⁶⁸Ga-DOTATATE Compared with ¹¹¹In-DTPA-Octreotide and Conventional Imaging for Pulmonary and Gastroenteropancreatic Neuroendocrine Tumors: A Systematic Review and Meta-Analysis

Abstract

Neuroendocrine tumors (NETs) are uncommon tumors with increasing incidence and prevalence. Current reports suggest that ⁶⁸Ga-DOTATATE PET/CT imaging improves diagnosis and staging of NETs compared with ¹¹¹In-DTPA-octreotide and conventional imaging. We performed a systematic review of ⁶⁸Ga-DOTATATE for safety and efficacy compared with octreotide and conventional imaging to determine whether available evidence supports U.S. Food and Drug Administration approval. Methods: Medline, EMBASE, Web of Science, and Cochrane Reviews electronic databases were searched from January 1999 to September 2015. Results were restricted to human studies comparing diagnostic accuracy of ⁶⁸Ga-DOTATATE with octreotide or conventional imaging for pulmonary or gastroenteropancreatic NET and for human studies reporting safety/toxicity for ⁶⁸Ga-DOTATATE with 10 subjects or more thought to have NETs. Direct communication with corresponding authors was attempted to obtain missing information. Abstracts meeting eligibility criteria were collected by a research librarian and assembled for reviewers; 2 reviewers independently determined whether or not to include each abstract. If either reviewer chose inclusion, the abstract was accepted for review. Results: Database and bibliography searches yielded 2,479 articles, of which 42 were eligible. Three studies compared the 2 radiopharmaceuticals in the same patient, finding ⁶⁸Ga-DOTATATE to be more sensitive than octreotide. Nine studies compared ⁶⁸Ga-DOTATATE with conventional imaging. ⁶⁸Ga-DOTATATE estimated sensitivity, 90.9% (95% confidence interval, 81.4%–96.4%), and specificity, 90.6% (95% confidence interval, 77.8%–96.1%), were high. Five studies were retained for safety reporting only. Report of harm possibly related to ⁶⁸Ga-DOTATATE was rare (6 of 974), and no study reported major toxicity or safety issues. Conclusion: No direct comparison of octreotide and ⁶⁸Ga-DOTATATE imaging for diagnosis and staging in an unbiased population of NETs has been published. Available information in the peer-reviewed literature regarding diagnostic efficacy and safety supports the use of ⁶⁸Ga-DOTATATE for imaging of NETs where it is available.