Elsevier

Surgery

Volume 124, Issue 6, December 1998, Pages 1000-1004
Surgery

American Association of Endocrine Surgeons
Use of somatostatin receptor scintigraphy to image extrahepatic metastases of neuroendocrine tumors

Presented at the 19th Annual Meeting of the American Association of Endocrine Surgeons, Orlando, Fla, Apr 26-28, 1998.
https://doi.org/10.1067/msy.1998.93919Get rights and content

Abstract

Background: The presence of lymph node metastases significantly influences the modality of treatment in patients with liver metastases of neuroendocrine tumors (NET). Somatostatin receptor scintigraphy (Octreo-Scan, Mallinckrodt-Diagnostica, Petten, the Netherlands) is a method for localization and staging NET. The aim of our prospective study was to evaluate the effectiveness of somatostatin receptor scintigraphy in the identification of extrahepatic tumor spread. Methods: Thirty-five patients with liver metastases of NET were studied over a 5-year period. The presence of NET was confirmed histologically in all cases. To detect extrahepatic metastases or local tumor recurrence, conventional imaging techniques and somatostatin receptor scintigraphy were carried out. Results: In correlation with the findings of conventional imaging methods, somatostatin receptor scintigraphy confirmed liver metastases in all patients. Additionally, 19 of 35 patients (54.2%) had extrahepatic tumor lesions not detected by other imaging techniques. Of those, 15 had extensive abdominal or thoracic lymph node metastases, 3 patients had bone metastases, and in 1 patient with bronchial carcinoid local tumor recurrence was detected. All 19 patients were excluded from further evaluation for liver resection or transplantation and subjected to conservative treatment. The somatostatin receptor scintigraphy sensitivity, confirmed at the time of operation, was 91.6%. In 1 patient, in whom cluster transplantation was performed, somatostatin receptor scintigraphy failed to disclose disseminated carcinosis of the pleural cavity, detected at autopsy (false-negative rate 8.3%). Conclusion: In our experience, somatostatin receptor scintigraphy provides a highly sensitive diagnostic method to localize metastases of NET. We recommend somatostatin receptor scintigraphy before liver surgery in every patient with hepatic metastases of NET to identify candidates suitable for resection. (Surgery 1998;124:1000-4.)

Section snippets

Patients and methods

We prospectively studied 35 consecutive patients with confirmed histologic diagnosis of neuroendocrine tumors who were referred to the Department of Surgery, University Hamburg, between September 1992 and March 1998 for treatment of liver metastases diagnosed elsewhere (Table I).

. Histologic distribution of neuroendocrine tumors in patients referred for resection of liver metastases

Tumor histologic diagnosisNo.
Carcinoid24
MTC4
Insulinoma2
Gastrinoma1
MEN 1 gastrinoma1
MEN 1 VIPoma1
MEN 2

Results

The presence of liver metastases was confirmed in all 35 patients by CT, MRI, and ultrasonography. Additionally, in 4 patients (11%) CT and MRI disclosed extrahepatic tumor. Two patients, 1 with gastrinoma and 1 with carcinoid, had bone metastases and in 2 patients with bronchial carcinoids extensive intra-abdominal lymph node metastases were diagnosed.

Octreotide scintigraphy showed liver metastases in each patient (Fig 1).

. A, CT scan of upper abdomen showing bilateral, multiple liver

Discussion

The presence of liver metastases is the single most important prognostic factor in patients with malignant neuroendocrine tumors. Liver resection is the only potentially curative therapy and offers the best chance of survival. However, curative resection can only be achieved when there are no extrahepatic metastases or local tumor recurrence. To select candidates that should undergo surgery, extensive preoperative diagnostic workup including imaging techniques such as CT, MRI, and conventional

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Reprint requests: Andrea Frilling, MD, Department of General Surgery, University Hospital Essen, Hufelandstr 55, 42155 Essen, Germany.

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