1. Radioguided Surgery With Gallium 68 Dotatate for Patients With Neuroendocrine Tumors
- Author
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Naris Nilubol, Karel Pacak, Douglas Wiseman, Electron Kebebew, Mustapha El Lakis, Samira M. Sadowski, Amit Tirosh, Martha Quezado, Pavel Nockel, Dhaval Patel, and Andreas Gianakou
- Subjects
Male ,Gallium Ga 68-DOTATATE ,Pheochromocytoma ,030230 surgery ,Neuroendocrine tumors ,Preoperative care ,Lesion ,Paraganglioma ,03 medical and health sciences ,0302 clinical medicine ,Positron Emission Tomography Computed Tomography ,medicine ,Organometallic Compounds ,Humans ,Prospective Studies ,Prospective cohort study ,Original Investigation ,Gastrointestinal Neoplasms ,business.industry ,Middle Aged ,medicine.disease ,Pancreatic Neoplasms ,Neuroendocrine Tumors ,medicine.anatomical_structure ,Treatment Outcome ,Editorial ,Surgery, Computer-Assisted ,030220 oncology & carcinogenesis ,Positron-Emission Tomography ,Abdomen ,Surgery ,Female ,medicine.symptom ,Radiopharmaceuticals ,Nuclear medicine ,business - Abstract
IMPORTANCE: Neuroendocrine tumors (NETs) express somatostatin receptors, which can be targeted with radiolabeled peptides. In a variety of solid tumors, radioguided surgery (RGS) has been used to guide surgical resection. Gallium 68 ((68)Ga) dota peptides have been shown to be more accurate than other radioisotopes for detecting NETs. A pilot study previously demonstrated the feasibility and safety of (68)Ga-dotatate RGS for patients with NETs. OBJECTIVE: To evaluate what intraoperative techniques and thresholds define positive lesions that warrant resection during (68)Ga-dotatate RGS. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study, conducted between October 23, 2013, and February 14, 2018, included 44 patients with NETs who underwent (68)Ga-dotatate RGS. INTERVENTION: Gallium 68–dotatate RGS. MAIN OUTCOMES AND MEASURES: The in vivo and ex vivo tumor to background ratio (TBR) was assessed for resected lesions and correlated with the histopathologic findings. RESULTS: Forty-four patients (22 women and 22 men; mean [SD] age, 51.0 [13.7] years) had 133 lesions detected on preoperative imaging scans, with a diagnosis of a pancreatic NET (19 of 44 [43%]), gastrointestinal NET (22 of 44 [50%]), and pheochromocytoma or paraganglioma (3 of 44 [7%]). The TBR was obtained by normalizing to the omentum (106 of 133 [79.7%]) or other solid organs (27 of 133 [20.3%]). The omentum had a significantly lower mean (SD) count than other solid organs for background count activity 3 hours after injection (22.1 [17.0] vs 34.5 [39.0]; P
- Published
- 2018