The Added Diagnostic Value of 18F-Fluorodihydroxyphenylalanine PET/CT in the Preoperative Work-Up of Small Bowel Neuroendocrine Tumors
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The precise localization of the primary tumor and/or the identification of multiple primary tumors improves the preoperative work-up in patients with small bowel (SB) neuroendocrine tumor (NET). The present study assesses the diagnostic value of 18F-fluorodihydroxyphenylalanine (18F-FDOPA) positron emission tomography/computed tomography (PET/CT) during the preoperative wok-up of SB NETs.
Between January 2010 and June 2017, all consecutive patients with SB NETs undergoing preoperative 18F-FDOPA PET/CT and successive resection were analyzed. Preoperative work-up included computed tomography (CT), somatostatin receptor scintigraphy (SRS), and 18F-FDOPA PET/CT. Sensitivity and accuracy ratio for primary and multiple tumor detection were compared with data from surgery and pathology.
There were 17 consecutive patients with SB NETs undergoing surgery. Nine patients (53%) had multiple tumors, 15 (88%) metastatic lymph nodes, 3 (18%) peritoneal carcinomatosis, and 9 patients (53%) liver metastases. A total of 70 SB NETs were found by pathology. Surgery identified the primary in 17/17 (100%) patients and recognized seven of 9 patients (78%) with multiple synchronous SB. Preoperatively, 18F-FDOPA PET/CT displayed a statistically significant higher sensitivity for primary tumor localization (100 vs. 23.5 vs. 29.5%) and multiple tumor detection (78 vs. 22 vs. 11%) over SRS and CT. Compared with pathology, 18F-FDOPA PET/CT displayed the highest accuracy ratio for number of tumor detected over CT and SRS (2.0 ± 2.2 vs. 0.4 ± 0.7 vs. 0.6 ± 1.5, p = 0.0003).
18F-FDOPA PET/CT significantly increased the sensitivity and accuracy for primary and multiple SB NET identification. 18F-FDOPA PET/CT should be included systematically in the preoperative work-up of SB NET.
KeywordsNeuroendocrine tumors Small bowel carcinoid 18F-FDOPA PET/CT Multiple tumors
The authors thank Gerlinde Averous, MD, and Marie Pierrette Chenard, MD, from the Department of Pathology, University Hospitals of Strasbourg, for pathological examinations of surgical specimens.
Substantial contributions to the conception or design of the work: PA, GP, BG, LL, CB, DM, BR, IJN, PB, and AI.
Acquisition, analysis, or interpretation of data for the work; PA, GP, BG, LL, CB, DM, BR, IJN, PB, and AI.
Drafting the work or revising it critically for important intellectual content: PA, GP, BG, LL, CB, DM, BR, IJN, PB, and AI.
Final approval of the version to be published: PA, GP, BG, LL, CB, DM, BR, IJN, PB, and AI.
Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: PA, GP, BG, LL, CB, DM, BR, IJN, PB, and AI.
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