Personalized Medicine and Imaging Superiorityof [Ga]-DOTATATEPET/CTtoOther Functional Imaging Modalities in the Localization of SDHB-Associated Metastatic Pheochromocytoma and Paraganglioma

Purpose: Patients with succinate dehydrogenase subunit B (SDHB) mutation–related pheochromocytoma/paraganglioma (PHEO/PGL) are at a higher risk for metastatic disease than other hereditary PHEOs/PGLs. Current therapeutic approaches are limited, but the best outcomes are based on the early and proper detection of as many lesions as possible. Because PHEOs/PGLs overexpress somatostatin receptor 2 (SSTR2), the goal of our study was to assess the clinical utility of [Ga]-DOTA(0)-Tyr(3)-octreotate ([Ga]-DOTATATE) positron emission tomography/computed tomography (PET/CT) and to evaluate its diagnostic utility in comparison with the currently recommended functional imaging modalities [F]-fluorodopamine ([F]-FDA), [F]-fluorodihydroxyphenylalanine ([F]-FDOPA), [F]-fluoro-2-deoxy-D-glucose ([F]FDG) PET/CT as well as CT/MRI. Experimental Design: [Ga]-DOTATATE PET/CT was prospectively performed in 17 patients with SDHB-relatedmetastatic PHEOs/PGLs. All patients also underwent [F]-FDG PET/CT and CT/MRI, with 16 of the 17 patients also receiving [F]-FDOPA and [F]-FDA PET/CT scans. Detection rates of metastatic lesions were compared between all these functional imaging studies. A composite synthesis of all used functional and anatomical imaging studies served as the imaging comparator. Results: [Ga]-DOTATATE PET/CT demonstrated a lesionbased detection rate of 98.6% [95% confidence interval (CI), 96.5%–99.5%], [F]-FDG, [F]-FDOPA, [F]-FDA PET/CT, and CT/MRI showed detection rates of 85.8% (CI, 81.3%–89.4%; P < 0.01), 61.4% (CI, 55.6%–66.9%; P < 0.01), 51.9% (CI, 46.1%– 57.7%; P < 0.01), and 84.8% (CI, 80.0%–88.5%; P < 0.01), respectively. Conclusions: [Ga]-DOTATATE PET/CT showed a significantly superior detection rate to all other functional and anatomical imaging modalities and may represent the preferred future imagingmodality in the evaluation of SDHB-relatedmetastatic PHEO/ PGL. Clin Cancer Res; 21(17); 3888–95. 2015 AACR. See related commentary by Hofman and Hicks, p. 3815