Real-World Results from 2,249 Copper-64 DOTATATE PET Scans for Neuroendocrine Tumors

Retrospective analysis of all clinical routine copper-64 DOTATATE PET/CT scans performed at Copenhagen University Hospital-Rigshospitalet from April 2018 to May 2022. Referral text and image reports for all 2,249 scans were reviewed. Each scan's indication was classified according to established appropriate use criteria (AUC). Image results were categorized as no disease, stable, progression, or other.

Somatostatin receptor PET/CT using peptide-based tracers is the gold standard for imaging neuroendocrine tumors, but guidelines about when to use it are still evolving. This is the largest real-world study of copper-64 DOTATATE, and it provides the evidence base to expand appropriate use criteria. The finding that PET detected progression invisible to CT in over 20% of worsening cases is clinically important — it means some patients would have their disease progression missed without the peptide-based scan.

Peptide-based PET imaging using somatostatin analogs (like DOTATATE labeled with gallium-68 or copper-64) has transformed neuroendocrine tumor management. This study demonstrates the clinical value of these scans at scale and provides data to support broader use. The copper-64 label offers potential advantages over gallium-68 including longer half-life and potentially better image quality. Real-world studies like this are essential for developing evidence-based imaging guidelines.

This is a single-center, retrospective study from a specialized neuroendocrine tumor center, which may not reflect practice patterns at general hospitals. Referral bias toward more complex cases could inflate the rate of detected progression. The study did not compare copper-64 DOTATATE directly with gallium-68 DOTATATE or FDG-PET. Clinical outcomes based on scan findings were not reported.