Abstract

Metastasis is a critical determinant of prognosis and treatment strategies in patients with high-grade neuroendocrinetumors (NETs). The identification of metastatic niches within the body is essential for accurate staging and personalizedtherapy. Traditional imaging techniques have limitations in detecting small metastases and differentiating them from benign lesions. In this context, nuclear medicine sequence imaging, including positron emission tomography (PET) and single-photon emission computed tomography (SPECT), has emerged as a promising tool. This article provides anoverview of the latest advancements in the identification of metastatic niches in high-grade NETs. Specifically, the use oftriple-positive radiolabelled molecular probes in nuclear medicinesequence imaging is highlighted. These probes targetmultiple biomarkers expressed on high-grade NET cells, enhancing specificity and reducing false-positive results. By accurately identifying metastatic niches, clinicians can optimize treatment decisions and offer targeted therapies suchas peptide receptor radionuclide therapy (PRRT) or selective internal radiation therapy (SIRT). The identification ofmetastatic niches through nuclear medicine sequence imaging holds significant clinical implications, improving staging accuracy, treatment planning, and monitoring of disease progression. Further research in this field promises to advanceour understanding and management of high-grade NETs, ultimately improving patient outcomes.