e16318 Background: Neuroendocrine tumors (NET) are a biologically diverse set of neoplasms that vary in malignant potential. The wide spectrum of disease tempos and the long course require timely clinical judgement for good long-term outcomes. Clinical decision making is critically dependent on imaging results; however, the lack of detail and variation in reports can make the process inconsistent. Automated quantitative analysis of change in every lesion over the course of treatment can contribute to the standardization of therapeutic decisions by providing more precise calculations of disease progression. Methods: A retrospective analysis of fifty-one patients from a high-volume neuroendocrine practice was completed to evaluate the clinical utility of automated lesion quantification from DOTATATE PET/CT PET scans. The automated analysis provided total standardized uptake values (total, max and mean) for the total disease and each lesion, lesion volume, and a 3-D spatial map showing the location of each lesion. PET/CT reports from the radiologist were assessed for the presence of both qualitative and quantitative information. Clinical decisions based on the imaging automated analysis and radiology report were correlated. Results: Fifty-one consecutive patients with metastatic NET were analyzed (small intestine/midgut: 42, pancreatic: 6, rectal: 2, appendiceal 1). Radiologists mentioned the total number of lesions in 12%, lesions size change in 58%, and clear overall response in 56% of the reports. The automated quantitation gave a Total SUV range from 0 – 23088 and PET Volume 0 – 899 cm3. From these values, we were able to calculate volume disease tempo (change in PET volume/time) which ranged from –992 to 281 cm3/year and SUV disease tempo (change in total SUV/time) which ranged from –15135 to 6760. Patients who underwent surgery/procedure had the largest decrease in quantitative parameters. Patients with volume disease tempo > 25 cm3/year all continued with surveillance. Patients with > 25 cm3/year underwent treatment change. One patient with metastatic small intestinal NET had a 144% increase in total SUV and was administered 177Lu-DOTATATE therapy. After the completion of treatment, the total SUV decreased by 5%. Conclusions: Management of patients with NET requires detailed and timely data, yet it is infeasible for radiologists to provide such data for each lesion. Automated quantitative PET analysis provided comprehensive, standardized data for change in each lesion that proved clinically impactful for decisions to continue or change therapies.
Liu et al. (Thu,) studied this question.