Diagnostic performance and impact on patient management of [68Ga]Ga-DOTA-TOC PET/CT in colorectal neuroendocrine tumors derived from hindgut
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Abstract:
The main purpose of this retrospective study was to determine the diagnostic performance of [68Ga]Ga-DOTA-D-Phe1-Try3-octreotide(DOTA-TOC) positron emission tomography/computed tomography (PET/CT) in patients with well-differentiated colorectal Neuroendocrine Tumours (NETs) originating from the hindgut. The other aims were to assess the impact of the examination on patient management and to analyze the results of 2-[18F]FDG and/or 6-[18F]FDOPA PET/CT when they were performed. [68Ga]Ga-DOTA-TOC PET/CT and clinical data from 30 patients with biopsy-proven well-differentiated NETs originating from the hindgut were retrospectively reviewed and analyzed by comparing the [68Ga]Ga-DOTA-TOC PET/CT findings with pathological and/or follow-up data. We also compared the [68Ga]Ga-DOTA-TOC PET/CT results with 2-[18F]FDG and/or 6-[18F]FDOPA PET/CT results in 6 patients. The impact on management was determined in hindsight by comparing the patient management decided before and after the TEP examination based on data from multidisciplinary team meetings. On a patient basis, [68Ga]Ga-DOTA-TOC PET/CT was accurate in 30 of the 30 examinations. [68Ga]Ga-DOTA-TOC PET/CT correctly identified the primary tumor in all patients with primary tumors not resected before the examination and allowed the detection of unexpected distant metastases in 36% of the patients referred for initial staging. [68Ga]Ga-DOTA-TOC PET/CT findings affected patient management in 57% of cases with generally major intermodality changes. Intraindividual comparison of the results of the different PET radiopharmaceuticals showed a clear superiority of [68Ga]Ga-DOTA-TOC PET/CT considering both the number of lesions and the intensity of uptake. [68Ga]Ga-DOTA-TOC PET/CT is an accurate imaging modality for the assessment of well-differentiated colorectal NETs that highly impact patient management. Thus, we suggest that [68Ga]Ga-DOTA-TOC PET/CT be employed as a first choice for the assessment of these tumors in nuclear medicine.Keywords:
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PET-CT
DOTA
Carcinoid tumours are generally classified according to their origin as foregut, midgut or hindgut. 111In pentetreotide and 123I labelled mIBG are commonly used for diagnosis of these tumours. The aim of our study was to assess the difference in mIBG uptake in foregut, midgut and hindgut carcinoids. Fifty-two patients with carcinoid tumours (13 foregut, 30 midgut, 4 hindgut, and 5 unknown) underwent 123I labelled mIBG whole-body and liver SPECT imaging. The tumour uptakes were classified on visual analysis as grade 1 (tumour uptake less than liver), grade 2 (uptake equal to liver) and grade 3 (uptake greater than liver). Eighteen (34%) patients had grade 1 uptake (3 foregut, 14 mid and hindgut, 1 unknown), 18 (34%) had grade 2 uptake (7 foregut, 7 mid and hindgut, 4 unknown) and 16 (32%) had grade 3 uptake (3 foregut, 13 mid and hindgut). Grade 3 uptake was seen in more patients with mid and hindgut carcinoids (38%) than foregut (23%). 123I labelled mIBG demonstrated high uptake (grade 3) in mid and hindgut compared to foregut carcinoids and is more useful. The low to moderate uptake in foregut carcinoids could be due to the known cytochemical differences in these tumours.
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Carcinoid tumour
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Spirochetes are observed in the hindguts of termites and the wood-eating cockroach. Hindgut spirochetes occur free in the gut fluid as well as attached to the surfaces of hindgut protozoa. The two species of spirochetes from termite hindguts were determined to be Treponema azotonutricium and Treponema primitia. Some hindgut spirochetes attach by one end to the surface of certain flagellate protozoa found only in the lower termites and Cryptocercus punctulatus. Motile spirochetes have been observed within the cytoplasm of hindgut protozoa. The hindgut spirochetes and Cryptocercus punctulatus will be included in the family Spirochaetaceae and placed among the spirochetal genera. Spirochaetes / Spirochaetia / Spirochaetales / Hindgut spirochetes of termites and Cryptocercus punctulatus
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Introduction: Neuroendocrine tumors (NET) constitute a heterogeneous group of rare neoplasms, with a sustained increase in incidence in recent years. They originate in neuroendocrine cells, the most common are those of the gastrointestinal system and most are sporadic, although they can be part of hereditary syndromes. Neuroendocrine neoplasms are divided into well-differentiated neuroendocrine tumors (WDNET) and poorly differentiated neuroendocrine carcinomas (PDNEC). Material and methods: We retrospectively evaluated 78 WDNET of the anterior, middle and posterior intestine, in a period of 20 years (01/01/2000 to 07/31/2020), with the SATB2 antibody, in which it is considered a diagnostic marker for WDNET of the hindgut tract. Results: Of the 40 WDNET of the anterior intestine, 2 (5%) tumors showed reactivity with SATB 2. Positive staining with SATB2 was observed in 1/17 (5.88%) of WDNET of the midgut. Among the 21 WDNET of the hindgut, we observed SATB2 staining in 19 (90.57%) of the tumors. Conclusion: Our results indicate that SATB2 is a sensitive marker for hindgut WDNET, although it is not specific. Keywords: STAB2 protein; Carcinoid tumors; Gastroenteropancreatic neuroendocrine tumors; Neuroendocrine tumor; Colorectal neuroendocrine tumors.
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Large intestine
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Omnivorous experimental animals with different levels of short-chain fatty acids in hindgut contents or in feces were established by surgical bypass of the colon and/or the cecum. Levels of short-chain fatty acids, amounts of luminal contents, and the water contents in these animals were compared. Regional variations in water absorption and retention of luminal contents are likely to be major factors in the regulation of hindgut functions.
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Short-chain fatty acid
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Specialized junctional complexes and the ultrastructural morphology of the hindgut epithelial cells indicate that the terrestrial isopod hindgut epithelium functions in transport. The hindgut is divided into an anterior hindgut (typhlosole region), a posterior hindgut (papillate region) and a rectum. Using mitochondrial morphometry as an indicator of cell transport activity, Coruzzi et al. demonstrated that the posterior hindgut of Arniadillidium vulgare is active in osmoregulation to a greater degree than O. asellus . A study was undertaken to determine if this difference is reflected in the CA ++ -ATPase activity of the hindgut epithelial cells of O. asellus .
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Ventral nerve cord
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