Metastases outside the liver and abdominal/retroperitoneal lymph nodes are nowadays detected frequently in patients with neuroendocrine tumours (NETs), owing to the high sensitivity of positron emission tomography (PET) with Gallium‐68‐DOTA‐somatostatin analogues (68Ga‐SSA) and concomitant diagnostic computed tomography (CT). Our aim was to determine the prevalence of extra‐abdominal metastases on 68Ga‐DOTATOC‐PET/CT in a cohort of patients with small intestinal (Si‐NET) and pancreatic NET (Pan‐NET), as well as that of pancreatic metastasis in patients with Si‐NET. Among 2090 patients examined by 68Ga‐DOTATOC‐PET/CT at two tertiary referral centres, a total of 1177 patients with a history of Si‐ or Pan‐NET, were identified. The most recent 68Ga‐DOTATOC‐PET/CT report for each patient was reviewed, and the location and number of metastases of interest were recorded. Lesions outside the liver and abdominal nodes were found in 26% of patients (n = 310/1177), of whom 21.5% (255/1177) were diagnosed with Si‐NET and 4.5% (55/1177) Pan‐NET. Bone metastases were found in 18.4% (215/1177), metastases to Virchow's lymph node in 7.1% (83/1177), and lung/pleura in 4.8% (56/1177). In the subset of 255 Si‐NET patients, 5.4% (41/255) manifested lesions in the pancreas, 1.5% in the breast (18/255), 1.3% in the heart (15/255) and 1% in the orbita (12/255). In Si‐NET patients, the Ki‐67 proliferation index was higher in those with ≥2 metastatic sites of interest, than with 1 metastatic site, (p <0.001). Overall, extra‐abdominal or pancreatic metastases were more often found in patients with Si‐NET (34%) than in those with Pan‐NET (13%) (p <0.001). Bone metastases were 2.6 times more frequent in patients with Si‐NET compared to Pan‐NET patients (p <0.001). Lesions to the breast and orbita were encountered in almost only Si‐NET patients. In conclusion, lesions outside the liver and abdominal nodes were detected in as many as 26% of the patients, with different prevalence and metastatic patterns in patients with Si‐NET compared to Pan‐NET. The impact of such metastases on overall survival and clinical decision‐making needs further evaluation.

中文翻译：

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小肠和胰腺神经内分泌肿瘤患者 68Ga-DOTATOC-PET/CT 肝外和腹部淋巴结转移的发生率

由于使用镓-68-DOTA-生长抑素类似物进行正电子发射断层扫描（PET）的高灵敏度，如今在神经内分泌肿瘤（NET）患者中经常检测到肝脏以外和腹部/腹膜后淋巴结的转移。68Ga-SSA）和伴随诊断计算机断层扫描（CT）。我们的目的是确定腹外转移瘤的患病率68Ga-DOTATOC-PET/CT 在一组小肠 (Si-NET) 和胰腺 NET (Pan-NET) 患者以及 Si-NET 患者胰腺转移患者中进行。在接受检查的 2090 名患者中68在两个三级转诊中心进行 Ga-DOTATOC-PET/CT，共识别出 1177 名有 Si- 或 Pan-NET 病史的患者。最近的68审查每位患者的 Ga-DOTATOC-PET/CT 报告，并记录感兴趣转移的位置和数量。 26%的患者发现肝脏以外的病变和腹部淋巴结（n= 310/1177），其中 21.5%（255/1177）被诊断为 Si-NET，4.5%（55/1177）为 Pan-NET。 18.4% (215/1177) 发现骨转移，7.1% (83/1177) 发现 Virchow 淋巴结转移，4.8% (56/1177) 发现肺/胸膜转移。在 255 名 Si-NET 患者中，5.4% (41/255) 表现为胰腺病变，1.5% 表现为乳腺病变 (18/255)，1.3% 表现为心脏病变 (15/255)，1% 表现为眼眶病变(12/255)。在 Si-NET 患者中，具有 ≥2 个感兴趣转移部位的患者的 Ki-67 增殖指数高于具有 1 个转移部位的患者（p<0.001）。总体而言，Si-NET 患者 (34%) 比 Pan-NET 患者 (13%) 更常发现腹外或胰腺转移（p<0.001）。与 Pan-NET 患者相比，Si-NET 患者的骨转移发生率高 2.6 倍（p<0.001）。几乎只有 Si-NET 患者才会出现乳房和眼眶损伤。总之，多达 26% 的患者检测到肝脏和腹部淋巴结以外的病变，与 Pan-NET 患者相比，Si-NET 患者的患病率和转移模式不同。此类转移对总体生存和临床决策的影响需要进一步评估。