Abstract Pulmonary carcinoid tumors present a rare form of pulmonary cancers. A computed tomography (CT) scan in 3 months, tissue sampling, or a positron emission tomography-computed tomography (PET-CT) is recommended after a 0.8 centimeter (cm) lesion is found. In our case, we present a 66-year-old female smoker who was found to have a 0.8 cm right middle lobe (RML) nodule that grew to 1.1 cm within 3 months. This patient proceeded to biopsy via robotic bronchoscopy and endobronchial ultrasound (EBUS) with lymph node biopsy. RML cryobiopsy and fine needle aspiration (FNA) of the nodule was obtained. The cryobiopsy was a carcinoid tumor with 10%-20% Ki-67 positivity and a lack of mitosis and necrosis. Lymph node sampling was negative. Fluorodeoxyglucose (FDG) PET-CT was performed for staging and found no abnormal uptake in the location of the RML nodule or anywhere else. Patient then underwent a Copper-64 dotatate (64Cu-Dotatate) PET-CT and the RML nodule also had no somatostatin receptor activity. Currently the gold standard for evaluation and staging of neuroendocrine tumors is the Gallium 68-somatostatin analogue PET-CT (68Ga-Dotatate PET-CT). It has a sensitivity of 91% and a specificity of 94%. There are logistical challenges with this tracer as it has a short half-life of 68 min. However, 64Cu-Dotatate is an emerging tracer in the evaluation of neuroendocrine tumors. It has a half-life of 12.7 hours and a shelf life of at least 24 hours. It has been shown to have equal sensitivity as 68Ga-Dotatate and better detection rates of true positive lesions in one cohort. 68Ga has higher positron emission rates, which causes a 10-20% underestimation of uptake in small lesions, whereas 64Cu does not share this problem. Our patient’s negative 64Cu-Dotatate scan, despite significant nodule size, raises the question of the need for further head-to-head studies between the two tracers, especially in pulmonary nodules. Most current studies are limited and have even less data on pulmonary nodules. Pulmonary carcinoid tumors are the second most common presentation of neuroendocrine tumors after those found in the gastrointestinal tract. Even though there is rising popularity of the 64Cu-Dotatate tracer, there is minimal pulmonary data; thus, institutions should remain guarded in adopting it regardless of the logistical benefit. This abstract is funded by: None
Samuel et al. (Fri,) studied this question.