Poster Presentation ESA-SRB-ANZOS 2025 in conjunction with ENSA

Initial experience with Somatostatin receptor scintigraphy in evaluating patients with Neuroendocrine neoplasms in a resource-limited setting (128734)

Pavani Punchihewa 1 2 , Supun Wijayawardena 2 , Nethrani Pathirana 3 , Athukorala Tharaka 3 , Udugama Chandragupta 4 , Rabel Prasanna 3 , Bulugahapitiya Uditha 3 , Muthukuda Dimuthu 2
  1. St John of God Midland Public and Private Hospital, Midland, WA, Australia
  2. Sri Jayawardenapura General Hospital, Colombo, Sri Lanka
  3. National Hospital of Sri Lanka, Colombo, Sri Lanka
  4. Lanka Hospital PLC, Colombo, Sri Lanka

Neuroendocrine neoplasms (NENs) are rare tumors that frequently express somatostatin receptors (SSTR), making them amenable to functional imaging with somatostatin receptor scintigraphy (SRS). Although advanced SRS are now available, lack of access to functional imaging remains a major obstacle in the effective management of NEN in developing countries. We present the initial experience with Octreotide scan in Sri Lanka.

Case 1: 44-year-old male with suspected MEN-1 syndrome had a pancreatic lesion, liver metastases and elevated gastrin levels with gastric hyperplasia. SRS helped to localize the gastrinoma.

Case 2: 41-year-old male with suspected MEN-1 syndrome had pancreatic lesions, elevated gastrin levels. SRS demonstrated NEN in 2nd part of duodenum and uncinate process of pancreas.

Case 3: 53-year-old male with cervical, mediastinal lymphadenopathy was found to have NEN on biopsy.  Anterior mediastinal mass, pericardial effusion with a cardiac free-wall mass, suggested metastasis. SRS aided the diagnosis of a metastatic NEN.

Case 4: 50-year-old male with prior hemicolectomy, presented with carcinoid syndrome and was found to have SSTR-positive hepatic metastases on SRS.

Case 5: 47-year-old male with MEN-1 syndrome had prior insulinoma resection with positive LN. He underwent SRS for suspected pancreatic tumor recurrence; scan was negative guiding conservative follow-up.

Case 6: 42-year-old female with a history of distal pancreatectomy for NEN, presented with Zollinger-Ellison syndrome. Biochemistry suggested NEN recurrence. Although CECT was negative, SRS demonstrated SSTR positive focus in liver.

Case 7: 68-year-old male with diarrhoea, mesenteric mass, liver metastases had biochemistry suggesting NEN. However, SRS was negative suggesting poorly differentiated NEN.

Patients with SRS demonstrating SSTR positivity, were commenced on Octreotide treatment.

These highlight the clinical utility of Octreotide scan in management of NEN, where conventional imaging is inconclusive in a resource-limited setting. However, financial constraints and lack of international collaborations continue to hinder the sustainability of this service.