68Ga-DOTATATE and 18F-FDG PET/CT dual-modality imaging enhances precision of staging and treatment decision for gastroenteropancreatic neuroendocrine neoplasms

doi:10.12122/j.issn.1673-4254.2025.06.10

Abstract

Abstract:

Objective To evaluate the value of ⁶⁸Ga-DOTATATE and ¹⁸F-FDG PET/CT imaging in staging and treatment decision for gastroenteropancreatic neuroendocrine neoplasms (GEP-NEN). Methods This retrospective analysis was conducted in 49 patients with GEP-NEN undergoing ¹⁸F-FDG and ⁶⁸Ga-DOTATATE PET/CT imaging at our hospital from August, 2020 to March, 2023, including 34 newly diagnosed patients and 15 patients with recurrence or metastasis after treatment. GEP-NEN were classified into G1, G2, and G3 neuroendocrine tumors (NET) and neuroendocrine carcinomas (NEC) based on pathological typing. The detection efficiency were classified into 4 patterns based on the number of positive tumor lesions detected by the two tracers: ⁶⁸Ga-DOTATATE>¹⁸F-FDG (A); ⁶⁸Ga-DOTATATE=¹⁸F-FDG (B); ⁶⁸Ga-DOTATATE<¹⁸F-FDG (C); and complementation (D). The value of dual-modality imaging in staging and treatment decision were evaluated by visual analysis. Results In the 49 patients with GEP-NEN, ⁶⁸Ga-DOTATATE PET/CT was superior to ¹⁸F-FDG PET/CT for detecting systemic tumor lesions (P<0.001) and more sensitive for detecting primary/recurrent lesions, lymph node metastasis, liver metastasis, and bone metastasis (P<0.05), while ¹⁸F-FDG PET/CT had higher detection rates for lung metastasis and peritoneal metastasis (P<0.05). In terms of the detection efficiency, Pattern A was found in 46.9% (23/49) patients, Pattern B in 38.8% (19/49), Pattern C in 12.2% (6/49), and Pattern D in 2.0% (1/49). The complementary value of ¹⁸F-FDG PET/CT to ⁶⁸Ga-DOTATATE PET/CT was 0% in G1 NET patients (0/13), 8.3% in G2 NET patients (2/24), 50% in G3 NET patients (3/6), and 33.3% in NEC patients (2/6). 12.2% (6/49) of the patients had their staging confirmed or changed due to additional lesions detected by ¹⁸F-FDG PET/CT imaging, resulting subsequently in establishment or adjustment of their treatment plans. Conclusion ⁶⁸Ga-DOTATATE PET/CT imaging should be the primary choice for GEP-NEN patients. Additional ¹⁸F-FDG PET/CT imaging can potentially improve precision of staging and treatment decision-making for G2, G3 and NEC patients but provides virtually no clinical benefits for G1 NET patients.

Key words: neuroendocrine tumors, somatostatin receptor, octreotide, gallium radioisotope Ga68, fluorodeoxyglucose F18, positron emission tomography, tomography, X-ray computed

Xiaoxiang ZHANG, Ying TIAN, Lilan FU, Yin ZHANG, Ye DONG, Fei XIE, Li CHEN, Yanchao HUANG, Hubing WU, Jianer TAN. ⁶⁸Ga-DOTATATE and ¹⁸F-FDG PET/CT dual-modality imaging enhances precision of staging and treatment decision for gastroenteropancreatic neuroendocrine neoplasms[J]. Journal of Southern Medical University, 2025, 45(6): 1212-1219.

Figures/Tables 5

References 49

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Characteristics	Value	Ratio (%)
Gender (n)
Male	29	59.2
Female	20	40.8
Age [year, M(P₂₅,P₇₅)]	55 (45.5-60)	-
Diagnosis (n)
Newly diagnosed	34	69.4
Recurrence or metastasis after treatment	15	30.6
Primary tumor (n)
Gastric	6	12.2
Colorectal	18	36.7
Pancreatic	25	51.0
Histopathology (n)
G1 NET	13	26.5
G2 NET	24	49.0
G3 NET	6	12.2
NEC	6	12.2
Patient with metastasis (n)
Yes	30	61.2
No	19	38.8

Characteristics	Value	Ratio (%)
Gender (n)
Male	29	59.2
Female	20	40.8
Age [year, M(P₂₅,P₇₅)]	55 (45.5-60)	-
Diagnosis (n)
Newly diagnosed	34	69.4
Recurrence or metastasis after treatment	15	30.6
Primary tumor (n)
Gastric	6	12.2
Colorectal	18	36.7
Pancreatic	25	51.0
Histopathology (n)
G1 NET	13	26.5
G2 NET	24	49.0
G3 NET	6	12.2
NEC	6	12.2
Patient with metastasis (n)
Yes	30	61.2
No	19	38.8

Lesion	Number of patients (n)	Number of lesions (n)	¹⁸F-FDG positive lesion detection [n(%)]	⁶⁸Ga-DOTATATE positive lesion detection [n(%)]	P
Total	49	539	347 (64.4)	447 (82.9)	<0.001
Primary/recurrent	45	45	32 (71.1)	42 (93.3)	0.011
Lymph nodes	29	109	89 (81.7)	107 (98.2)	<0.001
Liver	1	277	193 (69.7)	220 (79.4)	0.011
Bone	9	65	11 (16.9)	62 (95.4)	<0.001
Lung	3	23	9 (39.1)	2 (8.7)	0.035
Peritoneum	2	6	6 (100)	1 (16.7)	0.015
Adrenal	2	3	3 (100)	3 (100)	>0.999
Brain	1	3	2 (66.7)	3 (100)	>0.999
Kidney	1	1	1 (100)	1 (100)	>0.999
Spleen	1	2	0 (0.0)	2 (100)	0.333
Pancreas	1	1	0 (0.0)	1 (100)	>0.999
Ovary	1	1	0 (0.0)	1 (100)	>0.999
Soft tissue	2	3	1 (33.3)	2 (66.7)	>0.999

Lesion	Number of patients (n)	Number of lesions (n)	¹⁸F-FDG positive lesion detection [n(%)]	⁶⁸Ga-DOTATATE positive lesion detection [n(%)]	P
Total	49	539	347 (64.4)	447 (82.9)	<0.001
Primary/recurrent	45	45	32 (71.1)	42 (93.3)	0.011
Lymph nodes	29	109	89 (81.7)	107 (98.2)	<0.001
Liver	1	277	193 (69.7)	220 (79.4)	0.011
Bone	9	65	11 (16.9)	62 (95.4)	<0.001
Lung	3	23	9 (39.1)	2 (8.7)	0.035
Peritoneum	2	6	6 (100)	1 (16.7)	0.015
Adrenal	2	3	3 (100)	3 (100)	>0.999
Brain	1	3	2 (66.7)	3 (100)	>0.999
Kidney	1	1	1 (100)	1 (100)	>0.999
Spleen	1	2	0 (0.0)	2 (100)	0.333
Pancreas	1	1	0 (0.0)	1 (100)	>0.999
Ovary	1	1	0 (0.0)	1 (100)	>0.999
Soft tissue	2	3	1 (33.3)	2 (66.7)	>0.999

Grades	Patterns A	Patterns B	Patterns C	Patterns D
Total	23 (46.9)	19 (38.8)	6 (12.2)	1 (2.0)
G1 NET	6 (12.2)	7 (14.3)	0 (0.0)	0 (0.0)
G2 NET	14 (28.6)	8 (16.3)	2 (4.1)	0 (0.0)
G3 NET	2 (4.1)	1 (2.0)	2 (4.1)	1 (2.0)
NEC	1 (2.0)	3 (6.1)	2 (4.1)	0 (0.0)

⁶⁸Ga-DOTATATE and ¹⁸F-FDG PET/CT dual-modality imaging enhances precision of staging and treatment decision for gastroenteropancreatic neuroendocrine neoplasms

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