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Factors Predicting Tracer Uptake in Somatostatin Receptor and MIBG Scintigraphy of Metastatic Gastroenteropancreatic Neuroendocrine Tumors

¹ Department of Nuclear Medicine, University of Bonn, Bonn, Germany; ² Department of Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada; and ³ Department of Pathology, University of Bonn, Bonn, Germany

Correspondence: For correspondence or reprints contact: Samer Ezziddin, MD, Department of Nuclear Medicine, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53115 Bonn, Germany E-mail: samer.ezziddin{at}ukb.uni-bonn.de

Radiolabeled octreotide analogs (Oct) and metaiodobenzylguanidine (MIBG) offer 2 different approaches for imaging and targeting metastatic gastroenteropancreatic neuroendocrine tumors (GEP-NET). Despite successful establishment of the revised World Health Organization (WHO) classification, which distinguishes between low- and high-grade malignant GEP-NET, there is a lack of scintigraphic studies comparing uptake behavior on the basis of this categorization. This study aims to define predisposing factors of tracer uptake for both imaging principles implementing the updated tumor criteria of the current WHO classification. Methods: Fifty-seven consecutive patients with histologically confirmed metastatic GEP-NET evaluated with both ¹¹¹In-pentetreotide and ¹²³I/¹³¹I-MIBG scintigraphy were included in this study. Intensity of tracer uptake was graded according to the different metastatic regions. Patients were classified as overall positive when avid uptake in the clinically relevant tumor lesions was present. Correlation was tested between the proportion of positive patients and tumor origin, function, and malignancy. Results: Overall, 52 patients (91.2%) were Oct positive and 28 patients (49.1%) were MIBG positive. The proportion of tracer-positive patients was significantly higher (P < 0.05) in low-grade malignant tumors for both tracers and in functioning as well as in gastroenteral NET for MIBG. Five patients were negative for both tracers. None of the Oct-negative patients proved to be MIBG positive. Conclusion: Oct affinity is observed with high frequency throughout the subgroups of metastatic GEP-NET, whereas corresponding MIBG uptake is overall less prevalent and more group dependent. Tumor differentiation significantly impacts both Oct and MIBG uptake, whereas functionality predisposes only for MIBG accumulation. Though clearly inferior to Oct-based radioimaging in most GEP-NET, MIBG achieves a remarkable rate of radioligand accumulation in functioning midgut enterochromaffin cell metastases (>80% of patients positive). These results may have implications for patient management and potentially for selection and performance of targeted therapy.

Key Words: somatostatin receptor scintigraphy • ¹²³I-MIBG • ¹³¹I-MIBG • ¹¹¹In-pentetreotide • gastroenteropancreatic neuroendocrine tumors

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