Consensus on molecular imaging and theranostics in neuroendocrine neoplasms

Ambrosini V, Kunikowska J, Baudin E, Bodei L, Bouvier C, Capdevila J, Cremonesi M, de Herder WW, Dromain C, Falconi M, Fani M, Fanti S, Hicks RJ, Kabasakal L, Kaltsas G, Lewington V, Minozzi S, Cinquini M, Öberg K, Oyen WJ, O'Toole D, Pavel ME, Ruszniewski P, Scarpa A, Strosberg J, Sundin A, Taïeb D, Virgolini I, Wild D, Herrmann K, Yao J (2021)

Publication Type: Journal article, Review article

Publication year: 2021


Book Volume: 146

Pages Range: 56-73

DOI: 10.1016/j.ejca.2021.01.008


Nuclear medicine plays an increasingly important role in the management neuroendocrine neoplasms (NEN). Somatostatin analogue (SSA)-based positron emission tomography/computed tomography (PET/CT) and peptide receptor radionuclide therapy (PRRT) have been used in clinical trials and approved by the European Medicines Agency (EMA) and the US Food and Drug Administration (FDA). European Association of Nuclear Medicine (EANM) Focus 3 performed a multidisciplinary Delphi process to deliver a balanced perspective on molecular imaging and radionuclide therapy in well-differentiated neuroendocrine tumours (NETs). NETs form in cells that interact with the nervous system or in glands that produce hormones. These cells, called neuroendocrine cells, can be found throughout the body, but NETs are most often found in the abdomen, especially in the gastrointestinal tract. These tumours may also be found in the lungs, pancreas and adrenal glands. In addition to being rare, NETs are also complex and may be difficult to diagnose. Most NETs are non-functioning; however, a minority present with symptoms related to hypersecretion of bioactive compounds. NETs often do not cause symptoms early in the disease process. When diagnosed, substantial number of patients are already found to have metastatic disease. Several societies' guidelines address Neuroendocrine neoplasms (NENs) management; however, many issues are still debated, due to both the difficulty in acquiring strong clinical evidence in a rare and heterogeneous disease and the different availability of diagnostic and therapeutic options across countries. EANM Focus 3 reached consensus on employing 68gallium-labelled somatostatin analogue ([68Ga]Ga-DOTA-SSA)-based PET/CT with diagnostic CT or magnetic resonance imaging (MRI) for unknown primary NET detection, metastatic NET, NET staging/restaging, suspected extra-adrenal pheochromocytoma/paraganglioma and suspected paraganglioma. Consensus was reached on employing 18fluorine-fluoro-2-deoxyglucose ([18F]FDG) PET/CT in neuroendocrine carcinoma, G3 NET and in G1-2 NET with mismatched lesions (CT-positive/[68Ga]Ga-DOTA-SSA-negative). Peptide receptor radionuclide therapy (PRRT) was recommended for second line treatment for gastrointestinal NET with [68Ga]Ga-DOTA-SSA uptake in all lesions, in G1/G2 NET at disease progression, and in a subset of G3 NET provided all lesions are positive at [18F]FDG and [68Ga]Ga-DOTA-SSA. PRRT rechallenge may be used for in patients with stable disease for at least 1 year after therapy completion. An international consensus is not only a prelude to a more standardised management across countries but also serves as a guide for the direction to follow when designing new research studies.

Authors with CRIS profile

Involved external institutions

European Institute of Oncology / Istituto Europeo di Oncologia (IEO) IT Italy (IT) Vall d'Hebron University Hospital / Hospital Universitari Vall d'Hebron ES Spain (ES) University of Texas MD Anderson Cancer Center US United States (USA) (US) Trinity College Dublin IE Ireland (IE) Humanitas Research Hospital / IRCCS Istituto Clinico Humanitas IT Italy (IT) Lausanne University Hospital / Centre hospitalier universitaire vaudois (CHUV) CH Switzerland (CH) Memorial Sloan Kettering Cancer Center US United States (USA) (US) Universitätsspital Basel CH Switzerland (CH) University of Bologna / Università di Bologna IT Italy (IT) The University of Melbourne AU Australia (AU) Medizinische Universität Innsbruck AT Austria (AT) University of Verona / Università degli Studi di Verona IT Italy (IT) Hôpital de la Timone FR France (FR) Universitätsklinikum Essen DE Germany (DE) Mario Negri Institute for Pharmacological Research (IRCCS) / Istituto di Ricerche Farmacologiche Mario Negri IT Italy (IT) Uppsala University Hospital / Akademiska sjukhuset SE Sweden (SE) King’s College London GB United Kingdom (GB) Institut Gustave-Roussy FR France (FR) International Neuroendocrine Cancer Alliance US United States (USA) (US) H. Lee Moffitt Cancer Center & Research Institute US United States (USA) (US) Beaujon Hospital / Hôpital Beaujon FR France (FR) Istanbul University Cerrahpaşa / İstanbul Üniversitesi Cerrahpaşa (IUC) TR Turkey (TR) National and Kapodistrian University of Athens GR Greece (GR) Ospedale San Raffaele (früher: Centro San Raffaele del Monte Tabor Foundation) IT Italy (IT) Wrocław Medical University / Uniwersytet Medyczny we Wrocławiu PL Poland (PL) Erasmus University Medical Center (MC) NL Netherlands (NL)

How to cite


Ambrosini, V., Kunikowska, J., Baudin, E., Bodei, L., Bouvier, C., Capdevila, J.,... Yao, J. (2021). Consensus on molecular imaging and theranostics in neuroendocrine neoplasms. European Journal of Cancer, 146, 56-73.


Ambrosini, Valentina, et al. "Consensus on molecular imaging and theranostics in neuroendocrine neoplasms." European Journal of Cancer 146 (2021): 56-73.

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