Charpentier E, Cadiot G, Le Guludec D, Viens-Bitker C; International Society of Technology Assessment in Health Care. Meeting.
Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 1998; 14: 50.
Comitee for Evaluation and Diffusion of Innovative Technologies (CEDIT), AP-HP, Paris, France.
PURPOSE: Octreotide is an analog of the somatostatin, a hormone selectively fixed on specific endocrinous receptors. These receptors are frequent in neuroendocrine digestive tumours; thus, octreotide has been proposed as a diagnostic tool as well as a therapeutic agent in these diseases. In-octreotide scintigraphy (IOS) has been recognized as a diagnostic tool able to discover numerous tumors or metastases, quite specific but insufficiently sensitive to be used as a stand-alone imaging technique. Its clinical impact, however, was poorly documented at the time of the study. In order to forecast the potential diffusion of this diagnostic technique, we choose to assess the clinical importance of the discovered abnormalities and its impact on patient management rather then its sensitivity and specificity. METHODS: During one year, all patients for which an IOS was requested by the hepatogastroenterology department of Hpital Bichat for management planning of an already proved endocrine digestive tumor (either for initial diagnosis or recurrence) were first to be given a complete set of conventional examinations giving an initial diagnosis, followed by an initial (tentative) management plan. IOS was then made, and its stand-alone results (image interpretation) recorded. These results were then confronted to the whole medical record and a new (final) management plan drafted. Comparisons were made between tumor count and locations as recorded in the initial diagnosis record and the scintigraphic findings. Tentative and final management plans were also compared, and these differences were ranked. RESULTS: 37 patients were included: 14 for Zollinger-Ellison syndromes, 6 for carcinoid syndrome, 5 for a pancreatic non-secreting endocrine tumor, 3 for digestive carcinoid tumor, 9 other cases. 35 of these patients had had an abdominal CT, 30 a thoracic radiography, 27 a bone scintigraphy, 26 an abdominal echography, 23 a fibroscopy, 21 a non-abdominal echography. One patient presented no tumor whatever the image process used: this patient, whose diagnosis was supported only by clinical and biochemical evidence, has been withdrawn from the following results. In-octreotide scintigraphy exhibited 32 tumors already known or suspected by at least one other imaging process; 29 other tumors previously unknown were discovered by IOS alone; but 19 tumors already known were not shoen by IOS. For twelve patients, IOS and initial diagnosis were in exact coincidence; 17 patients presented at least one lesion objectived by IOS only; among them, 5 patients had only tumors objectivable by IOS only. However, 12 patients had at least one already known tumor not objectived by IOS. There is no concordance at all for 12 patients. For 15 patients, tentative and final treatment plans were identical: IOS gave no new information. For 11 patients, minor modifications of the treatment plans were made (mostly new examiniations and reordering of previously-decided examiniations). For 11 patients, the impact of IOS of management plans was deemed major: in 5 cases, a previously-decided surgical procedure was cancelled; in 2 cases, a new surgical procedure was planned; in 2 cases, a previously-decided surgical procedure was deeply changed; and in 3 cases, the initial diagnosis or the tentative management plan were to be totally reconsidered. Assessment of sensitivity and specificity of this procedure appears to be difficult: the only possible "gold standard" (pathology) was often unreachable for ethical reasons. However, since the very nature of this imaging technique gives it an almost 100% specificity, the new information gained can be used with confidence ( a retrospective study of clinical outcome of these patients did not lead to suspicion of "false positives"). IOS sensitivity appears to be poor (76%) when it is used as a stand-alone procedure, but better than the conventional imaging procedures alone (63%). CONCLUSIONS: This study shows that In-octreotide scintigraphy is unable to be substituted to any of the conventional imaging procedures. However, IOS gives new information for two thirds of the patients, and influences the management of most of them. Management of 30% of all the patients is deeply modified.
Publication Types:
Keywords:
- Endocrine Gland Neoplasms
- Hormones
- Humans
- Malignant Carcinoid Syndrome
- Neuroendocrine Tumors
- Octreotide
- Physical Examination
- Receptors, Somatostatin
- Retrospective Studies
- Sensitivity and Specificity
- Somatostatin
- Zollinger-Ellison Syndrome
- diagnosis
- methods
- psychology
- radionuclide imaging
- hsrmtgs
Other ID:
UI: 102234634
From Meeting Abstracts