Would you ever consider treatment without tissue diagnosis for a gastrointestinal neuroendocrine metastatic tumor based on a positive DOTATATE scan alone?

Tissue would be ideal, but I would treat the above scenario with caveats.

The sensitivity and specificity of modern-day DOTA SSTR imaging approaches 90%.

The question I would have is whether the patient needs treatment in the first place, based on burden of disease seen?

Is disease behaving aggressi...

Based on oncologic principles, we should have a tissue diagnosis. However, if two biopsy attempts are non-diagnostic, I would consider treating based on a gallium dotatate scan. The sensitivity and specificity of this scan for NET are 91% and 94%, respectively, according to a recent meta-analysis of...