Background

Radioguided surgery (RGS) for gastroenteropancreatic neuroendocrine tumours (GEP-NETs) has been suggested as a way to improve intraoperative lesion detection. This systematic literature review of reports of the use of RGS for GEP-NETs was performed to determine if there is a benefit.

Methods

A literature search was conducted using Google Scholar and PubMed, and snowballing from any relevant literature. Full-text studies were included if they were published in the English language and reported outcomes of RGS on human subjects with GEP-NETs. Qualitative data synthesis was performed.

Results

Twenty-six papers including a total of 209 patients were included. The tracers used were predominantly indium-111 pentetreotide, gallium-68 DOTA-peptides, and technetium-99m EDDA/HYNIC-peptides. Heterogeneous protocols make comparisons difficult, but most papers reported a benefit from the use of RGS in tumours in the gastrointestinal tract; utility in localisation of pancreatic tumours was less clear. Time between tracer administration and operation varied: from 16 h to 8 days with indium-111, 0–24 h with technetium-99m, and 19–193 min with gallium-68. Eight teams reported the thresholding technique used for discrimination—four used a ratio, four statistical methods, and one looked at the sensitivity and specificity of different cut-offs. Six teams performed follow-up of 24 patients (three pancreas, eight gastrinoma, 13 gastrointestinal tract) for between 3 months and 3 years. Two patients relapsed (one pancreas, one gastrinoma) between 6 and 12 months post-surgery.

Conclusions

RGS appears to aid in localisation of gastrointestinal NETs, but the benefit is more equivocal in pancreatic NETs. Further work into outcomes is warranted.

中文翻译：

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胃肠胰腺神经内分泌肿瘤的放射引导手术：系统性文献综述

背景

胃肠胰腺神经内分泌肿瘤 (GEP-NET) 的放射引导手术 (RGS) 已被建议作为改善术中病变检测的一种方法。对 GEP-NET 使用 RGS 的报告进行了系统的文献回顾，以确定是否有益处。

方法

使用 Google Scholar 和 PubMed 进行文献搜索，并从任何相关文献中滚雪球。如果全文研究以英语发表并报告了 RGS 对具有 GEP-NET 的人类受试者的结果，则包括在内。进行了定性数据合成。

结果

共纳入 26 篇论文，共 209 名患者。使用的示踪剂主要是铟 111 喷曲肽、镓 68 DOTA 肽和锝 99m EDDA/HYNIC 肽。异构方案使比较变得困难，但大多数论文报告了在胃肠道肿瘤中使用 RGS 的好处；胰腺肿瘤定位的效用不太清楚。示踪剂给药和操作之间的时间各不相同：使用铟 111 为 16 小时至 8 天，使用锝 99m 为 0-24 小时，使用镓 68 为 19-193 分钟。八个团队报告了用于区分的阈值技术——四个使用了比率，四种统计方法，一个研究了不同临界值的敏感性和特异性。六个团队对 24 名患者（三名胰腺、八名胃泌素瘤、13 胃肠道）3 个月至 3 年。两名患者在术后 6 至 12 个月内复发（一名胰腺，一名胃泌素瘤）。

结论

RGS 似乎有助于胃肠道 NETs 的定位，但在胰腺 NETs 中的益处更不明确。有必要进一步研究结果。