TY - JOUR

T1 - Use and perceived utility of [18F]FDG PET/CT in neuroendocrine neoplasms

T2 - A consensus report from the European Neuroendocrine Tumor Society (ENETS) Advisory Board Meeting 2022

AU - Ambrosini, Valentina

AU - Caplin, Martyn

AU - Castaño, Justo P.

AU - Christ, Emanuel

AU - Denecke, Timm

AU - Deroose, Christophe M.

AU - Dromain, Clarisse

AU - Falconi, Massimo

AU - Grozinsky-Glasberg, Simona

AU - Hicks, Rodney J.

AU - Hofland, Johannes

AU - Kjaer, Andreas

AU - Knigge, Ulrich Peter

AU - Kos-Kudla, Beata

AU - Koumarianou, Anna

AU - Krishna, Balkundi

AU - Lamarca, Angela

AU - Pavel, Marianne

AU - Reed, Nicholas Simon

AU - Scarpa, Aldo

AU - Srirajaskanthan, Rajaventhan

AU - Sundin, Anders

AU - Toumpanakis, Christos

AU - Prasad, Vikas

N1 - Publisher Copyright: © 2023 British Society for Neuroendocrinology.

PY - 2023

Y1 - 2023

N2 - Somatostatin receptor (SST) PET/CT is the gold standard for well-differentiated neuroendocrine tumours (NET) imaging. Higher grades of neuroendocrine neoplasms (NEN) show preferential [18F]FDG (FDG) uptake, and even low-grade NET may de-differentiate over time. FDG PET/CT's prognostic role is widely accepted; however, its impact on clinical decision-making remains controversial and its use varies widely. A questionnaire-based survey on FDG PET/CT use and perceived decision-making utility in NEN was submitted to the ENETS Advisory Board Meeting attendees (November 2022, response rate = 70%). In 3/15 statements, agreement was higher than 75%: (i) FDG was considered useful in NET, irrespective of grade, in case of mis-matched lesions (detectable on diagnostic CT but negative/faintly positive on SST PET/CT), especially if PRRT is contemplated (80%); (ii) in NET G3 if curative surgery is considered (82%); and (iii) in NEC prior to surgery with curative intent (98%). FDG use in NET G3, even in the presence of matched lesions, as a baseline for response assessment was favoured by 74%. Four statements obtained more than 60% consensus: (i) FDG use in NET G3 if locoregional therapy is considered (65%); (ii) in neuroendocrine carcinoma before initiating active therapy as a baseline for response assessment (61%); (iii) biopsy to re-assess tumour grade prior to a change in therapeutic management (68%) upon detection of FDG-positivity on the background of a prior G1-2 NET; (iv) 67% were in favour to reconsider PRRT to treat residual SST-positive lesions after achieving complete remission on FDG of the SST-negative disease component. Multidisciplinary opinion broadly supports the use of FDG PET/CT for characterisation of disease biology and to guide treatment selection across a range of indications, despite the lack of full consensus in many situations. This may reflect existing clinical access due to lack of reimbursement or experience with this investigation, which should be addressed by further research.

AB - Somatostatin receptor (SST) PET/CT is the gold standard for well-differentiated neuroendocrine tumours (NET) imaging. Higher grades of neuroendocrine neoplasms (NEN) show preferential [18F]FDG (FDG) uptake, and even low-grade NET may de-differentiate over time. FDG PET/CT's prognostic role is widely accepted; however, its impact on clinical decision-making remains controversial and its use varies widely. A questionnaire-based survey on FDG PET/CT use and perceived decision-making utility in NEN was submitted to the ENETS Advisory Board Meeting attendees (November 2022, response rate = 70%). In 3/15 statements, agreement was higher than 75%: (i) FDG was considered useful in NET, irrespective of grade, in case of mis-matched lesions (detectable on diagnostic CT but negative/faintly positive on SST PET/CT), especially if PRRT is contemplated (80%); (ii) in NET G3 if curative surgery is considered (82%); and (iii) in NEC prior to surgery with curative intent (98%). FDG use in NET G3, even in the presence of matched lesions, as a baseline for response assessment was favoured by 74%. Four statements obtained more than 60% consensus: (i) FDG use in NET G3 if locoregional therapy is considered (65%); (ii) in neuroendocrine carcinoma before initiating active therapy as a baseline for response assessment (61%); (iii) biopsy to re-assess tumour grade prior to a change in therapeutic management (68%) upon detection of FDG-positivity on the background of a prior G1-2 NET; (iv) 67% were in favour to reconsider PRRT to treat residual SST-positive lesions after achieving complete remission on FDG of the SST-negative disease component. Multidisciplinary opinion broadly supports the use of FDG PET/CT for characterisation of disease biology and to guide treatment selection across a range of indications, despite the lack of full consensus in many situations. This may reflect existing clinical access due to lack of reimbursement or experience with this investigation, which should be addressed by further research.

KW - FDG

KW - neuroendocrine neoplasms

KW - neuroendocrine tumours

KW - PET/CT

UR - http://www.scopus.com/inward/record.url?scp=85179678295&partnerID=8YFLogxK

U2 - 10.1111/jne.13359

DO - 10.1111/jne.13359

M3 - Journal article

C2 - 38097193

AN - SCOPUS:85179678295

VL - 36

SP - 1

EP - 10

JO - Journal of Neuroendocrinology

JF - Journal of Neuroendocrinology

SN - 0953-8194

IS - 1

M1 - e13359

ER -