Use and perceived utility of [18F]FDG PET/CT in neuroendocrine neoplasms: A consensus report from the European Neuroendocrine Tumor Society (ENETS) Advisory Board Meeting 2022

IF 4.3 3区 材料科学 Q1 ENGINEERING, ELECTRICAL & ELECTRONIC ACS Applied Electronic Materials Pub Date : 2023-12-14 DOI:10.1111/jne.13359
Valentina Ambrosini, Martyn Caplin, Justo P. Castaño, Emanuel Christ, Timm Denecke, Christophe M. Deroose, Clarisse Dromain, Massimo Falconi, Simona Grozinsky-Glasberg, Rodney J. Hicks, Johannes Hofland, Andreas Kjaer, Ulrich Peter Knigge, Beata Kos-Kudla, Anna Koumarianou, Balkundi Krishna, Angela Lamarca, Marianne Pavel, Nicholas Simon Reed, Aldo Scarpa, Rajaventhan Srirajaskanthan, Anders Sundin, Christos Toumpanakis, Vikas Prasad
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Abstract

Somatostatin receptor (SST) PET/CT is the gold standard for well-differentiated neuroendocrine tumours (NET) imaging. Higher grades of neuroendocrine neoplasms (NEN) show preferential [18F]FDG (FDG) uptake, and even low-grade NET may de-differentiate over time. FDG PET/CT's prognostic role is widely accepted; however, its impact on clinical decision-making remains controversial and its use varies widely. A questionnaire-based survey on FDG PET/CT use and perceived decision-making utility in NEN was submitted to the ENETS Advisory Board Meeting attendees (November 2022, response rate = 70%). In 3/15 statements, agreement was higher than 75%: (i) FDG was considered useful in NET, irrespective of grade, in case of mis-matched lesions (detectable on diagnostic CT but negative/faintly positive on SST PET/CT), especially if PRRT is contemplated (80%); (ii) in NET G3 if curative surgery is considered (82%); and (iii) in NEC prior to surgery with curative intent (98%). FDG use in NET G3, even in the presence of matched lesions, as a baseline for response assessment was favoured by 74%. Four statements obtained more than 60% consensus: (i) FDG use in NET G3 if locoregional therapy is considered (65%); (ii) in neuroendocrine carcinoma before initiating active therapy as a baseline for response assessment (61%); (iii) biopsy to re-assess tumour grade prior to a change in therapeutic management (68%) upon detection of FDG-positivity on the background of a prior G1-2 NET; (iv) 67% were in favour to reconsider PRRT to treat residual SST-positive lesions after achieving complete remission on FDG of the SST-negative disease component. Multidisciplinary opinion broadly supports the use of FDG PET/CT for characterisation of disease biology and to guide treatment selection across a range of indications, despite the lack of full consensus in many situations. This may reflect existing clinical access due to lack of reimbursement or experience with this investigation, which should be addressed by further research.

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神经内分泌肿瘤中[18F]FDG PET/CT的使用和认知效用:欧洲神经内分泌肿瘤学会(ENETS)咨询委员会2022年会议共识报告
体生长抑素受体(SST)PET/CT 是分化良好的神经内分泌肿瘤(NET)成像的黄金标准。分化程度较高的神经内分泌肿瘤(NEN)会优先摄取[18F]FDG(FDG),即使是低分化的NET也可能随着时间的推移而发生去分化。FDG PET/CT 的预后作用已被广泛接受,但其对临床决策的影响仍存在争议,其使用情况也大相径庭。我们向ENETS顾问委员会会议(2022年11月,回复率=70%)的与会者提交了一份关于FDG PET/CT在NEN中的使用和决策效用的问卷调查。在 3/15 项陈述中,同意率高于 75%:(i)FDG在NET中被认为是有用的,无论其分级如何,如果出现误匹配病灶(诊断性CT可检测到,但SST PET/CT为阴性/弱阳性),尤其是考虑进行PRRT时(80%);(ii)如果考虑进行根治性手术,FDG在NET G3中被认为是有用的(82%);(iii)FDG在NEC进行根治性手术前被认为是有用的(98%)。74% 的人赞成在 NET G3 中使用 FDG 作为反应评估的基线,即使存在匹配病灶也是如此。有四项声明获得了 60% 以上的共识:(i) 如果考虑进行局部治疗,则将 FDG 用于 NET G3(65%);(ii) 在开始积极治疗前,将 FDG 用于神经内分泌癌,作为反应评估的基线(61%);(iv)67%的人赞成在SST阴性疾病部分经FDG检测达到完全缓解后,重新考虑PRRT治疗残留的SST阳性病灶。多学科意见广泛支持将 FDG PET/CT 用于描述疾病生物学特征和指导各种适应症的治疗选择,尽管在许多情况下缺乏完全一致的意见。这可能反映了由于缺乏报销或缺乏这种检查经验而导致的现有临床使用情况,应通过进一步研究加以解决。
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