Most of the Intended Management Changes After 68Ga-DOTATATE PET/CT Are Implemented

Abstract

In this prospective referring-physician-based survey, we investigated the definite clinical impact of ⁶⁸Ga-DOTATATE PET/CT on managing patients with neuroendocrine tumors (NETs). Methods: We prospectively studied 130 patients with ⁶⁸Ga-DOTATATE PET/CT referred for initial or subsequent management decisions (NCT02174679). Referring physicians completed one questionnaire before the scan (Q1) to indicate the treatment plan without PET/CT information, one immediately after review of the imaging report to denote intended management changes (Q2), and one 6 mo later (Q3) to verify whether intended changes were in fact implemented. To further validate the Q3 responses, a systematic electronic chart review was conducted. Results: All 3 questionnaires were completed by referring physicians for 96 of 130 patients (74%). ⁶⁸Ga-DOTATATE PET/CT resulted in intended management changes (Q2) in 48 of 96 patients (50%). These changes were finally implemented (Q3) in 36 of 48 patients (75%). Q3 responses were confirmed in all patients with an available electronic chart (36/96; 38%). Conclusion: This prospective study confirmed a significant impact of ⁶⁸Ga-DOTATATE PET/CT on the intended management of patients with NETs (50% of changes) and notably demonstrated a high implementation rate (75%) of these intended management changes.

Keywords: DOTATATE; PET/CT; impact on implemented management; neuroendocrine tumors; somatostatin receptor.

FIGURE 1.

Patient flowchart for inclusion and management change.

FIGURE 2.

Example 62-y-old man referred for initial staging of metastatic small-bowel low-grade NET. CT and MRI showed mesenteric mass, enlarged abdominal lymph nodes, and equivocal liver lesions (hemangiomas vs. metastases). He had prior slightly increased level of 24-h urine 5-hydroxyindoleacetic acid, supporting suspicion of hepatic metastases. Referring physician indicated in Q1 that patient was being considered for octreotide treatment. ⁶⁸Ga-DOTATATE PET/CT ruled out hepatic metastasis (yellow arrows) and confirmed mesenteric primary site and lymph node involvement (red arrows), as seen on ⁶⁸Ga-DOTATATE PET maximum-intensity projection (A), fused ⁶⁸Ga-DOTATATE PET/CT axial views (B and D), and corresponding CT axial views (C and E). In Q2, referring physician indicated intended management change toward surgery, which was confirmed later in Q3. Patient finally underwent resection of small-bowel NET with wide margins. Follow-up MRI and urinary carcinoid biomarker showed no disease recurrence.