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Theranostic implications of molecular imaging phenotype of well-differentiated pulmonary carcinoid based on 68Ga-DOTATATE PET/CT and 18F-FDG PET/CT

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Abstract

Purpose

This study aimed to analyse the molecular imaging (MI) phenotype of typical carcinoid (TC) and atypical carcinoid (AC) by 68Ga-DOTATATE (GaTATE) and 18F-FDG (FDG) PET/CT with the emphasis on its potential theranostic implications for peptide receptor radionuclide therapy (PRRT).

Methods

Retrospective review of patients with biopsy-proven TC or AC undergoing both GaTATE and FDG PET/CT at presentation. Based on correlative CT or MRI, positive lesions on either scan were defined by uptake above liver parenchyma. Per patient MI phenotypic pattern was classified as score 1, if all lesions were negative on both scans; score 2, if all were GaTATE positive/FDG negative; score 3, if all lesions were GaTATE positive but some or all were also FDG positive and score 4, if there were any GaTATE negative/FDG positive lesions. Scores 1 and 4 were deemed unsuitable for PRRT.

Results

Of 56 patients (median age 66.5 years, 32 female), 22 had TC, and 34 had AC. Distant metastases were seen in 32% of TC and 94% of AC. At a median follow-up of 37 months for TC and 38 months for AC, 100% and 63% were alive, respectively. Median OS for AC was 56 months (95% CI 43, not reached [NR]), and TC was NR. On inter-patient dual-tracer analysis, scores 1, 2, 3 and 4 were 23%, 18%, 36% and 23% in TC and 3%, 15%, 32% and 50% in AC, respectively. In 16 patients (score 2, N = 3; score 3, N = 12; score 4, N = 1) who were treated with PRRT, disease control rate at 3 months and OS were, 85% and 54.6 months (95% CI 44–70), respectively.

Conclusions

TC and AC showed a wide inter-patient phenotypic heterogeneity on GaTATE and FDG with around half of patients (46% TC and 53% AC) having an unsuitable phenotype for PRRT. Dual-tracer MI phenotype can be used to select the most suitable patients for PRRT.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Funding

This work was partly funded by the Peter Mac Foundation and supported by an NHMRC Practitioner Fellowship of the Australian Health and Medical Research Foundation to Professor Hicks (APP1108050).

Author information

Authors and Affiliations

  1. Cancer imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

    Lamiaa Zidan, Amir Iravani, Grace Kong, Tim Akhurst & Rodney J Hicks

  2. Clinical Oncology and Nuclear Medicine department, Cairo University, Cairo, Egypt

    Lamiaa Zidan

  3. Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia

    Amir Iravani, Grace Kong, Tim Akhurst, Michael Michael & Rodney J Hicks

  4. Division of Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

    Michael Michael

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  1. Lamiaa Zidan
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Contributions

All authors contributed to the study concept and design. Material preparation, data collection, and analysis were performed by LZ, AI, GK, TA, MM and RJH. The first draft of the manuscript was written by LZ and AI, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Lamiaa Zidan.

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The authors declare that they have no conflict of interest relevant to this paper.

Ethical approval

Ethical approval was granted by the local Ethics Committee of Peter MacCallum Cancer Centre (Peter Mac Project No: 19/214R). In view of the retrospective nature of the study and all the procedures being performed were part of the routine care; the individual patient consent was waived by the Ethics Committee.

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This article is part of the Topical Collection on Oncology - Chest

Lamiaa Zidan and Amir Iravani are co-first authors

Electronic supplementary material

Supplementary Fig. 1

Inter-patient dual tracer scoring (a) in typical and atypical carcinoid. Comparison between GaTATE SUVmax (b) and FDG SUVmax (c) in typical and atypical carcinoid patients (JPG 168 kb)

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Zidan, L., Iravani, A., Kong, G. et al. Theranostic implications of molecular imaging phenotype of well-differentiated pulmonary carcinoid based on 68Ga-DOTATATE PET/CT and 18F-FDG PET/CT. Eur J Nucl Med Mol Imaging 48, 204–216 (2021). https://doi.org/10.1007/s00259-020-04915-7

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