Medical Radiology and Radiation Safety. 2018. Vol. 63. No. 3. P. 44-51

NUCLEAR MEDICINE

DOI: 10.12737/article_5b179a86bf0387.39000853

Evaluating the Effectiveness of Somatostatin Receptors Scintigraphy with ¹¹¹In-Octreotide in the Diagnosis of Neuroendocrine Tumors

A.A. Markovich, S.V. Shiryaev, M.O. Goncharov, A.S. Krylov, D.A. Komanovskaya, A.D. Ryzhkov

N.N. Blokhin National Medical Research Center of Oncology. Moscow, Russia, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

A.A. Markovich – PhD Med, Senior Researcher; S.V. Shiryaev – Dr. Sc. Med., Head of Lab., President of the OSMI, Member of the EANMMI, Member of the ACNMMI, Member of the SNMMI; M.O. Goncharov – Radiologist; A.S. Krylov – PhD Med., Radiologist, Member of the EANMMI; D.A. Komanovskaya – Radiologist; A.D. Ryzhkov – Dr. Sc. Med., Leading Researcher

Abstract

Purpose: Exploring methods to improve diagnosis of neuroendocrine tumors (NET) in different locations using somatostatin receptors scintigraphy with ¹¹¹In-octreotide.

Material and methods: The study included 125 patients with NET in different locations. Activity of injected ¹¹¹In-octreotide was 200–250 MBq (effective dose – 0.054 mSv/MBq), which allows to carry out a planar study as and single photon emission computed tomography. The study was performed after 24 hours on intravenous injection of indicator on the combined SPECT/CT machine Symbia T2 (Siemens, Germany).

Results: In the sample of patients, NET distribution by localization is indicated in Fig. 1. The results of the study with ¹¹¹In-octreotide are presented in the form of scintigrams in the whole body scanning mode and in the form of single-photon emission computer tomograms combined with CT. To determine the effectiveness of scintigraphy with ¹¹¹In-octreotide, after a visual evaluation of the scintigrams obtained, the number of positive and negative results of the study was calculated. A comparison was made with the data of other methods and the number of TP, TN, FP, and FN results was determined. Further, the characteristic parameters of the method studied were calculated to determine its effectiveness. The study of values of characteristic parameters showed that the sensitivity was 73 % (95 % CI: 63–83 %), specificity – 97 % (95 % CI: 88–100 %) accuracy is 79 % (95 % CI: 71–87 %). The value of the positive predictive value of 99 % (95 % CI: 94–100 %), the predictive value of negative results – 55 % (95 % CI: 40–70 %).

While the study shows a high frequency of TP results, while the frequencies of the TN and FN results are not significantly different (the average frequency of the FN results falls within the confidence interval for the frequency of the TN results). The method has a high value of the prognostic value of the positive result, which gives the right to assert about the high probability of the presence of a neuroendocrine neoplasm in obtaining a positive result. In the present study, no FP results were obtained due to the presence of concomitant diseases, in which accumulation of used radiopharmaceutical is possible, since the data on the presence of such diseases were taken into account in the analysis of scintigrams. The data obtained in this paper are in good agreement with the data obtained by other authors, as well as early Russian publications. It is worth noting that the data of domestic authors were obtained on a small sample, without specifying confidence intervals; the injected activity was less than in this study. In addition, the possibility of obtaining more information than using classical imaging methods (for SPECT/CT, the tissue with the pathological accumulation of ¹¹¹In-octreotide appeared to be intact on CT), allows us to recommend the method as a method of choice in the diagnosis of NET of different localization.

Conclusions: The method of somatostatin receptors scintigraphy using domestic analogue of somatostatin in the diagnosis of NET has a high efficiency (efficiency of the method, calculated as the average value of the parameters of sensitivity and specificity of 85 % (95 % CI: 66–100 %).

Keу words: ¹¹¹In-octreotide, neuroendocrine tumors, somatostatin receptor scintigraphy

REFERENCES

1. Finnerty BM, Gray KD, Moore MD, et al. Epigenetics of gastroenteropancreatic neuroendocrine tumors: A clinicopathologic perspective. World J Gastrointest Oncol. 2017;9(9):341-53. DOI: 10.4251/wjgo.v9.i9.341.
2. Oronsky B, Ma PC, Morgensztern D, Carter CA. Nothing But NET: A Review of Neuroendocrine Tumors and Carcinomas. Neoplasia. 2017;19(12):991-1002. DOI: 10.1016/j.neo.2017.09.002.
3. Gorbunova VA, Orel NF, Egorov GN, Kuzminov AE. Highly differentiated neuroendocrine tumors (carcinoids) and neuroendocrine tumors of the pancreas. A modern view of the problem. Moscow, Litterra; 2007. 104 p. Russian.
4. Hemminki K, Li X. Incidence trends and risk factors of carcinoid tumors: a nationwide epidemiologic study from Sweden. Cancer. 2001;92(8):2204-10.
5. Egorov AV, Kondrashin SA, Fominikh EV, et al. Analogs of Somatostatin in Diagnostics and Managements of Neuroendocrine Tumors. Annals of HPB surgery. 2009;14(4):71-8. Russian.
6. Oberg K. Neuroendocrine Gastroenteropancreatic Tumours – current views on diagnosis and treatment. Eur Oncol Rev.; 2005. P. 1-6. Available from: https://www.iart.academy/images/letteratura/O/oberg.pdf.
7. Simonenko VB. Neuroendocrine tumors. Moscow: Medicine; 2003. 216 p. Russian.
8. Trakhtenberg AH, Frank GA, Pikin OV, et al. Neuroendocrine tumors of the lungs. Experience of diagnosis and treatment. Herald of the Moscow Cancer Society. 2010;11(572):3-5. Russian.
9. Ni SJ, Sheng WQ, Du X. Pathologic research update of colorectal neuroendocrine tumors. World J Gastroenterol. 2010;16(14):1713-9.
10. Yu R, Wachsman A. Imaging of Neuroendocrine Tumors: Indications, Interpretations, Limits, and Pitfalls. Endocrinol Metab Clin North Am. 2017;46(3):795-814. DOI: 10.1016/j.ecl.2017.04.008.
11. Shiryaev SV. The possibilities of nuclear medicine in the diagnosis and therapy of neuroendocrine tumors. Effective pharmacotherapy. Oncology, Hematology and Radiology. 2010;(3):50-2. Russian.
12. Solodotsky VA, Ivanova VV, Panshin GA, Stavitsky RV. Possibilities of using the radiopharmaceutical Octreotide ¹¹¹In in oncological practice. Radiology-Practice. 2010;(4):42-8. Russian.
13. Shiryaev SV, Odzharova AA, Orel NF, et al. Scintigraphy with ¹¹¹In-octreotide in Diagnosis of Carcinoid Tumors of Different Location and Highly-differentiated Neuroendocrine Pancreatic Cancer. Medical Radiology and Radiation Safety. 2008;53(1):53-62. Russian.
14. Rebrova OYu. Statistical analysis of medical data. Application of the STATISTICA software package. Moscow; 2002.312 p. Russian.
15. Bombardieri E, Coliva A, Maccauro M, et al. Imaging of neuroendocrine tumours with gamma-emitting radiopharmaceuticals. Quart J Nucl Med Mol Imaging. 2010;54(1):3-15.
16. Kaltsas G, Korbonits M, Heintz E, et al. Comparison of somatostatin analog and meta-iodobenzylguanidine radionuclides in the diagnosis and localization of advanced neuroendocrine tumors. J Clin Endocrinol Metab. 2001;86(2):895-902. DOI: 10.1210/jcem.86.2.7194.
17. Koopmans KP, Jager PL, Kema IP, et al. ¹¹¹In-octreotide is superior to ¹²³I-metaiodobenzylguanidine for scintigraphic detection of head and neck paragangliomas. J Nucl Med. 2008;49(8):1232-7. DOI: 10.2967/jnumed.107.047738.
18. Gnanasegaran G, O’Doherty MJ. Imaging neuroendocrine tumours with radionuclide techniques. Minerva Endocrinol. 2008;33(2):105-26.
19. Lee ST, Kulkarni HR, Singh A, Baum RP. Theranostics of neuroendocrine tumors. Visc Med. 2017;33(5):358-66. DOI: 10.1159/000480383.
20. Gay E, Vuillez JP, Palombi O, et al. Intraoperative and postoperative gamma detection of somatostatin receptors in bone-invasive en plaque meningiomas. Neurosurgery. 2005;57 Suppl 1:107-13.

For citation: Markovich AA, Shiryaev SV, Goncharov MO, Krylov AS, Komanovskaya DA, Ryzhkov AD. Evaluating the Effectiveness of Somatostatin Receptors Scintigraphy with ¹¹¹In-Octreotide in the Diagnosis of Neuroendocrine Tumors. Medical Radiology and Radiation Safety. 2018;63(3):44-51. Russian. DOI: 10.12737/article_5b179a86bf0387.39000853

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