Nöroendokrin Tümörlerde Evreleme Galyum-68 Dotatate PET/BT Görüntüleme: Primer Tümör SUVmax Değeri ile Patolojik Grade ve Ki-67 Proliferasyon İndeksi Arasındaki İlişki

Year 2025, Volume: 7 Issue: 1, 101 - 108, 25.02.2025

Özge Vural Topuz , Emin Büyüktalancı

https://doi.org/10.52827/hititmedj.1605027

Abstract

Amaç: Nöroendokrin tümörlerde (NET) tedavi öncesi Ga-68 DOTATATE PET/BT görüntülemede primer lezyon maximum standartlaştırılmış alım değerinin (SUVmax) histolojik derece ve Ki-67 proliferasyon indeksini öngörmedeki rolünü belirlemektir.
Gereç ve Yöntem: Ocak 2021-Nisan 2024 tarihleri arasında Ga-68 DOTATATE PET/BT görüntülemesi yapılmış 57 nöroendokrin tümör tanılı hasta retrospektif değerlendirildi. Hastaların yaş, histopatoloji, primer tümör lokalizasyonları, tümör boyutları, Ki-67 proliferasyon indeksleri, histolojik dereceleri ve tümör SUVmax değerleri kayıt edildi. Histolojik derece 2 ve 3 grup bir arada gruplandı (derece 2&3).
Bulgular: Yaş ortalaması 49,44 ± 17,20 idi. En sık biyopsi lokasyonları karaciğer (%28,07), mide (%21,05) ve pankreas (%19,30) idi. Ortalama Ki-67 proliferasyon indeksi 5 idi (çeyrekler açıklığı: 2 - 8). 19 hastada (% 33,33) derece 1, 35 hastada derece 2 (% 61,40) ve 3 hastada derece 3 tümör (%5,26) vardı. ümörlerin SUVmax değerleri, tümör boyutları ve Ki-67 proliferasyon indeksleri ile, Ki-67 proliferasyon indeksleri de tümör boyutları ve mitoz sayıları ile pozitif korele idi. Derece 2&3 tümörlü hastalar daha ileri yaşlı olup tümör SUVmax değerleri derece 1 tümörlere göre anlamlı olarak daha yüksekti. ROC analizinde SUVmax değeri >12,5 eşiğinin derece 2&3 hasta grubunu %57,89 duyarlılık, %78,95 özgüllük, % 64,91doğruluk, % 84,62 pozitif öngörü değeri ve % 48,39 negatif öngörü değeri ile ayırt edebildiği gösterildi (EAA: 0,669, 95% CI: 0,526-0,811, p=0,039).
Sonuç: Nöroendokrin tümörlerde inisyal Ga-68 DOTATATE PET/BT’de primer tümöre ait SUVmax değerinin Ki-67 proliferasyon indeksleri ile pozitif korele olduğu ve 12,5 g/ml eşik değerinin üzerinde olmasının derece 2&3 hastaları erken dönemde yüksek pozitif öngörü değeri ile ayırt edebildiği gösterildi.

Keywords

DOTATATE, Ga-68, NET, SUVmax, PET

Ethical Statement

Bu çalışma için Gazi Üniversitesi Klinik Araştırmalar Etik Kurulu tarafından onay alınmıştır. (Karar No: 2018-836)

Supporting Institution

yok

Thanks

yok

Staging Gallium-68 DOTATATE PET/CT Imaging in Neuroendocrine Tumors: Relationship between Measured SUVmax of the Primary Tumor and the Pathological Grade and Ki-67 Proliferation Index

Abstract

Objective: To determine whether the maximum standardized uptake value (SUVmax) of the primary lesion measured via Ga-68 DOTATATE PET/CT imaging can be used to predict histological grade and Ki-67 proliferation index in treatment-naïve neuroendocrine tumors (NETs).
Material and Method: A total of 57 patients diagnosed with NET who underwent Ga-68 DOTATATE PET/CT between January 2021 and April 2024 were retrospectively evaluated. Patient data including age, histopathology, primary tumor localization, tumor size, Ki-67 proliferation index, histological grade, and SUVmax values from the same tumor were recorded. Histological grades 2 and 3 were pooled into a single group (grade 2&3).
Results: The mean age was 49.44 ± 17.20 years. The most common biopsy locations were the liver (28.07%), stomach (21.05%), and pancreas (19.30%). Median Ki-67 proliferation index was 5 (interquartile range: 2–8). Grade 1 tumors were present in 19 patients (33.33%), grade 2 tumors in 35 patients (61.40%), and grade 3 tumors in 3 patients (5.26%). The SUVmax values were positively correlated with tumor size and Ki-67 proliferation index, and Ki-67 proliferation index was positively correlated with tumor size and mitotic count. Patients with grade 2&3 tumors had significantly higher SUVmax values and were older compared to those with grade 1 tumors. For predicting grade 2&3 tumors, the SUVmax value had an area under the ROC curve value of 0.669 (95% CI: 0.526–0.811, p=0.039), which yielded an overall accuracy of 64.91%, with 57.89% sensitivity, 78.95% specificity, 84.62% positive predictive value, and 48.39% negative predictive value, at a cut-off value of >12.5.
Conclusion: Initial Ga-68 DOTATATE PET/CT imaging in NETs demonstrated that the SUVmax value of the primary lesion is positively correlated with Ki-67 proliferation index. A maximum standardized uptake value threshold of >12.5 g/ml was shown to distinguish grade 2&3 tumors at an early stage with high positive predictive value.

Keywords

SUVmax, PET, DOTATATE, NETs, Ga-68

Ethical Statement

This study was approved by the Gazi University Clinical Research Ethics Committee. (Decision no: 2018-836)

Supporting Institution

none

Thanks

none

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