The value of somatostatin-receptor scintigraphy in newly diagnosed endocrine gastroenteropancreatic tumors

• Published in: Journal of the American College of Surgeons Vol. 184; no. 5; pp. 487 - 492
• Main Authors: KISKER, O, BARTSCH, D, WEINEL, R, JOSEPH, K, WELCKE, U. H, ZARACA, F, ROTHMUND, M
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Science 01-05-1997; American College of Surgeons
• Subjects: Adult; Aged; Biological and medical sciences; Carcinoid Tumor - diagnostic imaging; Carcinoid Tumor - secondary; Diagnostic Imaging; Digestion. Liver. Biliary tract. Spleen. Pancreas; Evaluation Studies as Topic; Female; Gastrinoma - diagnostic imaging; Gastrinoma - secondary; Humans; Insulinoma - diagnostic imaging; Insulinoma - secondary; Investigative techniques, diagnostic techniques (general aspects); Liver Neoplasms - secondary; Male; Medical sciences; Middle Aged; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - pathology; Prospective Studies; Radionuclide Imaging - methods; Radionuclide investigations; Receptors, Somatostatin; Stomach Neoplasms - diagnostic imaging; Stomach Neoplasms - pathology; Performance evaluation; Radionuclide study; Human; Stomach; Gut; Scintigraphy; Interest; Secretory tumor; Digestive diseases; Medical imagery; Intestinal disease; Diagnosis; Somatostatin; Pancreas; Gastric disease; Pancreatic disease; Hormonal receptor
• ISSN: 1072-7515; 1879-1190

Conventional imaging techniques do not routinely detect endocrine gastroenteropancreatic tumors preoperatively. The purpose of this study was to determine whether the new technique of somatostatin-receptor scintigraphy would improve the detection rate of these tumors before initial treatment.
In a prospective study, 55 patients with a recent diagnosis of endocrine gastroenteropancreatic tumors (22 intestinal carcinoids, 17 gastrinomas, 10 nonfunctioning pancreatic tumors, and 6 insulinomas), were examined with somatostatin-receptor scintigraphy, computed tomography, and ultrasonography. Results of the three imaging modalities were compared with findings at surgical exploration.
None of the insulinomas were localized by somatostatin-receptor scintigraphy, but 4 of 6 insulinomas were detected by computed tomography and ultrasonography. Of 17 gastrinomas, 9 were detected by somatostatin-receptor scintigraphy; computed tomography and ultrasonography localized only 7. Metastases from the gastrinoma were localized by somatostatin-receptor scintigraphy in all cases; computed tomography and ultrasonography detected metastases in only 6 of 9 patients. Nonfunctioning tumors could be localized by somatostatin-receptor scintigraphy, computed tomography, and ultrasonography in 4, 7, and 8 of 10 cases, respectively. Detection rate for corresponding metastases was the same for all three imaging techniques. Primary carcinoids were identified by somatostatin-receptor scintigraphy, ultrasonography, and computed tomography in 7, 8, and 11 of 22 cases, respectively. Extra-abdominal metastases were detected by somatostatin-receptor scintigraphy in only 7 of 19 patients.
In patients with insulinomas, somatostatin-receptor scintigraphy is not indicated because none of the six tumors was imaged. This holds true for nonfunctional pancreatic endocrine tumors and their metastases because no advantage for somatostatin-receptor scintigraphy was found over computed tomography and ultrasonography. In contrast, somatostatin-receptor scintigraphy is superior to computed tomography and ultrasonography for determining the extent of the disease in patients with gastrinomas or carcinoids. The problem of detecting primary tumors in these patients is not solved by somatostatin-receptor scintigraphy.