Would you ever consider treatment without tissue diagnosis for a gastrointestinal neuroendocrine metastatic tumor based on a positive dotatate scan alone?

Tissue would be ideal, but I would treat the above scenario with caveats.

The sensitivity and specificity of modern-day DOTA SSTR imaging approaches 90%.

The question I would have is whether the patient needs treatment in the first place, based on burden of disease seen?

Is disease behaving aggressi...