Use of DOTATATE in the surgical management of small bowel neuroendocrine tumors

A discussion this week included the use of DOTATATE in the surgical management of small bowel neuroendocrine tumors.

Reference: Howe JR et al. The surgical management of small bowel neuroendocrine tumors: consensus guidelines of the North American Neuroendocrine Tumor Society (NANTES). Pancreas. 2017 Jul;46(6):715-731. doi:10.1097/MPA.0000000000000846

Summary: The three most commonly used 68Ga-labeled somatostatin receptor PET imaging agents are 68Ga-DOTATATE, 68Ga-DOTATOC and 68Ga-DOTANOC. Despite the slight variation of the somatostatin receptor affinity of these agents, all of them have shown excellent sensitivity in detection of NETs. At this time, there is no evidence of significant diagnostic superiority of one agent over the others.

68Ga-DOTATATE was recently approved by the United States Food and Drug Administration (FDA) in June 2016, while 68Ga-DOTATOC and 68Ga-DOTANOC are
considered investigational. These agents provide significant advantages over 111InOctreotide due to the higher resolution achieved with PET compared to SPECT, and higher affinity of 68Ga-DOTATATE for target somatostatin receptors (subtype 2; sstr2). The radiation dose to the patient is significantly lower with 68Ga-DOTA agents compared
to 111In-Octreotide, and imaging with 68Ga-DOTA agents is typically completed in 90
minutes, compared to multiple imaging sessions obtained over 24 hours with 111InOctreotide.

A meta-analysis of 17 eligible studies with 971 patients found a high accuracy of 68Ga-DOTATATE in diagnosing NETs, with a sensitivity of 90.9% (CI: 81.4%–96.4%), and specificity of 90.6% (CI: 77.8%–96.1%). Sadowski et al. recently compared 68Ga-DOTATATE with 111In-Octreotide and CT imaging in 131 patients with NETs. They found that 68Ga-DOTATATE PET/CT was significantly more sensitive for detection of NET lesions, with a sensitivity of 95% compared to 31% for 111In-Octreotide and 45% for CT imaging.

(Howe et al, 2017)

Additional reading: Mojtahedi A, et al. The value of 68Ga-DOTATATE PET/CT in diagnosis and management of neuroendocrine tumors compared to current FDA approved imaging modalities: a review of literature. American Journal of Nuclear Medicine and Molecular Imaging. 2014;4(5):426-434.

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