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

Sep 23, 2026

Uploaded by Bulrr

Neuroendocrine tumors (NET) are a diverse group of neoplasms that can arise from neuroendocrine cells and present in the skull base and paranasal sinuses, in addition to GI tract, lungs, and pancreas. While fluorodeoxyglucose PET (FDG PET) is routinely used for sinonasal malignancies, it has limitations in detecting NET recurrences near the cranium and cervical lymph node metastases. Somatostatin receptor 2 (SSTR2) is broadly expressed in olfactory neuroblastoma (ONB) and sinonasal neuroendocrine carcinomas (SNEC), supporting Gallium-68 DOTATATE PET (68Ga-DOTATATE) for targeted imaging. SSTR2 also provides a platform for peptide receptor radionuclide therapy (PRRT), expanding clinical value. Given FDG PET limitations, 68Ga-DOTATATE PET should be incorporated for staging and recurrence monitoring in ONB and SNEC.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

AccessFree to download

Introduction

Sinonasal tumors and the role of PET

Background

Sinonasal Neuroendocrine Carcinoma

Olfactory neuroblastoma (ONB)

International Forum of Allergy & Rhinology VIEWPOINT Enhancing Diagnostic Accuracy in Sinonasal Neuroendocrine Tumors: The Case for DOTATATE PET Over FDG PET Michael Sabbaj1 Anandraj Kanwar2 Carl H. Snyderman6 Brian D. Thorp7 Garett W. Choby6 Mathew Geltzeiler11 Jessica W. Grayson3 Nyall R. London4 Shirley Y. Su5 Dennis Tang8 David Gudis9 Eric W. Wang6 Edward C. Kuan10 1University of Vermont Larner College of Medicine, Burlington, Vermont, USA 2 Department of Radiology, New Orleans University Medical Center Hospital, New Orleans, Louisiana, USA 3 Department of Otolaryngology-Head and Neck Surgery, University of Alabama, Birmingham, Alabama, USA 4 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA 5 Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA 6 Department of Otolaryngology, Center for Skull Base Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA 7 Department of Otolaryngology, Center for Skull Base Surgery, University of North Carolina, Chapel Hill, North Carolina, USA 8 Department of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA 9 Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, USA 10 Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA 11 Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA Correspondence: Michael Sabbaj ([Michael.sabbaj@med.uvm.edu](Michael.sabbaj@med.uvm.edu)) Received: 8 April 2025 Revised: 21 June 2025 Accepted: 3 July 2025 Funding: The authors received no specific funding for this work. Keywords: Dotatate | esthesioneuroblastoma | neuroendocrine carcinoma | octreotide | olfactory neuroblastoma | positron-emission tomography | somatostatin ABSTRACT 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, 68GaDOTATATE PET scans should be incorporated into routine practice when staging and monitoring for recurrences in ONB and SNEC. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. © 2025 The Author(s) . International Forum of Allergy & Rhinology published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngic Allergy and American Rhinologic Society. International Forum of Allergy & Rhinology, 2025; 15:1023–1027 1023 of 1027 [https://doi.org/10.1002/alr.70001](https://doi.org/10.1002/alr.7

FAQs

Why are FDG PET scans limited for sinonasal neuroendocrine tumors?

FDG PET has limitations in detecting recurrences near the cranium and in cervical lymph node metastases in NETs such as olfactory neuroblastoma and sinonasal neuroendocrine carcinomas.

What makes DOTATATE PET useful in ONB and SNEC?

SSTR2 is membrane-bound and is expressed almost ubiquitously in ONB and SNEC, enabling targeted imaging with Gallium-68 DOTATATE (68Ga-DOTATATE).

How does SSTR2 expression relate to treatment beyond imaging?

SSTR2 expression opens avenues for peptide receptor radionuclide therapy (PRRT), broadening clinical utility in addition to diagnostic staging and monitoring.

Sep 23, 2026

Uploaded by Bulrr