, both tracers positive. Moreover, for each patient, the ratios of SUVmax on [68Ga]-DOTA-PET to that on [18F]FDG-PET were calculated (SUVr).

Results

Thirty-five patients had a final diagnosis of TC. Twenty-two TC (57%) had positive [68Ga]-DOTA-peptides PET; instead, 21/26 (81%) AC had positive [18F]FDG-PET/CT. On dual-tracer analysis, scores 1, 2, 3 and 4 were 13%, 20%, 43% and 24% for all populations; 17%, 26%, 20% and 37% for TC; 8%, 11%, 73% and 8% for AC. Median SUVr was significantly higher in TC than AC (6.4 vs. 0.4, p = 0.011). The best value of SUVr to predict the final diagnosis was 1.05 (AUC 0.889). Relapse or progression of disease happened in 17 patients (11 affected by AC) and death in 10 cases (7 AC). AC diagnosis, positive [18F]FDG-PET, negative DOTA-PET and dual tracer score were significantly correlated with PFS (p = 0.013, p = 0.033, p = 0.029 and p = 0.019), while only AC diagnosis with OS (p = 0.022).

Conclusion

PET/CT findings had also a prognostic role in predicting PFS. Dual-tracer PET behavior may be used to predict the nature of pulmonary carcinoids and select the most appropriate management.

Key Points

• Combination of [18F]FDG and [68Ga]-DOTA-peptides PET/CT results may help to differentiate between atypical and typical lung carcinoids.

• The SUVmax ratio between [18F]FDG and [68Ga]-DOTA-peptides PET may help to differentiate between atypical and typical lung carcinoids.

• Histotype and PET/CT features have a prognostic impact on PFS.

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Abbreviations

[18F]FDG:

2-Deoxy-2-[18F]fluoro-D-glucose

[68Ga]:

Gallium68

AC:

Atypical carcinoid

CI:

Confidence intervals

HR:

Hazard ratio

L-BP SUV R:

Lesion-to-blood-pool SUV ratio

LC:

Lung carcinoid

L-L SUV R:

Lesion-to-liver SUV ratio

L-S SUV R:

Lesion-to-spleen SUV ratio

NEN:

Neuroendocrine neoplasm

OS:

Overall survival

PET/CT:

Positron emission tomography/computed tomography

PFS:

Progression-free survival

ROI:

Region of interest

SSTR:

Somatostatin receptor

SUVmax:

Maximum standardized uptake value

SUVr:

SUVratio

TC:

Typical carcinoid

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Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Nuclear Medicine, ASST Spedali Civili di Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy

    Domenico Albano, Francesco Dondi & Francesco Bertagna

  2. Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; Nuclear Medicine, University of Brescia, Brescia, Italy

    Domenico Albano & Francesco Bertagna

  3. Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genova, Italy

    Matteo Bauckneht & Silvia Morbelli

  4. Department of Health Sciences (DISSAL), University of Genova, Genova, Italy

    Matteo Bauckneht & Silvia Morbelli

  5. Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy

    Manuela Albertelli

  6. Nuclear Medicine, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy

    Rexhep Durmo, Angelina Filice & Annibale Versari

  7. PhD Program in Clinical and Experimental Medicine (CEM), University of Modena and Reggio Emilia, Modena, Italy

    Rexhep Durmo

  8. Medical Oncology Unit, ASST Spedali Civili di Brescia, Brescia, Italy

    Alfredo Berruti

Authors
  1. Domenico Albano
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  10. Francesco Bertagna
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Corresponding author

Correspondence to Domenico Albano.

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Guarantor

The scientific guarantor of this publication is Dr. Domenico Albano.

Conflict of interest

Dr. Annibale Versari received honoraria from Novartis, Advanced Accelerator Applications and GE Healthcare; Dr. Angelina Filice received honoraria from Novartis and Advanced Accelerator Applications; The other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all patients in this study.

Ethical approval

Institutional Review Board approval was obtained (NP 5048).

Methodology

• retrospective

• multicenter study

• diagnostic and prognostic study

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Albano, D., Dondi, F., Bauckneht, M. et al. The diagnostic and prognostic role of combined [18F]FDG and [68Ga]-DOTA-peptides PET/CT in primary pulmonary carcinoids: a multicentric experience. Eur Radiol 33, 4167–4177 (2023). https://doi.org/10.1007/s00330-022-09326-w

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