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Can Fluorodihydroxyphenylalanine PET Replace Somatostatin Receptor Scintigraphy in Patients with Digestive Endocrine Tumors?

¹ Médecine Nucléaire, Hôpital Tenon AP-HP and Université Pierre et Marie Curie (Paris6), Paris, France; ² Gastro-entérologie, Hôpital Beaujon AP-HP, Clichy, France; ³ Gastro-entérologie, Hôpital Tenon AP-HP and Université Pierre et Marie Curie (Paris6), Paris, France; and ⁴ Oncologie, Hôpital Tenon AP-HP and Université Pierre et Marie Curie (Paris6), Paris, France

Correspondence: For correspondence or reprints contact: Françoise Montravers, MD, PhD, Médecine Nucléaire, Hôpital Tenon, 4 rue de la Chine, 75020 Paris, France. E-mail: francoise.montravers{at}tnn.aphp.fr

The aim of this study was to evaluate whether ¹⁸F-fluorodihydroxyphenylalanine (¹⁸F-FDOPA) PET is accurate for the diagnosis and follow-up of any type of well-differentiated digestive endocrine tumor and to assess its performance compared with standard somatostatin receptor scintigraphy (SRS) using ¹¹¹In-pentetreotide. Methods: We reviewed the results of 33 evaluable ¹⁸F-FDOPA PET and ¹¹¹In-pentetreotide SRS examinations performed between March 2002 and September 2005 in 30 patients referred for documented well-differentiated digestive endocrine tumor. Results: The sensitivity and accuracy of ¹⁸F-FDOPA PET were significantly better for carcinoid tumors (defined according to the World Health Organization 2000 classification) (n = 19) than for noncarcinoid tumors (n = 14)—that is, 93% versus 25% for sensitivity (P < 0.01) and 89% versus 36% for accuracy (P < 0.01), respectively. In contrast, the performances of ¹¹¹In-pentetreotide SRS did not differ according to the carcinoid or noncarcinoid type of the primary endocrine tumor—that is, 81% versus 75% for sensitivity and 79% versus 71% for accuracy, respectively. In carcinoid tumors, comparison between ¹⁸F-FDOPA PET and ¹¹¹In-pentetreotide SRS showed that ¹⁸F-FDOPA PET more accurately evaluated the extent of disease than ¹¹¹In-pentetreotide SRS. ¹¹¹In-Pentetreotide SRS did not reveal any additional lesions in any case. Conversely, in noncarcinoid tumors, the extent of the disease was more accurately evaluated in all cases by ¹¹¹In-pentetreotide SRS than by ¹⁸F-FDOPA PET. Conclusion: This preliminary study emphasizes the importance of a precise histologic characterization of well-differentiated digestive endocrine tumor to select the best radiopharmaceutical. ¹⁸F-FDOPA PET appears to be useful in carcinoid tumors and could become the first-line scintigraphic imaging modality for these tumors, but ¹¹¹In-pentetreotide SRS appeared to be a better first-line scintigraphic imaging modality for noncarcinoid digestive tumors.

Key Words: ¹⁸F-FDOPA PET • ¹¹¹In-pentetreotide somatostatin receptor scintigraphy • well-differentiated digestive endocrine tumor

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