The Value of 68GA-DOTATATE PET/CT in Sinonasal Neuroendocrine Carcinoma Management and Detection of Local and Distant Metastases: Case Study and Review of Literature

Background: 68Gallium-dotatate (Netspot) is a newer somatostatin analogue that can be used as a PET tracer to successfully identify neuroendocrine tumors (NETs). It has been shown to detect neuroendocrine tumors that traditional imaging failed to identify and offers superior image quality, spatial resolution of small lesions, and diagnostic utility. Due to the rarity of sinonasal NETs there are few recommendations for 68Ga-dotatate imaging and management options in these patients.

Case Presentation: We report the cases of four patients diagnosed with sinonasal NETs and discuss their management utilizing 68Ga-dotatate imaging. The first patient had a left sinonasal mass identified on CT. 68Ga-dotatate PET/CT identified a NET and revealed a pancreatic primary. Biopsy and immunostaining confirmed sinonasal small cell neuroendocrine carcinoma (SNEC). The second patient had a right sinonasal mass identified on MRI. 68Ga-dotatate PET/CT staging demonstrated NET primary malignancy, as well as T3 vertebral metastatic disease. Biopsy and immunostaining confirmed sinonasal SNEC. The third and fourth patients both had right-sided sinonasal NETs, confirmed by biopsy to be esthesioneuroblastomas (ENBs). 68Ga-dotatate PET/CT was used after surgical resection in these patients to scan for residual tumor and metastases, and the third patient was found to have potential residual tumor. Neither had evidence of local nor distant metastases. CONCLUSIONS: 68Ga-dotatate is a superior imaging modality for extrapulmonary sinonasal NETs, with potential to improve diagnostic accuracy and clinical decision making. This report demonstrated the utility of 68Ga-dotatate in sinonasal NET detection. Future studies are required to determine the role 68Ga-dotatate in sinonasal NET management.