RESEARCH PAPER
Value of somatostatin receptor scintigraphy in patients with appendiceal neuroendocrine neoplasms based on clinical follow-ups
 
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1
Department of Cardiology and Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Poland
2
MSC Memorial Cancer Centre and Institute - Maria Sklodowska-Curie, Warsaw, Poland
3
Central Clinical Hospital of Ministry of the Interior and Administration, Warsaw, Poland
CORRESPONDING AUTHOR
Sonia Joanna Konsek-Komorowska   

Department of Cardiology and Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Warszawska 30, 10-082 Olsztyn, Poland. Tel.: +4889 524 53 89.
Submission date: 2020-08-11
Final revision date: 2020-12-16
Acceptance date: 2020-12-17
Online publication date: 2021-01-04
 
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Appendiceal neuroendocrine neoplasms (ANEN) constitute a significant proportion of the tumours identified within the appendix.

Aim:
This retrospective study assesses the value of somatostatin receptor scintigraphy (SRS) in evaluating tumour extent, as well as in follow-up imaging, for those patients with confirmed well (G1) or moderately (G2) differentiated ANEN before or after surgery, and using intention to treat (ITT) analysis.

Material and methods:
Whole body (WB) and SPECT/CT SRS using 99mTc HYNICTOC was performed on 77 patients with confirmed ANEN to assess tumour extent before or after surgery also as follow-up imaging.

Results and discussion:
Of 77 patients, 71 (92%) were found to have NENG1 and 6 (8%) were found to have NENG2 ANEN. Post-surgical imaging restaging was performed on 30 patients. SRS detected active disease in 3 subjects (true positive, TP), and true negative (TN) results were found in 27 cases. Follow-up SRS imaging was performed after surgery with ITT on 47 patients, detecting TP result in single patient and TN in 46 patients, with no false positive or negative results. Sensitivity was shown to be 100%.

Conclusions:
SRS is a precise screening method for identifying the presence of active disease after non radical or extended surgery. However, as the primary treatment of the disease is highly effective, SRS is not a cost-effective choice for post-surgical follow-up screening.

FUNDING
None declared.
CONFLICT OF INTEREST
None declared.
 
REFERENCES (22)
1.
Ellis L, Shale MJ, Coleman MP. Carcinoid tumors of the gastrointestinal tract: trends in incidence in England since 1971. Am J Gastroenterol. 2010;105(12):2563–2569. https://doi.org/10.1038/ajg.20....
 
2.
Pape UF, Niederle B, Costa F, et al. ENETS Consensus Guidelines for Neuroendocrine Neoplasms of the Appendix (Excluding Goblet Cell Carcinomas). Neuroendocrinology. 2016;103(2):144–152. https://doi.org/10.1159/000443....
 
3.
Hauso O, Gustafsson BI, Kidd M, et al. Neuroendocrine tumor epidemiology: contrasting Norway and North America. Cancer. 2008;113:2655–2664. https://doi.org/10.1002/cncr.2....
 
4.
Mullen JT, Savarese DMF. Carcinoid tumors of the appendix: a population-based study. J Surg Oncol. 2011;104:41–44. https://doi.org/10.1002/jso.21....
 
5.
Pawa N, Clift AK, Osmani H, et al. Surgical Management of patients with Neuroendocrine Neoplams of the Appendix: Appendectomy or More. Neuroendocrinology. 2018;106(3):242–251. https://doi.org/10.1159/000478....
 
6.
Bednarczuk T, Bolanowski M, Zemczak A, et al. Neuroendocrine neoplasms of the small intestine and the appendix – management guidelines (recommended by the Polish Network of Neuroendocrine Tumours). Endokrynol Pol. 2017;68(2):223–236. https://doi.org/10.5603/ep.201....
 
7.
Hankus J, Tomaszewska R. Neuroendocrine neoplasms and somatostatin receptor subtypes expression. Nucl Med Rev Cent East Eur. 2016;19(2):111–117. https://doi.org/10.5603/nmr.20....
 
8.
Woltering EA, Bergsland EK, Beyer DT, et al. Neuroendocrine Tumors of the Appendix. American Joint Committee on Cancer 2017. In: Amin MB, et al. (eds.). AJCC Cancer Staging Manual. 8th Ed. New York: Springer 2017; 389–394.
 
9.
Decristoforo C, Melendez-Alafort L, Sosabowski JK, Mather SJ. 99mTc-HYNIC-[Tyr3]-octreotide for imaging somatostatin-receptor-positive tumors: Preclinical evaluation and comparison with 111In-octreotide. J Nucl Med. 2000; 41(6):1114–1119.
 
10.
Cwikla JB, Mikolajczak R, Pawlak D, et al. Initial direct comparison of 99mTc-TOC and 99mTc-TATE in identifying sites of disease in patients with proven GEP NETs. J Nucl Med. 2008;49(7):1060–1065. https://doi.org/10.2967/jnumed....
 
11.
Kwekkeboom DJ, Kam BL, van Essen M, et al. Somatostatin-receptor-based imaging and therapy of gastroenteropancreatic neuroendocrine tumors. Endocr Relat Cancer. 2010;17(1):R53–73. https://doi.org/10.1677/erc-09....
 
12.
Alexandraki KI, Kaltsas GA, Grozinsky-Glasberg S, Chatzellis E, Grossman AB. Appendiceal neuroendocrine neoplasms: diagnosis and management. Endocr Relat Cancer. 2016;23(1):R27–41. https://doi.org/10.1530/erc-15....
 
13.
Bamboat ZM, Berger DL. Is right hemicolectomy for 2.0-cm appendiceal carcinoids justified? Arch Surg. 2006;141(4):349–352. https://doi.org/10.1001/archsu....
 
14.
Alexandraki KI, Griniatsos J, Bramis KI, et al. Clinical value of right hemicolectomy for appendiceal carcinoids using pathologic criteria. J Endocrinol Invest. 2011;34(4):255–259. https://doi.org/10.1007/bf0334....
 
15.
O’Donnell ME, Carson J, Garstin WIH. Surgical treatment of malignant carcinoid tumours of the appendix. Int J Clin Pract. 2007;61(3):431–437. https://doi.org/10.1111/j.1742....
 
16.
Tchana-Sato V, Detry O, Polus M, et al. Carcinoid tumor of the appendix: a consecutive series from 1237 appendectomies. World J Gastroenterol. 2006;12(41):6699–6701. https://dx.doi.org/10.3748%2Fw....
 
17.
Roggo A, Wood WC, Ottinger LW. Carcinoid tumors of the appendix. Ann Surg. 1993;217(4):385–390. https://dx.doi.org/10.1097%2F0....
 
18.
Stinner B, Kisker O, Zielke A, Rothmund M. Surgical management for carcinoid tumors of small bowel, appendix, colon, and rectum. World J Surg. 1996;20(2):183–188. https://doi.org/10.1007/s00268....
 
19.
Goede AC, Caplin ME, Winslet MC. Carcinoid tumour of the appendix. Br J Surg. 2003;90(11):1317–1322. https://doi.org/10.1002/bjs.43....
 
20.
Ramage JK, Ahmed A, Ardill J, et al. Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours (NETs). Gut. 2012;61(1):6–32. http://dx.doi.org/10.1136/gutj....
 
21.
Kleiman DA, Finnerty B, Beninato T, et al. Features associated with metastases among well-differentiated neuroendocrine (Carcinoid) tumors of the appendix: The significance of small vessel invasion in addition to size. Dis Colon Rectum. 2015;58(12):1137–1143. https://doi.org/10.1097/dcr.00....
 
22.
Boudreaux JP, Klimstra DS, Hassan MM, et al. The NANETS consensus guideline for the diagnosis and management of neuroendocrine tumors: well-differentiated neuroendocrine tumors of the Jejunum, Ileum, Appendix, and Cecum. Pancreas. 2010;39(6):753–766. https://doi.org/10.1097/mpa.0b....