The utility of 18F-FDG and 68Ga-DOTA-Peptide PET/CT in the evaluation of primary pulmonary carcinoid: A systematic review and meta-analysis

Medicine (Baltimore). 2019 Mar;98(10):e14769. doi: 10.1097/MD.0000000000014769.


Background: Pulmonary carcinoids (PC) are histologically classified into typical carcinoid (TC) and atypical carcinoid (AC). The diagnosis of pulmonary carcinoid and possibly the differentiation between TC and AC could make a significant effect on the treatment planning as well as prognosis. Several studies have explored the utility of Ga-DOTA-Peptide (Ga-labelled [1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid]-peptide) and F-flurodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) in the evaluation of primary pulmonary carcinoids. Therefore, we performed a meta-analysis to evaluate the diagnostic accuracy and prediction efficiency of histological subtypes of these two imaging modalities in primary PC.

Methods: Relevant studies were identified by searching PubMed, Web of Science, and EMBASE published from 2006 to 2016. Two authors extracted characteristics of patients and their lesions using predefined criteria.

Results: Fourteen studies comprising 352 patients were included in this meta-analysis. The pooled sensitivity of Ga-DOTA-Peptide and F-FDG PET/CT in detecting pulmonary carcinoid were 90.0% (95% CI = 82.0-95.0%; P = .07; I = 49.6%) and 71.0% (95% CI = 66.0-76.0%; P < .001; I = 59.3%), respectively. An SUVmax ratio between Ga-DOTA-Peptide and F-FDG higher than the cutoff value of 4.28 was predictive of TC with 89.3% sensitivity and 100% specificity (AUC, 96.4%; 95% CI, 91.1-100%). The ratio of tumor uptake to atelectatic lung uptake was significantly higher for Ga-DOTA-peptide (2.5-91, mean 30.5 ± 28.1) than for F-FDG (0.3-10.3, mean 2.1 ± 2.3) (P < .001).

Conclusions: Both Ga-DOTA-peptide and F-FDG are highly sensitive in detecting pulmonary carcinoid, while Ga-DOTA-peptide is more sensitive than F-FDG (90.0% vs 71.0%). The SUVmax ratio was an accurate predictor of the histopathologic variety of the carcinoid tumor, and Ga-DOTA-peptide was better than F-FDG in cases with atelectasis.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Acetates*
  • Carcinoid Tumor / diagnostic imaging*
  • Carcinoid Tumor / metabolism
  • Fluorodeoxyglucose F18*
  • Gallium Radioisotopes*
  • Humans
  • Lung Neoplasms / diagnostic imaging*
  • Lung Neoplasms / metabolism
  • Peptides, Cyclic*
  • Positron Emission Tomography Computed Tomography*
  • Radiopharmaceuticals*


  • 68Ga-DOTA-Peptide
  • Acetates
  • Gallium Radioisotopes
  • Peptides, Cyclic
  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18