Abstract
Knowledge of receptor expression in neuroendocrine tumors (NET) is the key for therapy directed at tumor receptors. Receptor imaging (RI) for somatostatin receptor subtypes (SSTRs) expressing tumors offers complementary informations that enable the evaluation of the entire tumor burden and characterization of the heterogeneity of tumor receptor expression. RI allows to stratify patients responders and nonresponders to targeted treatment with somatostatin analogs.
(18)F-fluorodeoxyglucose (18F-FDG) PET/CT has no primary indication in the study of NET until they are well differentiated and maintain slow growth and low metabolic activity. A positive metabolic scan correlates with a high Ki-67 and with poorly differentiated NET. It may indicate the disappearance of SSTRs on tumor cells, decreeing a worse outcome.
We report a case of a male affected with node metastasis from poorly differentiated high-grade neuroendocrine carcinoma of unknown primary site. Patient underwent SSTR (111)Indium-DTPA-pentetreotide (octreoscan) whole-body-SPECT/CT scan and metabolic 18F-FDG PET scan. Octreoscan documented the loss of SSTR expression, while increased glucose metabolism at 18F-FDG PET correlated with high Ki-67 expression and disease progression, suggesting the utility of chemotherapy.
Tumor RI has a strong impact in the patient workup, but, similarly, a positive metabolic 18F-FDG PET can play a key role in NET management for its prognostic contribution, due to the variability in behavior of disease progression.
On behalf of the ENETS Center of Excellence Multidisciplinary Group for Neuroendocrine Tumors in Naples, Italy
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De Rimini, M.L., De Rosa, N., Settembre, A., Mazzarella, G., Muto, P. (2018). Prognostic Factors: Nuclear Medicine Imaging (FDG PET–Octreoscan/Gallium PET). In: Colao, A., Faggiano, A., de Herder, W. (eds) Neuroendocrine Tumors in Real Life. Springer, Cham. https://doi.org/10.1007/978-3-319-59024-0_9
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