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Accuracy of DOTATATE-positron emission tomography for preoperative nodal staging of carcinoid tumors of the lung.

Accuracy of DOTATATE-positron emission tomography for preoperative nodal staging of carcinoid tumors of the lung. JTCVS open Tsai, L. L., Bommakanti, S., Sridharan, S., Myall, N. J., Guenthart, B. A., Liou, D. Z., Lui, N. S., Backhus, L. M., Berry, M. F., Shrager, J. B., Elliott, I. A. 2025; 27: 157-163

Abstract

DOTATATE-positron emission tomography (PET) scans use a radiotracer that binds somatostatin receptor 2 on neuroendocrine cells to identify carcinoid tumors. Use of DOTATATE-PET during preoperative evaluation of lung carcinoids is increasing, but the accuracy of DOTATATE-PET in nodal staging of pulmonary carcinoids is unknown.We reviewed patients with lung carcinoids undergoing DOTATATE-PET before surgical resection between November 2013 and 2023. Exclusions included non-avid primary tumors on DOTATATE-PET or absent pathologic lymph node assessment. Using surgical pathology as the gold standard, we assessed concordance between DOTATATE-PET-based clinical stage and postoperative pathologic stage. Sensitivity, specificity, negative predictive value, and positive predictive value were calculated, with ?2 and Mann-Whitney U test used for comparisons.Among 58 patients undergoing resection of lung carcinoid tumors (48 typical, 10 atypical carcinoids), 15 (25.8%) had pathologic nodal involvement, but DOTATATE-PET detected only 3. For the 43 patients who were pathologic node-negative, DOTATATE-PET was negative in 42. This yielded 42 true negatives, 3 true positives, 12 false negatives, and 1 false positive, with sensitivity of 20%, specificity 97.7%, negative predictive value 77.8%, positive predictive value 75%, and overall accuracy of 77.6%. Larger tumor size was significantly associated with inaccurate DOTATATE-PET (P = .03). No other clinical characteristics significantly correlated with DOTATATE-PET accuracy.DOTATATE-PET has poor sensitivity for nodal disease in patients with pulmonary carcinoid tumors. Thorough pathologic lymph node evaluation is necessary regardless of DOTATATE-PET results when resecting carcinoid tumors. Given that primary surgery is indicated even if it were known there were positive lymph nodes, the utility of a DOTATATE-PET is likely limited.

View details for DOI 10.1016/j.xjon.2025.07.018

View details for PubMedID 41169312

View details for PubMedCentralID PMC12570576