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68 Ga-DOTATATE Compared with 111 In-DTPA-Octreotide and Conventional Imaging for Pulmonary and Gastroenteropancreatic Neuroendocrine Tumors: A Systematic Review and Meta-Analysis

2016; Society of Nuclear Medicine and Molecular Imaging; Volume: 57; Issue: 6 Linguagem: Inglês

10.2967/jnumed.115.165803

1535-5667

Stephen A. Deppen, Jeffrey D. Blume, Adam J. Bobbey, Chirayu Shah, Michael M. Graham, Patricia Lee, Dominique Delbeke, Ronald C. Walker,

Neuroblastoma Research and Treatments

Neuroendocrine tumors (NETs) are uncommon tumors with increasing incidence and prevalence. Current reports suggest that 68 Ga-DOTATATE PET/CT imaging improves diagnosis and staging of NETs compared with 111 In-DTPA-octreotide and conventional imaging. We performed a systematic review of 68 Ga-DOTATATE for safety and efficacy compared with octreotide and conventional imaging to determine whether available evidence supports U.S. Food and Drug Administration approval. Methods: Medline, EMBASE, Web of Science, and Cochrane Reviews electronic databases were searched from January 1999 to September 2015. Results were restricted to human studies comparing diagnostic accuracy of 68 Ga-DOTATATE with octreotide or conventional imaging for pulmonary or gastroenteropancreatic NET and for human studies reporting safety/toxicity for 68 Ga-DOTATATE with 10 subjects or more thought to have NETs. Direct communication with corresponding authors was attempted to obtain missing information. Abstracts meeting eligibility criteria were collected by a research librarian and assembled for reviewers; 2 reviewers independently determined whether or not to include each abstract. If either reviewer chose inclusion, the abstract was accepted for review. Results: Database and bibliography searches yielded 2,479 articles, of which 42 were eligible. Three studies compared the 2 radiopharmaceuticals in the same patient, finding 68 Ga-DOTATATE to be more sensitive than octreotide. Nine studies compared 68 Ga-DOTATATE with conventional imaging. 68 Ga-DOTATATE estimated sensitivity, 90.9% (95% confidence interval, 81.4%–96.4%), and specificity, 90.6% (95% confidence interval, 77.8%–96.1%), were high. Five studies were retained for safety reporting only. Report of harm possibly related to 68 Ga-DOTATATE was rare (6 of 974), and no study reported major toxicity or safety issues. Conclusion: No direct comparison of octreotide and 68 Ga-DOTATATE imaging for diagnosis and staging in an unbiased population of NETs has been published. Available information in the peer-reviewed literature regarding diagnostic efficacy and safety supports the use of 68 Ga-DOTATATE for imaging of NETs where it is available.