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Hepato-pancreato-biliary

E216: Correlation of DOTATATE PET-CT Uptake, Pathologic Grade, and ATRX/DAXX Loss of Expression in Localized Non-Metastatic Pancreatic Neuroendocrine Tumors

    ePoster Abstract Author(s)

  • Eleftherios A. Makris, MD PhD

    Surgical Oncology Fellow
    University of Pittsburgh Medical Center, Pennsylvania, United States

    • Submitter(s)

  • Eleftherios A. Makris, MD PhD

    Surgical Oncology Fellow
    University of Pittsburgh Medical Center, Pennsylvania, United States

    • Author(s)

  • Eleftherios A. Makris, MD PhD

    Surgical Oncology Fellow
    University of Pittsburgh Medical Center, Pennsylvania, United States

  • AM

    Ashok Muthukrishnan, MD MS

    Associate Professor of Radiology
    University of Pittsburgh Medical Center, United States

  • AS

    Aatur Singhi, MD, PhD

    Associate Professor of Anatomic Pathology
    University of Pittsburgh Medical Center
    Pittsburgh, Pennsylvania, United States

  • RE

    Rudy El Asmar, MD PhD

    Research Fellow
    University of Pittsburgh Medical Center, United States

  • KL

    Kenneth Lee, MD

    Professor of Surgery
    University of Pittsburgh Medical Center, United States

  • AP

    Alessandro Paniccia, MD

    Assistant Professor of Surgery
    Department of Surgery, University of Pittsburgh Medical Center, United States

  • Amer H. Zureikat, MD

    Professor and Chief
    Division of Surgical Oncology, University of Pittsburgh Medical Center
    Pittsburgh, Pennsylvania, United States

Introduction: DOTATATE PET-CT imaging detects neuroendocrine tumors (NETs) based on their somatostatin receptor (SSTR) expression. Ki-67 proliferation index (PI), and ATRX/DAXX loss of protein expression have been established as prognostic factors in pancreatic NETs (PNETs). We evaluated whether a correlation exists between PNETs pathologic features, ATRX/DAXX protein expression, and SSTR uptake on 68-Ga DOTATATE PET-CT.
 

Methods: Patients with localized primary non-metastatic PNETs that underwent surgical resection between 2018 and 2022 and had preoperative

DOTATATE PET-CT (either 68-Gallium or 64-Copper DOTATATE PET-CT) within a year before resection, were reviewed. Maximum standardized uptake values (SUVmax) of SSTR -PET from the resected lesions were measured and correlated with demographic parameters, pathologic features (tumor size, Ki-67 PI, grade, and mitotic rate) and ATRX/DAXX protein expression, using the Pearson correlation coefficient.

Results: Of 48 patients studied, 65% were male with a median age of 65. Of the 48 resected lesions 60% had Ki-67 PI < 3, 15% had a mitotic rate >2, and 42% were grade >1. The mean ± standard deviation size of the tumors was 3.2 ± 2.1 cm. ATRX/DAXX loss of protein expression was observed in 31% of the lesions and was more common in tumors of patients with advanced age (r=0.307, P=0.036). These were more commonly grade 2 tumors (r=0.366, P=0.011) and had increased Ki-67 PI (0.359 P=0.013). There was no association between tumor size and loss of ATRX/DAXX protein expression (r=0.074, P=0.62). PNETs with low SUVmax were more commonly grade 2 tumors (r=-390, P=0.008), with higher Ki-67 PI (r=-0.383, P</em>=0.009), and loss of ATRX/DAXX protein expression (r=-0.388, P=0.009). There was no association between tumor size and SUVmax (r=-0.028, P=0.857).
 

Conclusions:
Our analysis demonstrates an inverse correlation between SUVmax in DOTATATE PET-CT and Ki-67 PI, tumor grade, and ATRX/DAXX loss of protein expression in localized non-metastatic PNETs. DOTATATE PET-CT is an important preoperative imaging modality that can provide prognostic information and help guide management of PNETs.

Learning Objectives:

  • Upon completion, participant will be able to understand that 68-Ga DOTATATE PET-CT may provide information about the pathologic characteristics of pancreatic neuroendocrine tumors.
  • Upon completion, participant will be able to understand the association between ATRX/DAXX loss of protein expression and pathologic grade in pancreatic neuroendocrine tumors
  • Upon completion, participant may consider using 68-Ga DOTATATE PET-CT as a diagnostic imaging modality and prognostic tool to identify possible ATRX/DAXX loss of expression in pancreatic neuroendocrine tumors