64Cu-DOTATATE PET for Neuroendocrine Tumors: A Prospective Head-to-Head Comparison with 111In-DTPA-Octreotide in 112 Patients

TY - JOUR

T1 - 64Cu-DOTATATE PET for Neuroendocrine Tumors

T2 - A Prospective Head-to-Head Comparison with 111In-DTPA-Octreotide in 112 Patients

AU - Pfeifer, Andreas

AU - Knigge, Ulrich

AU - Binderup, Tina

AU - Mortensen, Jann

AU - Oturai, Peter

AU - Loft, Annika

AU - Berthelsen, Anne Kiil

AU - Langer, Seppo W

AU - Rasmussen, Palle

AU - Elema, Dennis

AU - von Benzon, Eric

AU - Højgaard, Liselotte

AU - Kjaer, Andreas

N1 - © 2015 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

PY - 2015/6/1

Y1 - 2015/6/1

N2 - Neuroendocrine tumors (NETs) can be visualized using radiolabeled somatostatin analogs. We have previously shown the clinical potential of 64Cu-DOTATATE in a small first-in-human feasibility study. The aim of the present study was, in a larger prospective design, to compare on a head-to-head basis the performance of 64Cu-DOTATATE and 111In-diethylenetriaminepentaacetic acid (DTPA)-octreotide (111In-DTPA-OC) as a basis for implementing 64Cu-DOTATATE as a routine. Methods: We prospectively enrolled 112 patients with pathologically confirmed NETs of gastroenteropancreatic or pulmonary origin. All patients underwent both PET/CT with 64Cu-DOTATATE and SPECT/CT with 111In-DTPA-OC within 60 d. PET scans were acquired 1 h after injection of 202 MBq (range, 183-232 MBq) of 64Cu-DOTATATE after a diagnostic contrast-enhanced CT scan. Patients were followed for 42-60 mo for evaluation of discrepant imaging findings. The McNemar test was used to compare the diagnostic performance. Results: Eightyseven patients were congruently PET-and SPECT-positive. No SPECT-positive cases were PET-negative, whereas 10 false-negative SPECT cases were identified using PET. The diagnostic sensitivity and accuracy of 64Cu-DOTATATE (97% for both) were significantly better than those of 111In-DTPA-OC (87% and 88%, respectively, P 5 0.017). In 84 patients (75%), 64Cu-DOTATATE identified more lesions than 111In-DTPA-OC and always at least as many. In total, twice as many lesions were detected with 64Cu-DOTATATE than with 111In-DTPA-OC. Moreover, in 40 of 112 cases (36%) lesions were detected by 64Cu-DOTATATE in organs not identified as disease-involved by 111In-DTPA-OC. Conclusion: With these results, we demonstrate that 64Cu-DOTATATE is far superior to 111In-DTPAOC in diagnostic performance in NET patients. Therefore, we do not hesitate to recommend implementation of 64Cu-DOTATATE as a replacement for 111In-DTPA-OC.

AB - Neuroendocrine tumors (NETs) can be visualized using radiolabeled somatostatin analogs. We have previously shown the clinical potential of 64Cu-DOTATATE in a small first-in-human feasibility study. The aim of the present study was, in a larger prospective design, to compare on a head-to-head basis the performance of 64Cu-DOTATATE and 111In-diethylenetriaminepentaacetic acid (DTPA)-octreotide (111In-DTPA-OC) as a basis for implementing 64Cu-DOTATATE as a routine. Methods: We prospectively enrolled 112 patients with pathologically confirmed NETs of gastroenteropancreatic or pulmonary origin. All patients underwent both PET/CT with 64Cu-DOTATATE and SPECT/CT with 111In-DTPA-OC within 60 d. PET scans were acquired 1 h after injection of 202 MBq (range, 183-232 MBq) of 64Cu-DOTATATE after a diagnostic contrast-enhanced CT scan. Patients were followed for 42-60 mo for evaluation of discrepant imaging findings. The McNemar test was used to compare the diagnostic performance. Results: Eightyseven patients were congruently PET-and SPECT-positive. No SPECT-positive cases were PET-negative, whereas 10 false-negative SPECT cases were identified using PET. The diagnostic sensitivity and accuracy of 64Cu-DOTATATE (97% for both) were significantly better than those of 111In-DTPA-OC (87% and 88%, respectively, P 5 0.017). In 84 patients (75%), 64Cu-DOTATATE identified more lesions than 111In-DTPA-OC and always at least as many. In total, twice as many lesions were detected with 64Cu-DOTATATE than with 111In-DTPA-OC. Moreover, in 40 of 112 cases (36%) lesions were detected by 64Cu-DOTATATE in organs not identified as disease-involved by 111In-DTPA-OC. Conclusion: With these results, we demonstrate that 64Cu-DOTATATE is far superior to 111In-DTPAOC in diagnostic performance in NET patients. Therefore, we do not hesitate to recommend implementation of 64Cu-DOTATATE as a replacement for 111In-DTPA-OC.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Biopsy

KW - Female

KW - Humans

KW - Image Processing, Computer-Assisted

KW - Male

KW - Middle Aged

KW - Multimodal Imaging

KW - Neoplasm Metastasis

KW - Neuroendocrine Tumors

KW - Octreotide

KW - Organometallic Compounds

KW - Pentetic Acid

KW - Positron-Emission Tomography

KW - Prospective Studies

KW - Receptors, Somatostatin

KW - Stomach Neoplasms

KW - Tomography, Emission-Computed, Single-Photon

KW - Tomography, X-Ray Computed

U2 - 10.2967/jnumed.115.156539

DO - 10.2967/jnumed.115.156539

M3 - Journal article

C2 - 25952736

SN - 0161-5505

VL - 56

SP - 847

EP - 854

JO - Journal of Nuclear Medicine

JF - Journal of Nuclear Medicine

IS - 6

ER -