# Lung Carcinoids—Time to Change Practices

## TL;DR

This study shows that lung carcinoids are often managed like lung cancer, leading to unnecessary tests and inconsistent care, suggesting a need for specialized treatment approaches.

## Contribution

The study provides real-world data on lung carcinoid management, highlighting the overuse of FDG-PET scans and advocating for multidisciplinary lung-NET boards.

## Key findings

- FDG-PET use was excessive in typical carcinoids, indicating a deviation from NET-specific guidelines.
- Diagnostic pathways and follow-up for lung carcinoids showed significant heterogeneity.
- Most patients presented with early-stage disease, yet treatment decisions often followed non-standardized protocols.

## Abstract

Lung carcinoids—typical and atypical—are rare neuroendocrine tumors, whose management often mirrors lung cancer protocols rather than NET-specific recommendations. Our retrospective evaluation of 12-year real-world experience with lung carcinoids at a Comprehensive Cancer Center identifies gaps in diagnostic work-up, treatment decision-making, and follow-up, such as excessive FDG-PET use in typical carcinoids. This finding reinforces the need for dedicated multidisciplinary lung-NET boards and national reference centers to homogenize and streamline patient management.

Background: Lung carcinoids—typical and atypical—are rare neuroendocrine tumors (NETs) representing 1–2% of lung cancers. Despite clinicopathological differences, their clinical management often mirrors lung cancer protocols rather than NET-specific recommendations. Objectives: Portray a 12-year real-world experience with lung carcinoids at a Comprehensive Cancer Center, identifying gaps in diagnostic work-up, treatment decision-making, and follow-up. Methods: Retrospective observational cohort study of adult patients with histologically confirmed lung carcinoids diagnosed at IPO Porto between January 2013 and December 2024. Demographic, clinical, imaging, and treatment data were collected from electronic patient records. Analyses were descriptive. Results: Among 179 identified cases, 129 met eligibility criteria. Median age was 62 years (range 18–84); 53.6% were women and 53.5% were non-smokers; 84.5% had ECOG-PS 0–1. The most frequent presentation was respiratory symptoms (34.1%), followed by incidental findings (43.4%, of which ~20% were during staging or surveillance of other cancers). Typical carcinoids accounted for 49.6% and atypical for 43.4%. FDG-PET/CT was requested in 70.9% of cases, including many with typical carcinoid, and SSTR-PET/CT in 64.6% (dual PET in 38.8%). Most patients (65.1%) presented with stage I disease; 17.1% were stage IV. Mean time-to-first treatment was 83 days (range 1–259). Surgery was the first treatment option for 78.3% of patients. Conclusions: This real-world series highlights heterogeneity in diagnostic pathways, excessive FDG-PET use in typical carcinoids, and non-standardized follow-up. Dedicated multidisciplinary lung-NET boards and national reference centers are needed to homogenize and streamline patient management.