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 aggre...