Head‐to‐head comparison between 18F‐DOPA PET/CT and 68Ga‐DOTA peptides PET/CT in detecting intestinal neuroendocrine tumours: A systematic review and meta‐analysis

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Abstract
Purpose: The imaging of intestinal neuroendocrine tumours (NETs) relies on functional positron emission tomography (PET) tracers; these tumours can be studied by means of both 68Ga‐DOTA peptides and 18F‐fluorodihydroxyphenyl‐ l‐alanine (18F‐DOPA) PET/computed tomography (CT). As yet, it is unclear which of these two modalities offers the better sensitivity. We therefore conducted a meta‐analysis to assess the available data.Methods: PubMed, CENTRAL, Scopus and Web of Science were searched for studies comparing the sensitivity of 68Ga‐DOTA peptides and 18F‐DOPA PET/CT; papers up to February 2021 were considered. In each study, we considered sensitivity in terms of patient‐based analysis (PBA), region‐based analysis (RBA) and lesion‐based analysis (LBA), and pooled the results yielded by each tracer. Multidisciplinary follow‐up served as the standard of truth.Results: Of the 636 records identified, 6 articles published between 2008 and 2021 were finally selected, and 112 intestinal NETs patients were included. The pooled sensitivity of 18F‐DOPA PET/CT was 83%, 89% and 95% on PBA, RBA and LBA, respectively. 68Ga‐DOTA peptides PET/CT showed sensitivity of 88%, 92% and 82% on PBA, RBA and LBA, respectively. No significant differences were found between the two tracers on PBA and RBA. By contrast, a clear trend towards significance in favour of 18F‐DOPA PET/CT was identified on LBA. The presence of a significant difference in favour of 18F‐DOPA PET/CT was confirmed in a subgroup analysis conducted only on the most recent and largest studies. In all three analyses, mild‐to‐high heterogeneity was found; however, no publication bias was observed.Conclusion: Both 18F‐DOPA PET/CT and 68Ga‐DOTA‐peptides PET/CT are reliable diagnostic procedures in patients with intestinal NETs. However, in terms of lesion detection, a non‐negligible difference in favour of 18F‐DOPA PET/CT was observed. Thus, the use of 18F‐DOPA PET/CT could be considered as a first‐line molecular procedure in intestinal NETs.

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