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Background <p>Accurate clinical TNM staging is crucial for managing GEP-NENs according to the latest NCCN guidelines. [<sup>68</sup>Ga] labeled somatostatin receptor (SSTR) PET/CT outperforms [<sup>18</sup>F]FDG PET/CT in evaluating well and moderately differentiated NENs. However, few studies have investigated the performance of [<sup>18</sup>F] labeled SSTRs in the exploration of GEP-NENs.</p> Purpose <p>This retrospective study compared the performance of [<sup>18</sup>F]AlF-NOTA-octreotide ([<sup>18</sup>F]OC) with [<sup>18</sup>F]FDG PET/CT for precise staging and restaging GEP-NENs.</p> Methods <p>Participants with clinically suspected or confirmed NENs were enrolled and underwent paired [<sup>18</sup>F]OC and [<sup>18</sup>F]FDG PET/CT between. Lesion findings and PET metabolic parameters, such as the maximum standardized uptake value (SUV<sub>max</sub>) and tumor-to-background ratio (TBR), were compared between the two types of radiotracers. The results of histology or imaging follow-up served as the reference standard for the final diagnosis.</p> Results <p>Thirty-seven patients and 209 suspicious lesions were included in the statistical analysis. In patients for initial staging (<i>n</i> = 19), [<sup>18</sup>F]OC PET/CT led to upstaging of the clinical T stage in 13 (66.7%) patients and TNM stage in 10 (52.6%) patients compared with [<sup>18</sup>F]FDG PET/CT. In posttreatment patients for restaging (<i>n</i> = 18), [<sup>18</sup>F]OC PET/CT demonstrated superior performance in 9 (50%) patients and inferior performance in 3 (16.7%) patients compared with [<sup>18</sup>F]FDG PET/CT. For the 176 confirmed NEN lesions, the SUV<sub>max</sub> and TBR of [<sup>18</sup>F]OC were greater than those of [<sup>18</sup>F]FDG (median SUV<sub>max</sub>, 11.3 vs. 2.1; <i>P</i> &lt; 0.001; median TBR, 8.0 vs. 1.6; <i>P</i> &lt; 0.001, respectively). For lesions &lt; 0.5&#xa0;cm, 0.5 ~ 1.0&#xa0;cm and 1.0 ~ 2.0&#xa0;cm in size, [<sup>18</sup>F]OC PET/CT had a significantly higher sensitivity than [<sup>18</sup>F]FDG PET/CT did (<i>P</i> = 0.041, &lt; 0.001, 0.028, respectively), whereas for lesions between 2.0 ~ 4.0&#xa0;cm and &gt; 4.0&#xa0;cm in size, the differences were not significant (<i>P</i> = 0.103 and 0.539).</p> Conclusions <p>[<sup>18</sup>F]OC PET/CT outperformed [<sup>18</sup>F]FDG PET/CT in detecting small well-differentiated GEP-NEN lesions and metastases less than 2.0&#xa0;cm in size, even tiny lesions (≤ 0.5&#xa0;cm), which helps improve GEP-NEN staging and restaging.</p> Clinical trial number <p>Not applicable.</p>

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The clinical benefits of [18F]AlF-NOTA-octreotide PET/CT in staging and restaging patients with gastroenteropancreatic neuroendocrine neoplasms: comparison of [18F]FDG PET/CT

  • 期刊论文

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  • 发表日期：

    2025年7月11日

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  • Donghe Chen,
  • Zhenfeng Liu,
  • Guolin Wang,
  • Mengjiao Tu,
  • Fei Yang,
  • Chunting Jiang,
  • Kui Zhao,
  • Xinhui Su

摘要

Background

Accurate clinical TNM staging is crucial for managing GEP-NENs according to the latest NCCN guidelines. [68Ga] labeled somatostatin receptor (SSTR) PET/CT outperforms [18F]FDG PET/CT in evaluating well and moderately differentiated NENs. However, few studies have investigated the performance of [18F] labeled SSTRs in the exploration of GEP-NENs.

Purpose

This retrospective study compared the performance of [18F]AlF-NOTA-octreotide ([18F]OC) with [18F]FDG PET/CT for precise staging and restaging GEP-NENs.

Methods

Participants with clinically suspected or confirmed NENs were enrolled and underwent paired [18F]OC and [18F]FDG PET/CT between. Lesion findings and PET metabolic parameters, such as the maximum standardized uptake value (SUVmax) and tumor-to-background ratio (TBR), were compared between the two types of radiotracers. The results of histology or imaging follow-up served as the reference standard for the final diagnosis.

Results

Thirty-seven patients and 209 suspicious lesions were included in the statistical analysis. In patients for initial staging (n = 19), [18F]OC PET/CT led to upstaging of the clinical T stage in 13 (66.7%) patients and TNM stage in 10 (52.6%) patients compared with [18F]FDG PET/CT. In posttreatment patients for restaging (n = 18), [18F]OC PET/CT demonstrated superior performance in 9 (50%) patients and inferior performance in 3 (16.7%) patients compared with [18F]FDG PET/CT. For the 176 confirmed NEN lesions, the SUVmax and TBR of [18F]OC were greater than those of [18F]FDG (median SUVmax, 11.3 vs. 2.1; P < 0.001; median TBR, 8.0 vs. 1.6; P < 0.001, respectively). For lesions < 0.5 cm, 0.5 ~ 1.0 cm and 1.0 ~ 2.0 cm in size, [18F]OC PET/CT had a significantly higher sensitivity than [18F]FDG PET/CT did (P = 0.041, < 0.001, 0.028, respectively), whereas for lesions between 2.0 ~ 4.0 cm and > 4.0 cm in size, the differences were not significant (P = 0.103 and 0.539).

Conclusions

[18F]OC PET/CT outperformed [18F]FDG PET/CT in detecting small well-differentiated GEP-NEN lesions and metastases less than 2.0 cm in size, even tiny lesions (≤ 0.5 cm), which helps improve GEP-NEN staging and restaging.

Clinical trial number

Not applicable.