Neuroendocrine Tumors (NET)

Clinical Ordering indications for Dotatate are:

1. Patients with history of or newly diagnosed/biopsy proven neuroendocrine tumor (NET) or carcinoid tumor for restaging or initial staging.

2. Patients with CT or MRI imaging features suspicious for NET or carcinoid tumor.

3. Patients with biochemical evidence/data suspicious for NET or carcinoid tumor. The general biochemical marker is chromogranin A (CgA) in the blood, or 24-h urine 5 hydroxyindoleacetic acid (5-HIAA), or elevated hormone levels suggesting GI or pancreatic endocrine tumors or pheochromocytoma/paragangliomas, just name a few.

Image Shown: PET/CT (78815) with Dotatate (A9587)

patient with biopsy proven right hilar neuroendocrine cancer. DOTATATE PET CT confirms a right hilar mass of 4.5 cm with intense tracer uptake, max SUV 125. There is no evidence for DOTATATE-avid metastasis. Note physiological/normal tracer distribution to multiple glands, including pituitary (not shown), salivary, thyroid, and adrenal glands, and multiple organs, including the liver, spleen, kidneys, and bowels.

ABOUT

Neuroendocrine tumors arise in cells called neuroendocrine cells, which are specialized hormone-producing cells found in most organs of the body. As a result, neuroendocrine tumors are a diverse, but rare group of cancers; according to the National Cancer Institute (NCI) there are at least 40 different
types of neuroendocrine tumors.

Gastroenteropancreatic neuroendocrine tumors are neuroendocrine tumors arising in the pancreas and different parts of the gastrointestinal tract, such as the stomach, intestines, colon, and rectum. They are among the most common neuroendocrine tumors, and they include the type of cancer that Steve Jobs was diagnosed with. According to the FDA, about one in every 27,000 U.S. adults are diagnosed with a gastroenteropancreatic neuroendocrine tumor each year.

Source: https://www.aacr.org/patients-caregivers/progress-against-cancer/targeted-radiotherapy-neuroendocrine-tumors-dotatate-lutathera/

NCCN Comments on NET’s and Dotatate PET/CT Imaging

“A major advance in imaging NETs came with the 2016 FDA approval of PET/CT imaging using the radiolabeled somatostatin analog gallium-68 (68Ga) DOTATATE. Several studies have shown the diagnostic utility, safety, specificity, and high sensitivity of 68Ga-DOTATATE PET/CT. A systematic review and meta-analysis of 22 studies determined that 68Ga-DOTATATE had a pooled sensitivity and specificity of 91% and 94%, respectively, for the initial diagnosis of NETs. One study even showed that it was able to more correctly identify patients for peptide receptor radiotherapy than 111indium- diethylenetriaminepentaacetic acid (111In-DPTA) scintigraphy.”

Source: https://www.nccn.org/professionals/physician_gls/pdf/neuroendocrine.pdf (page MS-7)