The role of 68Ga-DOTA derivatives PET-CT in patients with ectopic ACTH syndrome.

Abstract:

INTRODUCTION AND AIM:Ectopic ACTH secretion (EAS) is mostly secondary to thoracic/abdominal neuroendocrine tumours (NETs), or small cell-lung carcinoma (SCLC). We studied the diagnostic accuracy of computed tomography (CT) with 68Ga-Dota derivatives (68Ga-SSTR) positron emission tomography (PET) in localizing ACTH-secreting tumor in patients with EAS. MATERIALS AND METHODS:68Ga-SSTR-PET/CT was performed and compared with the nearest enhanced CT in 18 cases (16 primary and 2 recurrent neoplasms). Unspecific, indeterminate and false positive uptakes were assessed using conventional imaging, follow-up or histology. RESULTS:We diagnosed 13 thoracic (9 primary and 2 recurrent bronchial carcinoids, 2 SCLCs) and 1 abdominal (pancreatic NET) tumors. 8 ACTH-secreting tumors were promptly identified at EAS diagnosis ('overt', 4 pulmonary carcinoids with 2 recurrences, and 2 SCLC); 6 EAS have been discovered during the subsequent follow-up ('covert', 5 bronchial carcinoids and 1 pancreatic NET). At the time of EAS diagnosis, imaging was able to correctly detect the ACTH-secreting tumour in 8/18 cases (6 new diagnosis and 2 recurrences). During the follow-up, 6 out of initially 10 'occult' cases became 'covert'. At last available follow-up, CT and 68Ga-SSTR-PET/CT were able to diagnose respectively 11/18 and 12/18 ACTH-secreting tumours (respectively 11/14 and 12/14 considering only overt and covert cases). 4 cases have never been localized by conventional or nuclear imaging ('occult' EAS), despite an average follow up of 5 years. CONCLUSIONS:The 68Ga-SSTR-PET/CT is useful in localizing EAS, especially to enhance positive prediction of the suggestive CT lesions and to detect occult neoplasms.

journal_name

Endocr Connect

journal_title

Endocrine connections

authors

Ceccato F,Cecchin D,Gregianin M,Ricci G,Campi C,Crimì F,Bergamo M,Versari A,Lacognata C,Rea F,Barbot M,Scaroni C

doi

10.1530/EC-20-0089

subject

Has Abstract

pub_date

2020-03-01 00:00:00

issn

2049-3614

pii

EC-20-0089.R1

pub_type

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