Should 68Ga-DOTATATE PET/CT be Performed Routinely in Patients with Neuroendocrine Tumors Before Surgical Resection?

Background The only potential cure for neuroendocrine tumors (NETs) is operative resection, which may also offer a survival benefit for advanced disease. We aimed to assess the role of 68 Ga-DOTATATE PET/CT in preoperative planning and compared its performance to CT with IV contrast and MRI with Eovist ® , for abdominal NETs. Methods Records of patients who underwent 68 Ga-DOTATATE PET/CT in addition to MRI with Eovist ® and/or CT with IV contrast were retrospectively evaluated. The effect of imaging findings on surgical management and characteristics of detected lesions were analyzed. Descriptive statistics were used. Results Of 21 patients who underwent 68 Ga-DOTATATE PET/CT prior to surgical resection, five (24%) had a change in surgical management due to findings. In three patients, 68 Ga-DOTATATE PET/CT identified the primary tumor. In two patients, 68 Ga-DOTATATE PET/CT helped clarify equivocal hepatic lesions seen on MRI with Eovist ® . MRI with Eovist ® had the highest number of lesions found (median 13, versus 9 on CT and 9.5 on 68 Ga-DOTATATE PET/CT). DOTATATE-avid lesions were on average larger than lesions seen only on MRI with Eovist ® (1.6 cm versus 0.6 cm, p = 0.0002). The optimal cutoff point for detection by 68 Ga-DOTATATE PET/CT was a size of 0.95 cm, with a sensitivity of 56% and specificity of 98%. Conclusions Preoperative 68 Ga-DOTATATE PET/CT is useful only in a subset of patients undergoing surgical resection for NETs. MRI with Eovist ® is superior at identifying liver metastases when compared to 68 Ga-DOTATATE PET/CT and should therefore be used routinely before hepatic cytoreduction of NETs.