Complementary Role of [ 68 Ga]Ga-DOTA-3P-TATE-RGD PET/CT in Discriminating Non-Small Cell from Small Cell Lung Cancer.

[ 18 F]FDG PET/CT is widely used in the diagnosis and treatment monitoring of lung cancer, yet its ability to differentiate histologic heterogeneity remains limited. In this case, a 75-year-old man presented with a large pulmonary mass adjacent to a small satellite lesion. Bronchoscopic biopsy of the main lesion revealed small-cell lung cancer (SCLC). After first-line chemotherapy, the primary lesion showed partial response, while the smaller nodule remained stable. Posttreatment [ 18 F]FDG and [ 68 Ga]Ga-DOTA-3P-TATE-RGD PET/CT demonstrated divergent uptake patterns. Rebiopsy of the nodule with discordant tracer uptake confirmed squamous cell carcinoma, indicating synchronous double primary lung cancers. The dual-targeted tracer PET/CT guided precise biopsy and individualized therapy.