Diagnostic and therapeutic approach to neuroendocrine lung tumours: a narrative review

Background and Objective: Lung neuroendocrine tumours (NETs) comprise a diverse and heterogeneous group of neoplasms, characterized by wide variation in growth rates, metastatic potential, molecular profiles and therapeutic susceptibilities. This review summarises current diagnostic strategies and therapeutic approaches to pulmonary NETs, offering an updated synthesis of the most recent literature. Methods: A focused literature search of PubMed, Medline, and Google Scholar was conducted, covering the period from February 1st, 1986 to August 20th, 2025, and limited to studies published in English, including randomized trials and cohort studies, to evaluate diagnostic and therapeutic options of neuroendocrine lung tumours. Key Content and Findings: Advances in imaging, pathology, and molecular profiling are directly shaping treatment selection and improving patient outcomes in lung NETs by enabling more precise tumour classification, risk stratification, and identification of actionable targets. Current treatment strategies for lung NET range from surgical resection in early-stage disease to multimodal approaches—including chemotherapy, radiotherapy, targeted therapies, and immunotherapy—in advanced stages. Despite advances, several areas of uncertainty remain, particularly regarding the optimal management of rare entities such as diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH). Conclusions: Advances in imaging, pathology, and molecular profiling have improved diagnostic accuracy of lung NETs, while therapeutic strategies continue to evolve, integrating surgery, locoregional therapies, systemic chemotherapy, targeted agents, and immunotherapy. Despite progress, significant gaps remain in understanding tumor biology and optimizing treatment, underscoring the need for further research and well-designed clinical trials to improve outcomes for these patients.