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Superiority of [68Ga]-DOTATATE PET/CT to Other Functional Imaging Modalities in the Localization of SDHB-Associated Metastatic Pheochromocytoma and Paraganglioma.

ABSTRACT: PURPOSE:Patients with succinate dehydrogenase subunit B(SDHB) mutation-related pheochromocytoma/paraganglioma (PHEO/PGL) are at a higher risk for metastatic disease than other hereditary PHEOs/PGLs. Current therapeutic approaches are limited, but the best outcomes are based on the early and proper detection of as many lesions as possible. Because PHEOs/PGLs overexpress somatostatin receptor 2 (SSTR2), the goal of our study was to assess the clinical utility of [(68)Ga]-DOTA(0)-Tyr(3)-octreotate ([(68)Ga]-DOTATATE) positron emission tomography/computed tomography (PET/CT) and to evaluate its diagnostic utility in comparison with the currently recommended functional imaging modalities [(18)F]-fluorodopamine ([(18)F]-FDA), [(18)F]-fluorodihydroxyphenylalanine ([(18)F]-FDOPA), [(18)F]-fluoro-2-deoxy-d-glucose ([(18)F]- FDG) PET/CT as well as CT/MRI. EXPERIMENTAL DESIGN:[(68)Ga]-DOTATATE PET/CT was prospectively performed in 17 patients with SDHB-related metastatic PHEOs/PGLs. All patients also underwent [(18)F]-FDG PET/CT and CT/MRI, with 16 of the 17 patients also receiving [(18)F]-FDOPA and [(18)F]-FDA PET/CT scans. Detection rates of metastatic lesions were compared between all these functional imaging studies. A composite synthesis of all used functional and anatomical imaging studies served as the imaging comparator. RESULTS:[(68)Ga]-DOTATATE PET/CT demonstrated a lesion-based detection rate of 98.6% [95% confidence interval (CI), 96.5%-99.5%], [(18)F]-FDG, [(18)F]-FDOPA, [(18)F]-FDA PET/CT, and CT/MRI showed detection rates of 85.8% (CI, 81.3%-89.4%; P < 0.01), 61.4% (CI, 55.6%-66.9%; P < 0.01), 51.9% (CI, 46.1%-57.7%; P < 0.01), and 84.8% (CI, 80.0%-88.5%; P < 0.01), respectively. CONCLUSIONS:[(68)Ga]-DOTATATE PET/CT showed a significantly superior detection rate to all other functional and anatomical imaging modalities and may represent the preferred future imaging modality in the evaluation of SDHB-related metastatic PHEO/PGL.

SUBMITTER: Janssen I

PROVIDER: S-EPMC4558308 | biostudies-literature | 2015 Sep

REPOSITORIES: biostudies-literature

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Superiority of [68Ga]-DOTATATE PET/CT to Other Functional Imaging Modalities in the Localization of SDHB-Associated Metastatic Pheochromocytoma and Paraganglioma.

Janssen Ingo I Blanchet Elise M EM Adams Karen K Chen Clara C CC Millo Corina M CM Herscovitch Peter P Taieb David D Kebebew Electron E Lehnert Hendrik H Fojo Antonio T AT Pacak Karel K

Clinical cancer research : an official journal of the American Association for Cancer Research 20150414 17

<h4>Purpose</h4>Patients with succinate dehydrogenase subunit B(SDHB) mutation-related pheochromocytoma/paraganglioma (PHEO/PGL) are at a higher risk for metastatic disease than other hereditary PHEOs/PGLs. Current therapeutic approaches are limited, but the best outcomes are based on the early and proper detection of as many lesions as possible. Because PHEOs/PGLs overexpress somatostatin receptor 2 (SSTR2), the goal of our study was to assess the clinical utility of [(68)Ga]-DOTA(0)-Tyr(3)-oct ...[more]

PMID: 25873086

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Project description:Purpose18F-FDG PET/CT is widely used to evaluate indeterminate pulmonary nodules (IPNs). False positive results occur, especially from active granulomatous nodules. A PET-based imaging agent with superior specificity to 18F-FDG for IPNs, is badly needed, especially in areas of endemic granulomatous nodules. Somatostatin receptors (SSTR) are expressed in many malignant cells including small cell and non-small cell lung cancers (NSCLCs). 68Ga-DOTATATE, a positron emitter labeled somatostatin analog, combined with PET/CT imaging, may improve the diagnosis of IPNs over 18F-FDG by reducing false positives. Our study purpose was to test this hypothesis in our region with high endemic granulomatous IPNs.MethodsWe prospectively performed 68Ga-DOTATATE PET/CT and 18F-FDG PET/CT scans in the same 30 patients with newly diagnosed, treatment-naïve lung cancer (N = 14) or IPNs (N = 15) and one metastatic nodule. 68Ga-DOTATATE SUVmax levels at or above 1.5 were considered likely malignant. We analyzed the scan results, correlating with ultimate diagnosis via biopsy or 2-year chest CT follow-up. We also correlated 68Ga-DOTATATE uptake with immunohistochemical (IHC) staining for SSTR subtype 2A (SSTR2A) in pathological specimens.ResultsWe analyzed 31 lesions in 30 individuals, with 14 (45%) being non-neuroendocrine lung cancers and 1 (3%) being metastatic disease. McNemar's result comparing the two radiopharmaceuticals (p = 0.65) indicates that their accuracy of diagnosis in this indication are equivalent. 68Ga-DOTATATE was more specific (94% compared to 81%) and less sensitive 73% compared to 93%) than 18F-FDG. 68Ga-DOTATATE uptake correlated with SSTR2A expression in tumor stroma determined by immunohistochemical (IHC) staining in 5 of 9 (55%) NSCLCs.Conclusion68Ga-DOTATATE and 18F-FDG PET/CT had equivalent accuracy in the diagnosis of non-neuroendocrine lung cancer and 68Ga-DOTATATE was more specific than 18F-FDG for the diagnosis of IPNs. IHC staining for SSTR2A receptor expression correlated with tumor stroma but not tumor cells.

Project description:UnlabelledOur purpose was to evaluate the safety and efficacy of (68)Ga-DOTATATE PET/CT compared with (111)In-pentetreotide imaging for diagnosis, staging, and restaging of pulmonary and gastroenteropancreatic neuroendocrine tumors.Methods(68)Ga-DOTATATE PET/CT and (111)In-pentetreotide scans were obtained for 78 of 97 consecutively enrolled patients with known or suspected pulmonary or gastroenteropancreatic neuroendocrine tumors. Safety and toxicity were measured by comparing vital signs, serum chemistry values, or acquisition-related medical complications before and after (68)Ga-DOTATATE injection. Added value was determined by changes in treatment plan when (68)Ga-DOTATATE PET/CT results were added to all prior imaging, including (111)In-pentetreotide. Interobserver reproducibility of (68)Ga-DOTATATE PET/CT scan interpretation was measured between blinded and nonblinded interpreters.Results(68)Ga-DOTATATE PET/CT and (111)In-pentetreotide scans were significantly different in impact on treatment (P < 0.001). (68)Ga-DOTATATE PET/CT combined with CT or liver MRI changed care in 28 of 78 (36%) patients. Interobserver agreement between blinded and nonblinded interpreters was high. No participant had a trial-related event requiring treatment. Mild, transient events were tachycardia in 1, alanine transaminase elevation in 1, and hyperglycemia in 2 participants. No clinically significant arrhythmias occurred. (68)Ga-DOTATATE PET/CT correctly identified 3 patients for peptide-receptor radiotherapy incorrectly classified by (111)In-pentetreotide.Conclusion(68)Ga-DOTATATE PET/CT was equivalent or superior to (111)In-pentetreotide imaging in all 78 patients. No adverse events requiring treatment were observed. (68)Ga-DOTATATE PET/CT changed treatment in 36% of participants. Given the lack of significant toxicity, lower radiation exposure, and improved accuracy compared with (111)In-pentetreotide, (68)Ga-DOTATATE imaging should be used instead of (111)In-pentetreotide imaging where available.

Project description:Abstract Background: SDHB immunostaining can be used to functionally characterize SDH status in PCC and PGL. Assessing SDHB expression on tumors is inexpensive and can be used as an alternative to genetic testing. More importantly, assessment of SDHB expression can be of value in interpreting Variant of Unknown Significance (VUS) in SDH related genes. Objective: To investigate the effectiveness of SDHB immunostaining as an initial screening tool in identifying germline SDH mutations and the value of SDHB assessment in the clinical characterization of our patient cohort. Design: Prospective and retrospective analysis of 57 randomly selected patients with PCC and PGL from the year 1997 to 2018. Setting: In our institution on patients referred from London and South East England including Kent, Surrey and Sussex. Patients: Predominant Caucasian Population with diverse ethnicities. 57 patients - 34 patients (14M & 20F) with PGL and 25 with PCC (15M &10F). Age (mean: 41years at diagnosis with range 9-80 years). 2 patients had both PCC & PGL and multifocal PGLs were identified in few patients with SDHD and SDHB mutation. There were 65 tumors in total included in this study. Intervention: Resected tumor SDHB immunostaining with Sigma prestige antibodies (HPA002868 100UL - Anti-SDHB Rabbit monoclonal antibody) at a dilution of 1:1000. Genetic testing performed on predominant candidate genes. Main outcome measures: Concordance of SDHB loss of expression with presence of pathogenic mutation in candidate SDH genes. Secondarily, to explore SDHB immunostaining in our patient cohort with VUS in candidate genes. Results: SDHB immunostaining was negative in 22/23 tumors in patients with confirmed SDH mutation (false negative = 1 SDHB PCC where it was weak (+)). The staining was positive in 23/24 sporadic tumors, 10/11 VUS (in SDH, MAX and TMEM genes - both PCCs & PGLs), 2/2 PCCs in MEN-2, 2/2 PCCs in NF-1 and 2/3 PCCs in VHL. The negative immunostaining in 1 PGL with VUS in SDHB may imply lack of SDH enzyme activity and hence suggestive of a pathological mutation. The sensitivity is 96% and the specificity approaches 93% if the weak positive SDHB immunostaining with SDHD and VHL tumors were to be considered concordant. The concordance was 95% in the PGL group alone. Conclusions: SDHB immunostaining is a cost effective addition to PGL and PCC tumor characterization and performs with high sensitivity and specificity. SDH functional characterization has an important role in the management of patients who do not satisfy the current criteria for genetic testing (UK genetics testing directory for PCC/PGL). 18% of patients had VUS in a SDH related gene and we have found that SDHB immunostaining provided helpful information to inform follow-up and cascade screening decisions in this group.

Dataset Information

Superiority of [68Ga]-DOTATATE PET/CT to Other Functional Imaging Modalities in the Localization of SDHB-Associated Metastatic Pheochromocytoma and Paraganglioma.

Publications

Superiority of [68Ga]-DOTATATE PET/CT to Other Functional Imaging Modalities in the Localization of SDHB-Associated Metastatic Pheochromocytoma and Paraganglioma.

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