Cancer Integrin Imaging with [68Ga]Ga-Trivehexin PET/CT for a Patient with Breast Cancer and Neuroendocrine Neoplasm: A Case of Both (18F)FDG PET/CT and [68Ga]Ga-DOTATATE Positive but Integrin avβ6 Negative Lesion on [68Ga]Ga-Trivehexin PET

Gamze Beydağı; Nalan Alan Selçuk; Kaan Akçay; Onur Yaprak; Murat Kalaycı; Levent Kabasakal

doi:10.4274/mirt.galenos.2024.60320

Cancer Integrin Imaging with [⁶⁸Ga]Ga-Trivehexin PET/CT for a Patient with Breast Cancer and Neuroendocrine Neoplasm: A Case of Both (¹⁸F)FDG PET/CT and [⁶⁸Ga]Ga-DOTATATE Positive but Integrin avβ6 Negative Lesion on [⁶⁸Ga]Ga-Trivehexin PET

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Cancer Integrin Imaging with [⁶⁸Ga]Ga-Trivehexin PET/CT for a Patient with Breast Cancer and Neuroendocrine Neoplasm: A Case of Both (¹⁸F)FDG PET/CT and [⁶⁸Ga]Ga-DOTATATE Positive but Integrin avβ6 Negative Lesion on [⁶⁸Ga]Ga-Trivehexin PET

Mol Imaging Radionucl Ther 2025;34(2):143-145 DOI: 10.4274/mirt.galenos.2024.60320

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Abstract

Integrins play crucial roles in the migration of tumor cells during angiogenesis and metastasis. Consequently, avβ6-integrin-targeted positron emission tomography (PET) radiopharmaceuticals have been developed and tested in humans, with clinical trials highlighting their applications in idiopathic pulmonary fibrosis and carcinomas. However, data on integrins are limited, and the role of [⁶⁸Ga]Ga-Trivehexin tomography/computed tomography (CT) PET/CT is not well-established. Some studies have suggested that [⁶⁸Ga]Ga-Trivehexin PET/CT is more specific than ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) PET/CT, which can yield false-positive results. It has been shown to be more efficient in evaluating pancreatic lesions and head and neck tumors. The role of [⁶⁸Ga]Ga Trivehexin PET/CT in neuroendocrine tumors is not yet clearly defined. In our case, integrin was negative in the pancreatic neuroendocrine tumor but positive in the breast lobular tumor. Additionally, we observed that the lobular carcinoma lesion in the right breast is somatostatin receptor+positive on [⁶⁸Ga]Ga-DOTATATE PET/CT.

Keywords: Neuroendocrine tumor, integrin positron emission tomography, [68Ga]Ga-Trivehexin positron emission tomography/computed tomography

Figure 1. A 71-year-old woman presented with breast lobular carcinoma for evaluation staging with ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) (a). In the ¹⁸F-FDG PET/CT scan, a hypermetabolic mass consistent with the known primary malignancy was observed in the retroareolar region of the right breast (d). Additionally, in the head-body of the pancreas, a well-defined hypermetabolic lesion was identified (g). Given the possibility of ¹⁸F-FDG PET/CT false positivity in the pancreatic head mass, a [⁶⁸Ga]Ga-Trivehexin PET/CT (b) scan was conducted. The [⁶⁸Ga]Ga-Trivehexin PET/CT showed increased activity uptake in a portion of the right breast mass (e), and no activity uptake was observed in the pancreatic head mass (h). Based on these findings, a biopsy was performed to further investigate the pancreatic mass, which revealed a grade 2 neuroendocrine tumor. Additionally, a [⁶⁸Ga]Ga DOTATATE PET/CT (c) was performed, which demonstrated intense somatostatin receptor expression in the right breast mass (f) and pancreatic head lesion (ı). Integrins, particularly αvβ6-integrin, are involved in tumor cell migration, angiogenesis, and metastasis. Recently, αvβ6-integrin-targeted PET radiopharmaceuticals like [⁶⁸Ga]Ga-Trivehexin have shown promise in imaging certain cancers and fibrotic diseases (,). Comparative studies suggest that [⁶⁸Ga]Ga-Trivehexin may offer advantages over conventional ¹⁸F-FDG PET/CT by reducing false-positive findings. Despite promising results in pancreatic, head and neck lesions, its diagnostic performance in NETs is not yet clearly defined (,,). This study presents a case in which a pancreatic neuroendocrine tumor was integrin-negative, whereas a concurrent lobular carcinoma of the breast showed integrin positivity, also demonstrating somatostatin receptor on [⁶⁸Ga]Ga-DOTATATE PET/CT.

Footnotes

Ethics

Informed Consent: Patient consent was obtained for this study.

Authorship Contributions

Surgical and Medical Practices: O.Y., M.K., Concept: G.B., N.A.S., K.A., L.K., Design: N.A.S., L.K., Data Collection or Processing: G.B., Analysis or Interpretation: G.B., N.A.S., L.K., Literature Search: N.A.S., K.A., Writing: G.B., N.A.S., K.A.

Conflict of Interest: No conflicts of interest were declared by the authors.

Financial Disclosure: The authors declare that they have received financial support for this study from Nukleon Nuclear Technology Research Ind. Trade Ltd. Co.

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