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This study aims to reach expert consensus on the optimal sequencing of SSTR PET and EUS biopsy in the diagnostic workup and management of patients with suspected PNETs.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A three-round modified Delphi process was used. A multidisciplinary panel of experts was recruited via snowball sampling. A set of 22 baseline statements pertaining to diagnostic workup, imaging, and biopsy was developed based on literature review and feedback obtained through a focus group. Survey rounds were conducted electronically and anonymously. A panel of international experts was asked to indicate whether they agreed, disagreed, or lacked the appropriate background to answer each statement. Of the 55 experts invited, 38 (69%) accepted to participate. Consensus was achieved with\u2009&gt;\u200980% agreement.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Response rates were 97%, 100%, and 100% in rounds 1, 2, and 3, respectively. Following rounds 1 and 2, 29 final statements achieved consensus in the following three domains: diagnostic workup (15 statements), imaging (nine statements), and tissue sampling (five statements). Cronbach\u2019s alpha value, a measure of internal consistency, was 0.91 and 0.85 for rounds 1 and 2, respectively. The final set of statements achieved a 95% approval rate in round 3.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>This international Delphi study provides expert consensus-based guidance on the appropriate use of EUS biopsy in the diagnostic workup of PNETs in the era of SSTR PET imaging.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00464-025-11667-8","type":"journal-article","created":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T15:13:07Z","timestamp":1746198787000},"page":"3435-3446","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Appropriate use of tissue sampling and somatostatin receptor PET imaging in the diagnosis of pancreatic neuroendocrine tumors: results of an International Delphi Consensus"],"prefix":"10.1007","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7304-2805","authenticated-orcid":false,"given":"Megan","family":"Casey","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Tozzi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaeyun","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keon Min","family":"Park","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily","family":"Bergsland","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Hope","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hagen F.","family":"Kennecke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. 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Kennecke, Dr. J. Bart Rose, Dr. Michele Babicky, Dr. Shayan S. Irani, Dr. Kevin M. El-Hayek, Dr. Mohammad Abu Hilal, Dr. Horacio J. Asbun,, Dr. Sean Cleary, Dr. Peter Smeets, Dr. Frederik Berrevoet, Dr. Mohamed Adam, Dr. Niki Rashidian, and Dr. Adnan Alseidi have no conflicts of interest to disclose. In addition, Dr. Aman Chauhan, Dr. Andrew M. Bellizzi, Dr. \u00c5smund A. Fretland, Dr. Brendan C. Visser, Dr. Bryson W. Katona, Dr. Daniel Halperin, Dr. Delphine L. Chen, Dr. Eric Nakakura, Dr. Erik Mittra, Dr. Flavio G. Rocha, Dr. Grace E. Kim, Dr. Heloisa Soares, Dr. Anne Hoorens, Dr. Jess Maxwell, Dr. Jonathan Loree, Dr. Karen Geboes, Dr. Kevin El-Hayek, Dr. Linda Lee, Dr. Michael H. Larsen, Dr. Monica Dua, Dr. Mustafa Arain, Dr. Nadine Mallak, Dr. Nancy Joseph, Dr. Nitya Raj, Dr. Pieter Hindryckx, Dr. Sun-Chuan Dai, Dr. Thorvardur R. 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