Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Jul 4;15(13):3483.
doi: 10.3390/cancers15133483.

Diagnosis, Management and Theragnostic Approach of Gastro-Entero-Pancreatic Neuroendocrine Neoplasms

Leandra Piscopo  1 , Emilia Zampella  1 , Sara Pellegrino  1 , Fabio Volpe  1 , Carmela Nappi  1 , Valeria Gaudieri  1 , Rosa Fonti  1 , Silvana Del Vecchio  1 , Alberto Cuocolo  1 , Michele Klain  1
Affiliations
Review

Diagnosis, Management and Theragnostic Approach of Gastro-Entero-Pancreatic Neuroendocrine Neoplasms

Leandra Piscopo et al. Cancers (Basel). .

Abstract

Gastro-entero-pancreatic neuroendocrine neoplasms (GEP-NENs) constitute an ideal target for radiolabeled somatostatin analogs. The theragnostic approach is able to combine diagnosis and therapy by the identification of a molecular target that can be diagnosed and treated with the same radiolabeled compound. During the last years, advances in functional imaging with the introduction of somatostatin analogs and peptide receptor radionuclide therapy, have improved the diagnosis and treatment of GEP-NENs. Moreover, PET/CT imaging with 18F-FDG represents a complementary tool for prognostic evaluation of patients with GEP-NENs. In the field of personalized medicine, the theragnostic approach has emerged as a promising tool in diagnosis and management of patients with GEP-NENs. The aim of this review is to summarize the current evidence on diagnosis and management of patients with GEP-NENs, focusing on the theragnostic approach.

Keywords: 18F-FDG; Gallium68; PET/CT; SPECT; neuroendocrine neoplasms; peptide receptor radionuclide therapy; somatostatin receptors; theragnosis.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The theragnostic approach.
Figure 2
Figure 2
MIP views and transaxial fusion images of 68Ga-DOTATOC PET/CT (a,b) and of 18F-FDG PET/CT (c,d) scans performed on the same patient with metastatic mesenterial lymph nodes from ileal NET previously removed. Focal uptake is clearly visible on 68Ga-DOTATOC PET/CT images (a,b) while it is absent on 18F-FDG PET/CT images (c,d).
Figure 3
Figure 3
MIP views and transaxial fusion images of 68Ga-DOTATOC PET/CT (a–c) and of 18F-FDG PET/CT (d–f) scans performed on the same patient with metastatic NET of the lung. Focal uptake is absent on 68Ga-DOTATOC PET/CT images (a–c) while on 18F-FDG PET/CT images focal uptake is clearly visible on the right mandible (e), primary tumor and mediastinal lymph nodes (f).
Figure 4
Figure 4
The post-therapy whole body scan performed after I, II, III and IV cycle of therapy with 177Lu-DOTATATE in a patient with metastatic pancreatic NET, shows a focal and progressive reduction of uptake in the liver and lymph node metastases.
Figure 5
Figure 5
MIP views and transaxial fusion images of 68Ga-DOTATOC PET/CT scans performed before (a) and after (b) therapy with 177Lu-DOTATATE in a patient with metastases to the liver and abdominal lymph nodes from pancreatic NET previously removed. Focal uptake on liver and lymph node metastases is reduced on the post-therapy images.
See this image and copyright information in PMC

References

    1. Modlin I.M., Oberg K., Chung D.C., Jensen R.T., de Herder W.W., Thakker R.V., Caplin M., Delle Fave G., Kaltsas G.A., Krenning E.P., et al. Gastroenteropancreatic neuroendocrine tumours. Lancet Oncol. 2008;9:61–72. doi: 10.1016/S1470-2045(07)70410-2. - DOI - PubMed
    1. Pavel M., Öberg K., Falconi M., Krenning E.P., Sundin A., Perren A., Berruti A., ESMO Guidelines Committee Gastroenteropancreatic neuroendocrine neoplasms: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann. Oncol. 2020;31:844–860. doi: 10.1016/j.annonc.2020.03.304. - DOI - PubMed
    1. Papotti M., Bongiovanni M., Volante M., Allìa E., Landolfi S., Helboe L., Schindler M., Cole S.L., Bussolati G. Expression of somatostatin receptor types 1-5 in 81 cases of gastrointestinal and pancreatic endocrine tumors. A correlative immunohistochemical and reverse-transcriptase polymerase chain reaction analysis. Virchows Arch. Int. J. Pathol. 2002;440:461–475. doi: 10.1007/s00428-002-0609-x. - DOI - PubMed
    1. Reubi J.C. Somatostatin and other Peptide receptors as tools for tumor diagnosis and treatment. Neuroendocrinology. 2004;80((Suppl. S1)):51–56. doi: 10.1159/000080742. - DOI - PubMed
    1. Liberini V., Huellner M.W., Grimaldi S., Finessi M., Thuillier P., Muni A., Pellerito R.E., Papotti M.G., Piovesan A., Arvat E., et al. The Challenge of Evaluating Response to Peptide Receptor Radionuclide Therapy in Gastroenteropancreatic Neuroendocrine Tumors: The Present and the Future. Diagnostics. 2020;10:1083. doi: 10.3390/diagnostics10121083. - DOI - PMC - PubMed

LinkOut - more resources