Characterizing bone metastases and skeletal‐related events in patients with well‐differentiated neuroendocrine neoplasms utilizing 68Gallium‐DOTATATE positron emission tomography
9 affiliations
- 1Division of Hematology and Oncology Duke Cancer Center Durham North Carolina USA
- 2Division of Hematology and Oncology Mayo Clinic in Jacksonville Jacksonville Florida USA
- 3Division of Hematology and Oncology Wake Forest Baptist Medical Center Winston‐Salem North Carolina USA
- 4Division of Clinical Trials and Biostatistics Mayo Clinic in Jacksonville Jacksonville Florida USA
- 5Division of Nuclear Medicine Mayo Clinic in Jacksonville Jacksonville Florida USA
- 6Division of Nuclear Medicine Mayo Clinic in Rochester Rochester Minnesota USA
- 7Department of Radiation Oncology Mayo Clinic in Phoenix Phoenix Arizona USA
- 8Division of Hematology and Oncology Mayo Clinic in Phoenix Phoenix Arizona USA
- 9Division of Hematology and Oncology Mayo Clinic in Rochester Rochester Minnesota USA
Abstract
Tumors of neuroendocrine origin are a heterogenous group of related neoplasms which can arise from anywhere in the body. Neuroendocrine neoplasms (NENs) are categorized by site of origin, differentiation status and grade (Ki‐67 expression and/or mitotic rate), with significant prognostic variability accordingly. Historically, the prevalence of bone metastasis is reported to be 6%–12% based on “first generation” (i.e., 111Indium pentetreotide [Octreoscan®]) somatostatin receptor imaging (SSRI). We conducted a retrospective cohort study including patients with well‐differentiated NENs to determine the clinical and imaging characteristics of osseous metastases when evaluated with higher‐sensitivity 68Gallium‐DOTATATE positron emission tomography (PET) scans, as well as determining fracture prevalence in selected sub‐cohorts. We also developed a risk score analysis to assess risk of fracture in this cohort. Four hundred twenty‐four patients were identified for inclusion. The median age was 61 years. Most patients were asymptomatic (64%), had sclerotic lesions (77%), Krenning 4 (71%), and had >3 sites (69%) of osseous disease. A high proportion of patients had osseous metastases at sites with high risk for fracture, including vertebra (82%), pelvis (63%), and peri‐trochanteric femur (34%). Fifty‐seven patients (13%) in the entire cohort suffered a fracture. Fracture prevalence was significantly lower in small bowel neuroendocrine tumors (NETs, 7%) and Grades 1 and 2 disease (8% and 9%, respectively), with higher prevalence in pancreatic NETs, paragangliomas/pheochromocytomas, lung carcinoid, and Grade 3 disease (≥20% for each; p‐values <.05). Our study showed that the rate of osseous metastatic disease approximates 20% in well‐differentiated NENs. Most bone metastases are asymptomatic and the risk of fracture is variable based on the primary site of disease and tumor grade. Our novel risk score analysis for fracture was designed to assist clinician decision making as to management of bone metastasis in this patient population.
Related
- Use of bone-modifying agents for bone metastases from neuroendocrine neoplasms: a single-centre audit
- Editorial: Unveiling the complexity of neuroendocrine neoplasms: biomarkers, classification, and translational perspectives
- Spotlight on Small-Cell Lung Cancer and Other Lung Neuroendocrine Neoplasms.
- High concordance in molecular profiles between primary tumors and matched lymph node metastases in differentiated thyroid carcinoma: implications for clinical sample selection
- Primary Hepatic Neuroendocrine Neoplasms: Systematic Review and Expert Pathologist Reappraisal Using the WHO 6th Edition Framework
BibTeX
@article{coston2026characterizing,
title = {{Characterizing bone metastases and skeletal‐related events in patients with well‐differentiated neuroendocrine neoplasms utilizing 68Gallium‐DOTATATE positron emission tomography}},
author = {Tucker W. Coston and Himil J. Mahadevia and Marie M. Plante and Alex Hochwald and Joseph M. Accurso and Akash Sharma and Geoffrey B. Johnson and Jonathan B. Ashman and A. Tuba Kendi and Mohamad Bassam Sonbol and Patrick W. McGarrah and Timothy J. Hobday and Thorvardur R. Halfdanarson and Jason S. Starr},
journal = {Journal of Neuroendocrinology},
year = {2026},
month = oct,
doi = {10.1111/jne.70301},
url = {https://doi.org/10.1111/jne.70301},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Characterizing bone metastases and skeletal‐related events in patients with well‐differentiated neuroendocrine neoplasms utilizing 68Gallium‐DOTATATE positron emission tomography
AU - Tucker W. Coston
AU - Himil J. Mahadevia
AU - Marie M. Plante
AU - Alex Hochwald
AU - Joseph M. Accurso
AU - Akash Sharma
AU - Geoffrey B. Johnson
AU - Jonathan B. Ashman
AU - A. Tuba Kendi
AU - Mohamad Bassam Sonbol
AU - Patrick W. McGarrah
AU - Timothy J. Hobday
AU - Thorvardur R. Halfdanarson
AU - Jason S. Starr
PY - 2026
DA - 2026/10/27
JO - Journal of Neuroendocrinology
DO - 10.1111/jne.70301
UR - https://doi.org/10.1111/jne.70301
AB - Tumors of neuroendocrine origin are a heterogenous group of related neoplasms which can arise from anywhere in the body. Neuroendocrine neoplasms (NENs) are categorized by site of origin, differentiation status and grade (Ki‐67 expression and/or mitotic rate), with significant prognostic variability accordingly. Historically, the prevalence of bone metastasis is reported to be 6%–12% based on “first generation” (i.e., 111Indium pentetreotide [Octreoscan®]) somatostatin receptor imaging (SSRI). We conducted a retrospective cohort study including patients with well‐differentiated NENs to determine the clinical and imaging characteristics of osseous metastases when evaluated with higher‐sensitivity 68Gallium‐DOTATATE positron emission tomography (PET) scans, as well as determining fracture prevalence in selected sub‐cohorts. We also developed a risk score analysis to assess risk of fracture in this cohort. Four hundred twenty‐four patients were identified for inclusion. The median age was 61 years. Most patients were asymptomatic (64%), had sclerotic lesions (77%), Krenning 4 (71%), and had >3 sites (69%) of osseous disease. A high proportion of patients had osseous metastases at sites with high risk for fracture, including vertebra (82%), pelvis (63%), and peri‐trochanteric femur (34%). Fifty‐seven patients (13%) in the entire cohort suffered a fracture. Fracture prevalence was significantly lower in small bowel neuroendocrine tumors (NETs, 7%) and Grades 1 and 2 disease (8% and 9%, respectively), with higher prevalence in pancreatic NETs, paragangliomas/pheochromocytomas, lung carcinoid, and Grade 3 disease (≥20% for each; p‐values <.05). Our study showed that the rate of osseous metastatic disease approximates 20% in well‐differentiated NENs. Most bone metastases are asymptomatic and the risk of fracture is variable based on the primary site of disease and tumor grade. Our novel risk score analysis for fracture was designed to assist clinician decision making as to management of bone metastasis in this patient population.
SN - 0953-8194
SN - 1365-2826
ER -