Modern hybrid imaging of neuroendocrine tumors (clinical lecture)

Abstract

Background. Neuroendocrine tumors are a group of tumors arising from neuroendocrine cells that have biologically active properties. The onset of neuroendocrine tumors may be associated with the presence of multiple neuroendocrine neoplasia syndromes type 1. According to world statistics, the number of neuroendocrine tumors has increased fivefold in the last 30 years. This is likely to be due to improved detection, including advances in hybrid imaging techniques. Positron emission and single photon emission tomography, combined with computed tomography using somatostatin analogues (DOTA conjugate) labeled with 68Ga, 64Cu-SARTATE and scintigraphy with 99mTc-tectrotide are of most interest. The combination of anatomical and functional diagnostic methods allows to diagnose patients at an early stage of the disease and to influence the further prognosis and outcome of the disease. The urgency of the problem of neuroendocrine tumors is caused by the multidisciplinary nature of the pathology and the lack of screening programs. Purpose – to conduct the review of modern hybrid imaging techniques used for diagnosis, staging, and monitoring neuroendocrine tumors. Materials and methods. The analysis of full-text publications, which were selected by literature search in foreign databases (PubMed, Scopus, ScienceDirect-Elsevier) for the period 2003–2020, was performed. Results and discussion. During the analytical review of the literature the experience of application of modern methods of diagnostics of neuroendocrine tumors in Ukraine and abroad is analyzed. The choice of radiopharmaceutical drugs and tracers is considered. Positron emission computed tomography with DOTA conjugates has been shown to be the new «gold standard» in the imaging of neuroendocrine tumors with sensitivity and specificity well above 90 %. This method is able to detect early bone l esions not visible on CT or MRI and has a positive effect on stage determination and subsequent treatment. An assessment of the receptor status of neuroendocrine tumors for the selection of candidates for peptide-receptor radionuclide therapy is presented. Conclusions. Hybrid imaging plays a key role in diagnosis, determination of stages, choice of treatment and further monitoring of neuroendocrine effects. Innovative technologies based on somatostatin receptors also advance molecular diagnostics and therapy of neuroendocrine tumors, which improve the quality of life of lots of patients. Awareness of this disease can reduce the delay in diagnosis and facilitate expert multidisciplinary care.