Neuroendocrine Tumor Recurrence: Diagnosis with ⁶⁸Ga-DOTATATE PET/CT

Published Online:Feb 1 2014https://doi.org/10.1148/radiol.13122501

Abstract

In the follow-up of patients after curative resection of a neuroendocrine tumor, ⁶⁸Ga-DOTATATE PET/CT is accurate, thus substantiating its use in clinical routine diagnostic imaging.

Purpose

To evaluate diagnostic performance of gallium 68–tetraazacyclododecane tetraacetic acid–octreotate (⁶⁸Ga-DOTATATE) in detection of recurrent neuroendocrine tumors (NETs).

Materials and Methods

Approval was waived by the local ethics committee for this retrospective study. Between 2007 and 2011, 63 patients (mean age, 58 years) were examined with ⁶⁸Ga-DOTATATE positron emission tomography (PET)/computed tomography (CT) after primary NET curative resection. Reasons for PET/CT were regular follow-up examinations (n = 30), increased plasma levels of tumor markers (n = 27), or clinical suspicion of recurrence (n = 6). Final diagnosis was determined with histopathologic verification (n = 25) or clinical follow-up (n = 38). PET/CT scans were evaluated in consensus by two readers without blinding to clinical information and independently by two readers with blinding. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.

Results

Final diagnosis of NET recurrence was determined in 29 patients. In three other patients, tumors of nonneuroendocrine origin were diagnosed. ⁶⁸Ga-DOTATATE PET/CT helped identify NET recurrence in 26 of 29 patients (sensitivity, 90%) and exclude presence of recurrent NET in 28 of 34 patients (specificity, 82% ). PET/CT provided false-positive and false-negative results in six and three patients (PPV, 81% [26 of 32]; NPV, 90% [28 of 31]; accuracy, 86% [54 of 63]). In gastroenteropancreatic NET (n = 45), sensitivity was 94% (17 of 18); specificity was 89% (24 of 27); PPV was 85% (17 of 20); NPV was 96% (24 of 25); and accuracy was 91% (41 of 45). Two blinded readers achieved sensitivity of 79% (23 of 29) and 76% (22 of 29); specificity of 85% (29 of 34) and 94% (32 of 34) (κ = 0.80); and accuracy of 83% and 86%.

Conclusion

⁶⁸Ga-DOTATATE PET/CT is accurate in detection of recurrent NET. Blinded PET/CT review markedly decreased sensitivity, underlining importance of considering clinical parameters in NET recurrence. Present results must be further validated to substantiate use of ⁶⁸Ga-DOTATATE PET/CT in routine follow-up after curative resection of NET.

Online supplemental material is available for this article.

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Article History

Received November 9, 2012; revision requested December 28; final revision received March 6, 2013; accepted April 1; final version accepted July 19.
Published online: Feb 2014
Published in print: Feb 2014

Vol. 270, No. 2

Supplemental Material

Abbreviations

Abbreviations:
NET	neuroendocrine tumor
NPV	negative predictive value
PPV	positive predictive value

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Neuroendocrine Tumor Recurrence: Diagnosis with 68Ga-DOTATATE PET/CT