68-Ga-labeled Octreotide Analogues PET in Duodenal-pancreatic Neuroendocrine Tumours - Full Text View

Purpose

The diagnostic work-up of patients suspected of having neuroendocrine tumours (NETs) has traditionally been a challenging issue. The last two decades have been marked by the application to use in the diagnosis of NETs of 3 newly available diagnostic techniques: endoscopic ultrasonography (EUS), multidetector CT (MDCT), and more recently, positron emission tomography using 68Ga-labelled octreotide analogues (PET). In a prospective study conducted at a single referral centre that compared PET with conventional somatostatin receptor scintigraphy and MDCT in diagnosis, staging and follow-up of patients affected by NET, PET detected more primary and secondary lesions than other methods. Recent studies investigated the clinical impact of PET in the management of patients affected by NET, previously studied by MDCT. The investigators recently reported the results of the investigation of 19 patients suspected of having primary pancreatic NET and studied by PET, MDCT and EUS. The investigators preliminary data suggest that PET may be slightly more sensitive than MDCT in detecting small (<2cm) pancreatic lesions; accuracy of PET and EUS is probably similar. No prospective study has yet been devoted to evaluate the accuracy of PET in the diagnosis and staging of primary duodenal-pancreatic NETs. Furthermore, the clinical impact of the adjunct of PET to the traditional protocols of diagnosis and staging of these tumours waits to be thoroughly evaluated. Thus the appropriate place of PET in the diagnostic algorithm of patients suspected of having duodenal-pancreatic NET remains undefined.

The main aim of this project is to prospectively compare the accuracy of PET and MDCT in the diagnosis and staging of patients suspected of having duodenal-pancreatic NETs. The investigators hypothesised that PET is superior to MDCT in the diagnosis of these neoplasm (the dimension of the study sample is estimated in order to detect a 10% difference). The impact of PET on management plan of affected patients will also be evaluated. As a secondary endpoint of the study, the investigators will compare EUS, PET and MDCT in the diagnosis of primary duodenal-pancreatic NET. The study is designed as a multicentre, prospective, non-randomised clinical trial. All patients will undergo MDCT, PET and EUS in this fixed order.

Condition	Intervention	Phase
Neuroendocrine Tumours	Drug: Diagnostic work up	Phase 2

Study Type:	Interventional
Study Design:	Endpoint Classification: Safety/Efficacy Study Intervention Model: Single Group Assignment Masking: Open Label Primary Purpose: Diagnostic
Official Title:	Accuracy and Clinical Impact of 68-Ga-labeled Octreotide Analogues PET in Diagnosis and Staging of Duodenal-pancreatic Neuroendocrine Tumours; Proposal of a Multicenter, Prospective Clinical Trial

Resource links provided by NLM:

MedlinePlus related topics: Cancer

Drug Information available for: Octreotide acetate Octreotide

U.S. FDA Resources

Further study details as provided by Arcispedale Santa Maria Nuova-IRCCS:

Primary Outcome Measures:

Accuracy of the diagnostic test. [ Time Frame: one year ] [ Designated as safety issue: No ]
Accuracy was computed as: (number of true positives + true negatives)/(number + true positives + true negatives + false positives + false negatives). Accuracy of MDCT and PET in the diagnosis of primary duodenal-pancreatic NET will be calculated on a patient basis and they will be compared using McNemar test. Reference standard will be considered the diagnoses of primary NET, when supported by unambiguous cytology, histology or by at least one year of follow up.In cases of disagreement between cytological and histological findings, histology will be the gold standard.
Accuracy of the diagnostic test (after exclusion of patients enrolled due to a incidentally diagnosed lesion) [ Time Frame: one year ] [ Designated as safety issue: No ]
Accuracy was calculated as above, but based on subjects matching criteria 1-7 of the list of clinical situations suggestive for NET (see below, inclusion criteria). Patients with a lesion suspicion of NET incidentally diagnosed during abdominal ultrasound or MDCT not performed for clinical suspicion of NET were excluded.

Secondary Outcome Measures:

Number of Participants with Adverse Events as a Measure of Safety. [ Time Frame: one year ] [ Designated as safety issue: Yes ]
Number of patients with adverse events of each procedure: PET, MDCT, endoscopic ultrasonography-fine needle aspiration (EUS-FNA)
Sensitivity of the diagnostic tests. [ Time Frame: one year ] [ Designated as safety issue: No ]
Sensitivity (Number of true positive results/number of true positive + false negative results) of the diagnostic tests in the diagnosis of primary duodenal-pancreatic NET. Sensitivity of each diagnostic test (MDCT, PET, EUS) will be calculated separately on patient (number of true affected patients/number of true affected + number of false non affected patients) and on lesion basis (number of true positive lesions/number of true positive + false positive lesions)with its 95% confidence interval based on normal approximation.Reference standard will be considered the diagnoses of primary NET, when supported by unambiguous cytology, histology or by at least one year of follow up.In cases of disagreement between cytological and histological findings, histology will be the gold standard.
Specificity of the diagnostic tests. [ Time Frame: one year ] [ Designated as safety issue: No ]
Specificity (Number of true negative results/number of true negative + false positive results) of the diagnostic tests in the diagnosis of primary duodenal-pancreatic NET. Specificity of each diagnostic test (MDCT, PET, EUS) will be calculated separately on patient (number of true non affected patients/number of true non affected + number of false affected patients) and on lesion basis (number of true negative lesions/number of true negative positive + false positive lesions)with its 95% confidence interval based on normal approximation.Reference standard will be considered the diagnoses of primary NET, when supported by unambiguous cytology, histology or by at least one year of follow up.In cases of disagreement between cytological and histological findings, histology will be the gold standard.
Clinical impact of PET. [ Time Frame: one year ] [ Designated as safety issue: No ]
Changes in management plan in consequence of PET results. Prior to receiving the results of the PET scans, the referring clinician will be required to explicit a management plan for the patient. Following the release of the PET results, a second management plan will be recorded, including any changes resulting from the PET findings. The number of patients with changes in their management plan will be recorded.
Diameter of lesions. [ Time Frame: one year ] [ Designated as safety issue: No ]
Median diameter (cm) and ranges of lesions diagnosed by each technique will be calculated.

Other Outcome Measures:

Accuracy of EUS-FNA [ Time Frame: one year ] [ Designated as safety issue: No ]
Accuracy was computed as: (number of true positives + true negatives)/(number + true positives + true negatives + false positives + false negatives). Reference standard will be considered the diagnoses of primary NET, when supported by histology or by at least one year of follow up.

Estimated Enrollment:	142
Study Start Date:	August 2012
Estimated Study Completion Date:	August 2015
Estimated Primary Completion Date:	August 2015 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: Diagnostic work up The patients enrolled in the study (see below), with a consistent clinical suspicion of a primary duodenal-pancreatic NET.	Drug: Diagnostic work up Patients will undergo MDCT, PET and EUS. Every attempt will be made to achieve a pre-operative cytologic diagnosis of any primary lesion by EUS-FNA. All diagnostic tests (MDCT, PET, EUS) should be performed during a two month time span, in this fixed order. The nuclear medicine doctor will be blinded of findings of MDCT. The gastroenterologist will be blinded about the findings of MDCT and PET until he has completed the diagnostic EUS. For ethical reasons, the findings of MDCT and PET will be disclosed to her/him, while the patient is still sedated in the operating room, just before the FNA. The minimal technical requirement for the techniques, the requested levels of clinical competence of the operators and the procedure for critical revision of radiological and cytological and histological specimens are detailed in the protocol. For PET any 68Ga -labeled-octreotide analogue will be allowed. Before EUS, an extended-esophagogastroduodenoscopy (until the Treitz) until will be performed.

Arms

Assigned Interventions

Experimental: Diagnostic work up

The patients enrolled in the study (see below), with a consistent clinical suspicion of a primary duodenal-pancreatic NET.

Drug: Diagnostic work up

Patients will undergo MDCT, PET and EUS. Every attempt will be made to achieve a pre-operative cytologic diagnosis of any primary lesion by EUS-FNA. All diagnostic tests (MDCT, PET, EUS) should be performed during a two month time span, in this fixed order. The nuclear medicine doctor will be blinded of findings of MDCT. The gastroenterologist will be blinded about the findings of MDCT and PET until he has completed the diagnostic EUS. For ethical reasons, the findings of MDCT and PET will be disclosed to her/him, while the patient is still sedated in the operating room, just before the FNA. The minimal technical requirement for the techniques, the requested levels of clinical competence of the operators and the procedure for critical revision of radiological and cytological and histological specimens are detailed in the protocol. For PET any 68Ga -labeled-octreotide analogue will be allowed. Before EUS, an extended-esophagogastroduodenoscopy (until the Treitz) until will be performed.

Eligibility

Ages Eligible for Study:	18 Years to 90 Years
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Patients affected by proved MEN-I, in whom a neoplasm in the duodenal-pancreatic area is suspected.
Patients with clinical diagnosis of carcinoid syndrome.
Patients with clinical diagnosis of Zollinger-Ellison syndrome.
Patients with insulinoma, as proved by fasting test.
Patient with clinical pictures and laboratory findings suggesting other functional or non-functional NET.
Patients who had previously undergone surgery, including total and subtotal pancreatectomy, or a duodenotomy, intended as curative for a histologically confirmed NET.
Patients who were diagnosed with NET metastasis with unknown primary location of the disease.
Patients undergoing diagnostic work-up for a periduodenal or pancreatic lesion incidentally found during abdominal ultrasound (not performed for suspicion of a NET) and with ultrasonographic characteristics (rounded, hypoechoic or egg-eye, well demarcated) suspicious for NET.
Patients undergoing diagnostic work-up for a periduodenal or pancreatic lesion incidentally found during TC (not performed for suspicion of a NET) and with radiological characteristics (well demarcated, hypervascular) suspicious for NET.

Exclusion criteria:

Patient unwilling, or unable to consent.
Pregnancy, or lactation.
Age <18 years
Known diagnosis of duodenal-pancreatic NET.
Patients with concomitant life-threatening disease.
Patients who had already undergone PET or EUS, in the last six months. In particular patients should be excluded from the study, when a lesion in the duodenal-pancreatic area, with characteristic suspicious for a NET, is incidentally diagnosed by PET, or EUS, or when a previously unsuspected diagnosis of NET is suggested by EUS-FNA of a pancreatic lesion.
Patients who had previously undergone total gastrectomy or pancreatectomy will be included in the study, but they will not undergo EUS.

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT01673906

Contacts

Contact: Annibale Versari, MD

+390522296313

annibale.versari@asmn.re.it

Locations

Austria
Irene Virgolini	Not yet recruiting
Innsbruck, Austria
Contact: Irene Virgolini, MD
Principal Investigator: Irene Virgolini, MD
Italy
Federica Matteucci	Not yet recruiting
Forlì, Meldola, Italy
Contact: Federica Matteucci, MD
Principal Investigator: Federica Matteucci, MD
Laura Scaltriti	Not yet recruiting
Guastalla, Reggio Emilia, Italy, 42100
Contact: Laura Scaltriti, MD laura.scaltriti@ausl.re.it
Principal Investigator: Laura Scaltriti, MD
ASMN IRCCS Reggio Emilia	Recruiting
Reggio Emilia, RE, Italy, 42100
Contact: Annibale Versari, MD
Principal Investigator: Annibale Versari, MD
Enrico Papini	Not yet recruiting
Albano Laziale, Roma, Italy
Contact: Enrico Papini, MD
Principal Investigator: Enrico Papini, MD
Paola Tomassetti	Not yet recruiting
Bologna, Italy
Contact: Paola Tomassetti, MD paola.tomasetti@unibo.it
Principal Investigator: Paola Tomassetti, MD
Nadia Cremonini	Not yet recruiting
Bologna, Italy
Contact: Nadia Cremonini, MD nadia.cremonini@ausl.bo.it
Principal Investigator: Nadia Cremonini, MD
Fernando Cirillo	Not yet recruiting
Cremona, Italy
Contact: Fernando Cirillo, MD
Principal Investigator: Fernando Cirillo, MD
Diego Ferone	Not yet recruiting
Genova, Italy
Contact: Diego Ferone, MD
Principal Investigator: Diego Ferone, MD
Giovanna Pepe	Not yet recruiting
Milano, Italy
Contact: Giovanna Pepe, MD
Principal Investigator: Giovanna Pepe, MD
Rita Conigliaro	Not yet recruiting
Modena, Italy, 41121
Contact: Rita Conigliaro, MD r.conigliaro@ausl.mo.it
Principal Investigator: Rita Conigliaro, MD
Luppi Gabriele	Not yet recruiting
Modena, Italy
Contact: Luppi Gabriele, MD luppi.gabriele@policlinico.mo.it
Principal Investigator: Gabriele Luppi, MD
Pellegrino Crafa	Not yet recruiting
Parma, Italy, 43121
Contact: Pellegrino Crafa, MD r.crafa@ao.pr.it
Principal Investigator: Pellegrino Crafa, MD
Piero Ferolla	Not yet recruiting
Perugia, Italy
Contact: Piero Ferolla, MD
Principal Investigator: Piero Ferolla, MD
Antonio Chella	Not yet recruiting
Pisa, Italy
Contact: Antonio Chella, MD
Principal Investigator: Antonio Chella, MD
Roberto Baldelli	Not yet recruiting
Roma, Italy
Contact: Roberto Baldelli, MD
Principal Investigator: Roberto Baldelli, MD
Vittoria Rufini	Not yet recruiting
Roma, Italy
Contact: Paolo Limone, MD
Principal Investigator: Paolo Limone, MD
Claudio De Angelis	Not yet recruiting
Torino, Italy
Contact: Claudio De Angelis, MD
Principal Investigator: Claudio De Angelis, MD
Marco Gallo	Not yet recruiting
Torino, Italy
Contact: Marco Gallo, MD
Principal Investigator: Marco Gallo, MD
Paolo Limone	Not yet recruiting
Torino, Italy
Contact: Paolo Limone, MD
Principal Investigator: Paolo Limone, MD
Franco Grimaldi	Not yet recruiting
Udine, Italy
Contact: Franco Grimaldi, MD
Principal Investigator: Franco Grimaldi, MD
Roberto Castello	Not yet recruiting
Verona, Italy
Contact: Roberto Castello, MD
Principal Investigator: Roberto Castello, MD
Massimo Falconi	Not yet recruiting
Verona, Italy
Contact: Massimo Falconi, MD
Principal Investigator: Massimo Falconi, MD

Sponsors and Collaborators

Arcispedale Santa Maria Nuova-IRCCS

Investigators

Study Director:	Lorenzo Camellini, MD	Gastroenterology and Digestive Endoscopy Unit, Santa Maria Hospital, Reggio Emilia, Italy.
Study Director:	Gabriele Carlinfante, MD	Unit of Pathology, Santa Maria Nuova Hospital, Reggio Emilia, Italy
Study Director:	Andrea Frasoldati, MD	Department of Endocrinology, Thyroid Disease Center—Arcispedale Santa Maria Nuova of Reggio Emilia, Reggio Emilia, Italy.
Study Director:	Armando Froio, Biologist	Nuclear Medicine Unit, Santa Maria Nuova Hospital
Study Director:	Tiziana Cassetti, Biologist	Gastroenterology and Digestive Endoscopy Unit, Santa Maria Hospital, Reggio Emilia, Italy.

More Information

Publications:

Gabriel M, Decristoforo C, Kendler D, Dobrozemsky G, Heute D, Uprimny C, Kovacs P, Von Guggenberg E, Bale R, Virgolini IJ. 68Ga-DOTA-Tyr3-octreotide PET in neuroendocrine tumors: comparison with somatostatin receptor scintigraphy and CT. J Nucl Med. 2007 Apr;48(4):508-18.

Ambrosini V, Campana D, Bodei L, Nanni C, Castellucci P, Allegri V, Montini GC, Tomassetti P, Paganelli G, Fanti S. 68Ga-DOTANOC PET/CT clinical impact in patients with neuroendocrine tumors. J Nucl Med. 2010 May;51(5):669-73. Epub 2010 Apr 15.

Versari A, Camellini L, Carlinfante G, Frasoldati A, Nicoli F, Grassi E, Gallo C, Giunta FP, Fraternali A, Salvo D, Asti M, Azzolini F, Iori V, Sassatelli R. Ga-68 DOTATOC PET, endoscopic ultrasonography, and multidetector CT in the diagnosis of duodenopancreatic neuroendocrine tumors: a single-centre retrospective study. Clin Nucl Med. 2010 May;35(5):321-8.

Responsible Party:	Annibale Versari, Director of Nuclear Medicine Department, Arcispedale Santa Maria Nuova-IRCCS
ClinicalTrials.gov Identifier:	NCT01673906 History of Changes
Other Study ID Numbers:	2012-000994-22, 2012-000994-22
Study First Received:	August 9, 2012
Last Updated:	November 29, 2012
Health Authority:	Italy: The Italian Medicines Agency

Keywords provided by Arcispedale Santa Maria Nuova-IRCCS:

positron-emission tomography
neuroendocrine tumors
endosonography

tomography, X-ray computed
biopsy, fine needle
sensitivity and sensibility

Additional relevant MeSH terms:

Neuroendocrine Tumors
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Nerve Tissue
Neoplasms, Glandular and Epithelial
Pancreatic Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Endocrine Gland Neoplasms

Pancreatic Diseases
Adenoma, Islet Cell
Adenoma
Digestive System Diseases
Endocrine System Diseases
Octreotide
Antineoplastic Agents, Hormonal
Antineoplastic Agents
Therapeutic Uses
Pharmacologic Actions
Gastrointestinal Agents

ClinicalTrials.gov processed this record on May 19, 2013