神经内分泌肿瘤中心常规使用[64Cu]Cu-DOTATATE PET/CT:2,249 次连续扫描的转诊模式和图像结果。

Esben Andreas Carlsen, Mathias Loft, Camilla Bardram Johnbeck, Ulrich Knigge, Seppo W Langer, Jann Mortensen, Lotte Enevoldsen, Peter Oturai, Andreas Kjaer
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引用次数: 0

摘要

使用基于 68Ga 的示踪剂或[64Cu]Cu-DOTATATE(64Cu-DOTATATE)的体生长抑素受体(SSTR)PET/CT 在神经内分泌肿瘤(NEN)患者治疗中的作用由适当使用标准(AUC)指导。在本研究中,我们对转诊模式和常规 64Cu-DOTATATE PET/CT 扫描的图像结果进行了系统分析,以支持 AUC 的制定。方法:我们纳入了2018年4月10日(开始临床使用)至2022年5月2日期间在哥本哈根大学医院-Rigshospitalet进行的所有临床常规64Cu-DOTATATE PET/CT扫描。我们查看了每次扫描的转诊文本和图像报告,并根据 AUC 中列出的临床情况对适应症进行了分类。结果:共有 1,290 名患者接受了 2,249 次 64Cu-DOTATATE PET/CT 扫描。最常见的适应症(在 AUC 中定义为 "可能适合")是对常规成像和 SSTR PET 均显示为 NEN 但无临床进展证据的患者进行监测,共进行了 703 次(31.3%)扫描。NEN诊断后的初始分期(在AUC中定义为 "合适")和治愈性手术后的重新分期(在AUC中定义为 "可能合适")分别占221(9.8%)和241(10.7%)次扫描。选择符合肽受体放射性核素治疗条件的患者(在 AUC 中为 "适当")和完成肽受体放射性核素治疗后重新分期(在 AUC 中为 "适当")的扫描次数分别为 95 次(4.2%)和 115 次(5.1%)。因 AUC 中未定义的适应症而进行的扫描次数为 371 次(16.5%)。图像结果分析显示,669 次扫描(29.7%)无疾病,582 次扫描(25.9%)疾病稳定,461 次扫描(20.5%)疾病进展。在 461 次扫描中,有 99 次(21.5%)在正电子发射计算机断层扫描(PET)上检测到疾病进展,但在计算机断层扫描(CT)上未检测到。结论我们的研究提供了现实生活中的数据,可能有助于支持包括 AUC 在内的 64Cu-DOTATATE/SSTR PET/CT 指南的制定。目前的 AUC 中列出的一些 "可能合适 "的情况在我们的数据中经常出现。监测无临床进展证据的NEN患者是64Cu-DOTATATE PET/CT最常见的适应症,其中三分之一以上的患者可检测到疾病进展,很大一部分患者仅通过PET即可看到疾病进展。因此,我们得出结论,这种情况有可能被归类为适当的情况。
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Routine Use of [64Cu]Cu-DOTATATE PET/CT in a Neuroendocrine Tumor Center: Referral Patterns and Image Results of 2,249 Consecutive Scans.

The role of somatostatin receptor (SSTR) PET/CT, using 68Ga-based tracers or [64Cu]Cu-DOTATATE (64Cu-DOTATATE), in the management of patients with neuroendocrine neoplasm (NEN) is guided by appropriate use criteria (AUC). In this study, we performed systematic analyses of referral patterns and image findings of routine 64Cu-DOTATATE PET/CT scans to support AUC development. Methods: We included all clinical routine 64Cu-DOTATATE PET/CT scans performed between April 10, 2018 (start of clinical use), and May 2, 2022, at Copenhagen University Hospital-Rigshospitalet. We reviewed the referral text and image report of each scan and classified the indication according to clinical scenarios as listed in the AUC. Results: In total, 1,290 patients underwent 2,249 64Cu-DOTATATE PET/CT scans. Monitoring of patients with NEN seen both on conventional imaging and on SSTR PET without clinical evidence of progression was the most common indication (defined as "may be appropriate" in the AUC) and accounted for 703 (31.3%) scans. Initial staging after NEN diagnosis ("appropriate" in the AUC) and restaging after curative-intent surgery ("may be appropriate" in the AUC) accounted for 221 (9.8%) and 241 (10.7%) scans, respectively. Selection of patients eligible for peptide receptor radionuclide therapy ("appropriate" in the AUC) and restaging after peptide receptor radionuclide therapy completion ("appropriate" in the AUC) accounted for 95 (4.2%) and 115 (5.1%) scans, respectively. The number of scans performed for indications not defined in the AUC was 371 (16.5%). Image result analysis revealed no disease in 669 scans (29.7%), stable disease in 582 (25.9%), and progression in 461 (20.5%). In 99 of the 461 (21.5%) scans, progression was detected on PET but not on CT. Conclusion: Our study provided real-life data that may contribute to support development of 64Cu-DOTATATE/SSTR PET/CT guidelines including AUC. Some scenarios listed as "may be appropriate" in the current AUC were frequent in our data. Monitoring of patients with NEN without clinical evidence of progression was the most frequent indication for 64Cu-DOTATATE PET/CT, in which disease progression was detected in more than one third, and a large proportion was visible by PET only. We therefore conclude that this scenario could potentially be classified as appropriate.

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