84yr female who was found to have a 4.5cm right liver mass, bx positive for gr 2. NET, Ki 10-20%. Octreotide scan: right liver, left neck and vague central abdomen uptake. Treated her as metastatic and started octreotide. 3 months later, slight weight loss and right liver mass up to 6.8cm on CT, no other sites. Would you rpt functional imaging (not sure if we could get approved) and refer to Surg Onc or change therapy, if so what?
I think your best bet here is getting the patient seen at an academic center with a mutliD NET team. That amount of growth in just 3 months is concerning for a NET with only a KI 67 10-20%. Wondering if she would benefit from a 2nd opinion read on the path. Surgery/Y-90 could be options here but it's hard to know without those specialists weighing in. From a systemic standpoint, I think getting a PET-Dotatate scan would be warranted here - confirm PRRT candidacy and get a better sense of current disease burden - with hopefully PRRT to follow.
