Background: The role of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) in the diagnostic algorithm of entero-pancreatic neuroendocrine neoplasms (EP NENs) is unclear because most available data derive from heterogeneous populations in terms of tumor biology and disease status at time of examination. The aim of this study was to determine the ability of 18F-FDG PET to identify patients with more aggressive disease among those with advanced EP NENs. Subjects, Materials, and Methods . Patients with advanced EP NENs and known disease status (progressive disease [PD] or stable disease [SD]) according to imaging procedures, who received 18F-FDG PET and computed tomography scans during a time frame of 1 month, were included.
Results: A total of 93 patients, including 69 patients with pancreatic NENs and 24 patients with small-intestine NENs, were included. At the time of study entry, 64 patients (68.8%) had PD, and the remaining 29 patients (31.2%) had SD. A total of 62 patients (66.7%) had positive 18F-FDG PET, whereas 18F-FDG PET was negative in the remaining 31 patients (33.3%). Overall, 18F-FDG PET sensitivity and specificity to detect PD were 90.6% and 86.2%, respectively, resulting in a diagnostic accuracy of 89.2%. A positive 18F-FDG PET was significantly associated with PD at the time of study entry (p < .0001 at multivariate analysis). Although a higher proportion of 18F-FDG PET-positive examinations were observed in patients with higher tumor grade (p = .01), 53.8% of patients with grade 1 neuroendocrine tumors (NETs) had positive 18F-FDG PET, and 37.5% of patients with grade 2 NETs had negative 18F-FDG PET. Overall survival was significantly shorter in 18F-FDG PET-positive patients (median: 60 months) in comparison with 18F-FDG PET-negative patients (median not reached; p = .008).
Conclusion: 18F-FDG PET has a high diagnostic accuracy to identify progression of disease with unfavorable clinical outcome in patients with advanced EP NENs. Knowledge of disease status and G grading are key factors for physicians to better select patients for whom 18F-FDG PET is clinically useful.
Implications for practice: The findings of the present study may help physicians dealing with advanced neuroendocrine neoplasms to select patients for whom 18F-fluorodeoxyglucose positron emission tomography is useful to predict poor clinical outcome.
摘要
背景.18F‐氟脱氧葡萄糖正电子发射断层扫描（18F‐FDG PET）在肠胰神经内分泌肿瘤（EP NEN）诊断算法中的作用尚不清楚, 因为就检查时的肿瘤生物学和疾病状态而言, 大多数可获得的数据来源于异质性群体。本研究的目的是确定18F‐FDG PET能够在晚期EP NEN患者中鉴别出更具侵袭性疾病的能力。
受试者、材料和方法.纳入利用影像学方法确定具有晚期EP NEN和已知疾病状态[疾病进展（PD）或疾病稳定（SD）]的患者, 这些患者在1个月的时间范围内接受18F‐FDG PET和计算机断层扫描。
结果.共纳入93例患者, 其中包括69例胰腺NEN患者和24例小肠NEN患者。研究入组时, 64例患者（68.8%）PD, 其余29例患者（31.2%）SD。总共62例患者（66.7%）18F‐FDG PET为阳性, 其余31例患者（33.3%）18F‐FDG PET为阴性。总体而言, 18F‐FDG PET诊断PD的灵敏度和特异性分别为90.6%和86.2%, 诊断准确率为89.2%。研究入组时, 18F‐FDG PET阳性与PD显著相关（多因素分析p<0.000 1）。尽管在肿瘤分级较高的患者中, 18F‐FDG PET阳性检查的比例较高（p=0.01）, 但1级神经内分泌肿瘤（NET）患者中有53.8%为18F‐FDG PET阳性, 2级NET患者中有37.5%为18F‐FDG PET阴性。与18F‐FDG PET阴性患者（未达到中位数；p=0.008）相比, 18F‐FDG PET阳性患者的总生存期明显更短（中位数：60个月）。
结论.18F‐FDG PET用于鉴别晚期EP NEN患者不良临床预后的疾病进展时具有较高的诊断准确率。了解疾病状态和G分级是医生在临床上更好地选择可获益于18F‐FDG PET的患者的关键因素。
对临床实践的启示：本研究的结果可能有助于医生处理晚期神经内分泌肿瘤, 利用18F‐氟脱氧葡萄糖正电子发射断层扫描选择可能预测不良临床结局的患者。
Keywords: 18F‐fluorodeoxyglucose positron emission tomography; Clinical usefulness; Diagnosis; Neuroendocrine tumors; Prognosis.
© AlphaMed Press 2017.