Clinical validation and diagnostic accuracy of 99mTc-EDDA/HYNIC-TOC compared to 111In-DTPA-octreotide in patients with neuroendocrine tumours: the LACOG 0214 study

Cristina M Moriguchi-Jeckel, Rafael R Madke, Graciane Radaelli, Alice Viana, Patrícia Nabinger, Bruna Fernandes, Gustavo Gössling, Eduardo H Berdichevski, Eduardo Vilas, Juliana Giacomazzi, Matheus Soares Rocha, João Alfredo Borges, Elias Hoffmann, Samuel Greggio, Gianina T Venturin, Carlos H Barrios, Facundo Zaffaroni, Gustavo Werutsky, Jaderson C da Costa, Cristina M Moriguchi-Jeckel, Rafael R Madke, Graciane Radaelli, Alice Viana, Patrícia Nabinger, Bruna Fernandes, Gustavo Gössling, Eduardo H Berdichevski, Eduardo Vilas, Juliana Giacomazzi, Matheus Soares Rocha, João Alfredo Borges, Elias Hoffmann, Samuel Greggio, Gianina T Venturin, Carlos H Barrios, Facundo Zaffaroni, Gustavo Werutsky, Jaderson C da Costa

Abstract

99mTc-EDDA/HYNIC-TOC is an easily available and cheaper radionuclide that could be used for somatostatin-receptor-based imaging of neuroendocrine tumours (NETs). We aimed to evaluate the diagnostic performance of 99mTc-EDDA/HYNIC-TOC compared to111In-DTPA-octreotide in patients (pts) with NETs. We performed a prospective diagnostic study including pts with biopsy-confirmed NET and at least one visible lesion at conventional imaging. Two independent nuclear medicine physicians evaluated pts who underwent 99mTc and 111In scans and images. The primary outcome was comparative diagnostic accuracy of 99mTc and 111In. Secondary outcomes include safety. Nine pts were included and performed 14 paired scans. Overall, 126 lesions were identified. 99mTc demonstrated superior sensitivity both when all images were analysed (93.7, 95% CI 88.1% - 96.8% versus 74.8%, 95% CI 66.6 - 81.6%, p < 0.001) and when liver-specific images were analysed (97.8%, 95% CI 92.7% - 99.5% versus 85.1%, 95% CI 76.6% - 91.0%, p < 0.001). 99mTc was also associated with a lower negative likelihood ratio (LR) (0.002, 95% CI 0.009 - 0.1 versus 0.19, 95% CI 0.12 - 0.42, p = 0.009) when evaluating hepatic lesions. Adverse events happened in 3 pts after 111In and in 2 pts after 99mTc, all grade 1. The 99mTc demonstrated a higher sensitivity overall and a better negative LR in liver-specific images compared to 111In in pts with NETs. Our findings suggest that 99mTc is an alternative to 111In and is especially useful in ruling out liver metastases. NCT02691078.

Keywords: indium In111; neuroendocrine tumours; radionuclide imaging; technetium TC99m.

Conflict of interest statement

Dr Moriguchi-Jeckel and Dr Werutsky report grants from Financiadora de Estudos e Projetos (FINEP) for the conduct of the study. Drs R. Madke, Viana, Nabinger, and Fernandes report employment relationships with the RPH Group. Dr. Werutsky reports personal fees from AstraZeneca, Bayer, Beigene, Daiichi Sankyo, Genentech/Roche, GSK, Lilly, MSD, Novartis, Pfizer, Sanofi, and Seattle Genetics outside the submitted work. The other authors declare that they have no conflict of interest.

© the authors; licensee ecancermedicalscience.

Figures

Figure 1.. 99m Tc-EDDA/HYNIC-TOC compared to 111…
Figure 1.. 99mTc-EDDA/HYNIC-TOC compared to 111In-DTPA-octreotide. Example of scintigraphy examination using (a): 111In-DTPA-octreotide and (b): 99mTc-EDDA/HYNIC-TOC in the same patient, showing a more significant number of foci of uptake using 99mTc.

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