Toward Precision Imaging in Lung NET: A Clinically Oriented Framework Integrating Dual Tracer PET and Radiomics.
Authors
Affiliations (11)
Affiliations (11)
- National Center for Drug Research and Evaluation, National Institute of Health (ISS), 00161 Rome, Italy.
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy.
- Gastroenterology and Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy.
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, ENETS Center of Excellence, Sapienza University of Rome, 00189 Rome, Italy.
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, "Sapienza" University, 00189 Rome, Italy.
- Department of Experimental Medicine, Sapienza University of Rome, 00185 Rome, Italy.
- U.O.C. Diagnostic Imaging, PTV Policlinico "Tor Vergata" University, 00133 Rome, Italy.
- Nuclear Medicine Unit, University Hospital Sant'Andrea, 00189 Rome, Italy.
- Medical Oncology Unit, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy.
- Department of Clinical Medicine and Surgery, Section of Endocrinology, Diabetology, Andrology and Nutrition, University of Naples Federico II, 80138 Naples, Italy.
- UNESCO Chair for Health Education and Sustainable Development, University of Naples Federico II, 80138 Naples, Italy.
Abstract
<b>Background</b>: Pulmonary neuroendocrine tumors (lung NETs) comprise a biologically heterogeneous group of neoplasms ranging from indolent typical carcinoids to more aggressive atypical carcinoids. Accurate characterization of tumor biology is essential for optimizing staging, prognostic stratification, and treatment selection. Beyond conventional cross-sectional imaging, functional imaging and emerging quantitative imaging techniques are progressively redefining the diagnostic pathway. <b>Methods</b>: We performed a comprehensive narrative review of the current evidence regarding conventional radiological imaging, somatostatin receptor (SSTR) PET/CT, <sup>18</sup>F-FDG PET/CT, dual-tracer imaging, and radiomics in lung NETs, integrating recent international recommendations from ENETS, ESMO, AIOM, and other major societies. <b>Results</b>: Contrast-enhanced CT remains the cornerstone of anatomical staging, whereas <sup>68</sup>Ga-labelled somatostatin analogue (SSA) PET/CT provides highly sensitive assessment of receptor expression and patient eligibility for somatostatin analogue therapy and peptide receptor radionuclide therapy (PRRT). Conversely, <sup>18</sup>F-FDG PET/CT identifies metabolically active and biologically aggressive disease, particularly in atypical carcinoids and tumors showing dedifferentiation. Increasing evidence supports the complementary role of dual-tracer PET/CT for non-invasive characterization of tumor heterogeneity, prognostic stratification, and treatment planning. Radiomics further expands this paradigm by extracting quantitative imaging biomarkers that may improve histological prediction, recurrence risk assessment, and individualized management. Although promising, radiomics remains limited by methodological heterogeneity and the lack of prospective validation. <b>Conclusions</b>: The integration of conventional imaging, molecular imaging, and quantitative radiomics supports a shift from lesion detection toward biologically driven precision imaging. Future prospective multicenter studies incorporating imaging biomarkers, artificial intelligence, and clinical-pathological variables may further support personalized management of patients with lung NETs.