There is no relevant literature to support the use of FDG-PET/CT specifically to characterize subcentimeter liver lesions due to its limited sensitivity for lesions <1 cm. DOTATATE PET/CT Skull Base to Mid-Thigh Ga-68-DOTATATE PET/CT is sensitive for detection of metastases in patients with primary NET; however, there is no relevant literature on assessment of subcentimeter liver lesions. Octreotide Scan with SPECT or SPECT/CT Chest and Abdomen In patients with a history of primary NET, In-111 somatostatin receptor scan with SPECT or SPECT/CT can detect liver metastases; however, there is no relevant literature on assessment of subcentimeter liver lesions. MRI Abdomen For subcentimeter liver lesions detected on CT, the sensitivity, specificity, PPV, and NPV for differentiation of benign from malignant lesions for contrast-enhanced MRI are 83%, 98%, 92%, and 94%, respectively [86]. In patients with a history of colon cancer, MRI has a sensitivity of 60% for detection of subcentimeter metastases [87]. There is no relevant literature that has assessed the performance of MRI without IV contrast specifically for this clinical scenario. Therefore, the committee recommendations on the use of MRI without IV contrast are based primarily on expert opinion. Image-Guided Biopsy Liver Tissue sampling may be necessary to establish the definitive diagnosis in patients with a history of primary malignancy and indeterminate subcentimeter liver lesions. However, the role of percutaneous biopsy is limited in the evaluation of subcentimeter liver lesions because such lesions are typically difficult to target under image guidance. Furthermore, published data are not available to assess performance of percutaneous biopsy techniques for subcentimeter liver lesions. RBC Scan Abdomen and Pelvis There is no relevant literature to support the use of a Tc-99m RBC scan in this clinical scenario.
Liver Lesion Initial Characterization. There is no relevant literature to support the use of FDG-PET/CT specifically to characterize subcentimeter liver lesions due to its limited sensitivity for lesions <1 cm. DOTATATE PET/CT Skull Base to Mid-Thigh Ga-68-DOTATATE PET/CT is sensitive for detection of metastases in patients with primary NET; however, there is no relevant literature on assessment of subcentimeter liver lesions. Octreotide Scan with SPECT or SPECT/CT Chest and Abdomen In patients with a history of primary NET, In-111 somatostatin receptor scan with SPECT or SPECT/CT can detect liver metastases; however, there is no relevant literature on assessment of subcentimeter liver lesions. MRI Abdomen For subcentimeter liver lesions detected on CT, the sensitivity, specificity, PPV, and NPV for differentiation of benign from malignant lesions for contrast-enhanced MRI are 83%, 98%, 92%, and 94%, respectively [86]. In patients with a history of colon cancer, MRI has a sensitivity of 60% for detection of subcentimeter metastases [87]. There is no relevant literature that has assessed the performance of MRI without IV contrast specifically for this clinical scenario. Therefore, the committee recommendations on the use of MRI without IV contrast are based primarily on expert opinion. Image-Guided Biopsy Liver Tissue sampling may be necessary to establish the definitive diagnosis in patients with a history of primary malignancy and indeterminate subcentimeter liver lesions. However, the role of percutaneous biopsy is limited in the evaluation of subcentimeter liver lesions because such lesions are typically difficult to target under image guidance. Furthermore, published data are not available to assess performance of percutaneous biopsy techniques for subcentimeter liver lesions. RBC Scan Abdomen and Pelvis There is no relevant literature to support the use of a Tc-99m RBC scan in this clinical scenario.