Enhancing Diagnostic Accuracy in Sinonasal Neuroendocrine Tumors: The Case for DOTATATE PET Over FDG PET

Neuroendocrine tumors (NET) are a heterogeneous group of neoplasms that arise from neuroendocrine cells and commonly originate in the GI tract, lungs, and pancreas, but can also present in the skull base and paranasal sinuses. While fluorodeoxyglucose positron emission tomography (FDG PET) scans are routinely used in the evaluation of sinonasal malignancies, their limitations in detecting recurrences near the cranium and cervical lymph node metastases in NETs such as olfactory neuroblastoma (ONB) and sinonasal neuroendocrine carcinomas (SNEC) have prompted the search for an alternative imaging modality. Somatostatin receptor 2 (SSTR2) is a membrane-bound G protein expressed in several types of neuroendocrine and neural cells. Notably, it is also expressed almost ubiquitously in ONB and SNEC. Gallium-68 DOTATATE PET scans (68Ga-DOTATATE) utilize a somatostatin analog as a targeting imaging modality. The efficacy of 68Ga-DOTATATE scan has been well established for gastrointestinal NETs, but its place in head and neck cancers is still under investigation. Importantly, SSTR2 expression also opens avenues for peptide receptor radionuclide therapy (PRRT), further broadening its clinical utility. Given the limitations of FDG PET scans, 68Ga-DOTATATE PET scans should be incorporated into routine practice when staging and monitoring for recurrences in ONB and SNEC.