AI Article Synopsis

  • * Sensitivity for tumor identification was similar across contrast-enhanced CT (CECT) and two types of PET scans (SSTR and FDG), but notably low for DOPA-PET, while CECT showed better results for specific tumors like Thymic NET.
  • * SSTR-PET/CT is recommended as the preferred imaging method due to its lower false positive rate, although a significant number of tumors (about 25%) in patients remain undetected with current methods, indicating a need for further research.

Article Abstract

Background: To elucidate the role of various imaging modalities for tumor localization in ectopic ACTH Cushing's syndrome (EAS).

Design And Method: Systematic review of the literature published between January 2015-2024 was performed. Patients (290 EAS patients, 23.8% Occult) who underwent contrast enhanced CT (CECT) and at least one PET/CT-scan (Ga-SSTR, FDG and/or F-DOPA) were included.

Results: The sensitivity for identifying EAS tumor was comparable across CECT (63.1%, n=290), SSTR-PET/CT (58.2%, n=187), and FDG-PET/CT (57.6%, n=191), but was poor for DOPA-PET/CT (30.8%, n=26). Sensitivity for detecting metastasis was also comparable across CECT (78%, n=73), SSTR-PET/CT (85.3%, n=41), and FDG-PET (73.7%, n=38). For localised lesions, sensitivity as per etiology and grade of NET were similar for three scans, with exception of Thymic NET and grade 1 NET where CECT was better than FDG PET/CT. In patients not localised on CECT, sensitivity of SSTR PET/CT was 33.3% (vs. 18.9% FDG-PET/CT) whereas for patients negative on CECT and FDG-PET, sensitivity of SSTR-PET/CT was 15%. In cases where CECT and SSTR-PET/CT failed to localize, the sensitivities of FDG-PET/CT and DOPA-PET/CT were only 5.7% (2/35) and 0% (0/9), respectively. SSTR-PET/CT has a distinct advantage with significantly lesser false positive (FP) lesions (2.6%, mostly in thyroid/or pancreas). In comparison, CECT and FDG-PET/CT had FP ∼11% (mostly in lung and/or mediastinum), most of which were negative on SSTR-PET/CT.

Conclusions: As per the current evidence, SSTR-PET/CT can be considered as the scan of choice in EAS evaluation, and further research is needed as one-fourth of the lesions remain occult.

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Source
http://dx.doi.org/10.1016/j.ando.2024.07.001DOI Listing

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