Somatostatin Receptor PET/CT Imaging for the Detection and Staging of Pancreatic NET: A Systematic Review and Meta-Analysis.

Matteo Bauckneht,Priscilla Guglielmo,Riccardo Laudicella,Domenico Albano,Alessia Branca,Viviana Frantellizzi,Salvatore Annunziata,Cristina Ferrari,Laura Evangelista,Giulia Santo,Anna Giulia Nappi,Alessia Mirabile,Antonio Vento,Pierpaolo Alongi

doi:10.3390/diagnostics10080598

Abstract

We investigated the diagnostic performance of Somatostatin Receptor Positron Emission Tomography/Computed Tomography (SSR-PET/CT) for the detection of primary lesion and initial staging of pancreatic neuroendocrine tumors (pNETs). A comprehensive literature search up to January 2020 was performed selecting studies in presence of: sample size ≥10 patients; index test (i.e., 68Ga-DOTATOC or 68Ga-DOTANOC or 68Ga-DOTATATE PET/CT); and outcomes (i.e., detection rate (DR), true positive, true negative, false positive, and false-negative). The methodological quality was evaluated with QUADAS-2. Pooled DR and pooled sensitivity and specificity for the identification of the primary tumor were assessed by a patient-based and a lesion-based analysis. Thirty-eight studies were selected for the qualitative analysis, while 18 papers were included in the meta-analysis. The number of pNET patients ranged from 10 to 142, for a total of 1143 subjects. At patient-based analysis, the pooled sensitivity and specificity for the assessment of primary pNET were 79.6% (95% confidence interval (95%CI): 71–87%) and 95% (95%CI: 75–100%) with a heterogeneity of 59.6% and 51.5%, respectively. Pooled DR for the primary lesion was 81% (95%CI: 65–90%) and 92% (95%CI: 80–97%), respectively, at patient-based and lesion-based analysis. In conclusion, SSR-PET/CT has high DR and diagnostic performances for primary lesion and initial staging of pNETs.

Highlights

The incidence of pancreatic neuroendocrine tumors is less or equal to one case per one hundred thousand people per-year, and they account for roughly 5% of all pancreatic cancers.in the last few decades, their incidence has risen [1,2].Many biological features make these tumors clinically heterogeneous, including mutational status [3,4], hormone production, and histopathological grade
In the present systematic review and meta-analysis, we investigate the diagnostic performance of SSR-positron emission tomography and computed tomography (PET/CT) for the detection of the primary lesion and initial staging of pancreatic neuroendocrine tumors (pNETs)
To the best of our knowledge, this is the first systematic review and meta-analysis addressing the identification of the primary lesion and initial staging by using SSR-PET/CT in patients with pNETs

Summary

Introduction

The incidence of pancreatic neuroendocrine tumors (pNETs) is less or equal to one case per one hundred thousand people per-year, and they account for roughly 5% of all pancreatic cancers.in the last few decades, their incidence has risen [1,2].Many biological features make these tumors clinically heterogeneous, including mutational status [3,4], hormone production, and histopathological grade. The incidence of pancreatic neuroendocrine tumors (pNETs) is less or equal to one case per one hundred thousand people per-year, and they account for roughly 5% of all pancreatic cancers. In well-differentiated pNETs (G1, G2, and well-differentiated G3) the slow cancer growth is related to good long-term survival even in the presence of liver metastases [5], while poorly differentiated G3 neuroendocrine carcinomas (NECs) show higher proliferation rates and lower overall survival [6]. Tumor grade is strictly related to the expression of somatostatin receptors (SSR1-5) on the neoplastic cellular surface [6,7]. In low-grade pNETs, the high SSR expression allows the therapeutic use of somatostatin analogs and makes these neoplasms ideal for targeted radionuclide imaging [8]. The down-regulation of SSR makes high-grade NEC less suitable for these approaches

Methods

Results

Conclusion