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Quel bilan d’imagerie fonctionnelle et biologique faire au diagnostic et dans le suivi d’une tumeur neuroendocrine intestinale ?

What do imaging and biological test results provide in the diagnosis and monitoring of an intestinal neuroendocrine tumour?

  • Imagerie / Imaging
  • Published:
Côlon & Rectum

Résumé

Les techniques d’imagerie fonctionnelle sont recommandées au diagnostic et dans le suivi des tumeurs neuroendocrines (TNE) intestinales. Le choix du traceur est fonction du site primitif et du grade de la TNE. Pour les TNE digestives bien différenciées, la tomographie par émission de positons (TEP) à la 18F-DOPA ainsi que la TEP au 68Ga-DOTATOC ou encore la scintigraphie des récepteurs de la somatostatine (SRS) peuvent aider à la prise en charge du patient, en permettant la détection du primitif et des métastases, l’évaluation de l’extension et de la réponse au traitement. Pour les tumeurs plus agressives, notamment les TNE du côlon et du rectum, la TEP au 18F-FDG est plus pertinente. La SRS et la TEP DOTATOC permettent également de sélectionner les patients éligibles à un traitement par analogue de la somatostatine radiomarqué. Le marqueur biologique de la TNE est la chromogranine A, mais de nombreuses interférences sont possibles (faible spécificité). Le dosage des 5-HIAA urinaires dans la TNE du grêle permet de diagnostiquer un syndrome carcinoïde.

Abstract

Radionuclide imaging plays a major role in gastroenteropancreatic neuroendocrine tumors (NET). Tumor grade and primary location of the disease helps in determining the tracer selection. 18F-DOPA positron emission tomography (PET) is the more appropriate technique used for localization of primary occult ileal NET. Somatostatin receptor (SSTR) scintigraphy and 68Ga-DOTATOC-PET are also useful for well differentiated NETs and can help in the patient management. Indeed, they enable staging, monitoring response to therapy and can select patients with metastatic disease for SSTR radionuclide therapy. 18F-FDG PET is the more relevant technique used for low differentiated NETs, like colorectal lesions. Biological marker of NET is chromogranin A but multiple interferences are possible. Chemical dosage of urinary 5-HIAA helps to diagnose carcinoid syndrome of ileal NETs.

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  1. Service de médecine nucléaire, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, F-75010, Paris, France

    L. Rozenblum, L. Vercellino & C. N. Chougnet

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  1. L. Rozenblum
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  2. L. Vercellino
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  3. C. N. Chougnet
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Correspondence to C. N. Chougnet.

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Rozenblum, L., Vercellino, L. & Chougnet, C.N. Quel bilan d’imagerie fonctionnelle et biologique faire au diagnostic et dans le suivi d’une tumeur neuroendocrine intestinale ?. Colon Rectum 11, 220–226 (2017). https://doi.org/10.1007/s11725-017-0739-6

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  • DOI: https://doi.org/10.1007/s11725-017-0739-6

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