Management of Differentiated Thyroid Cancer: The Standard of Care

Avram, Anca M.; Zukotynski, Katherine; Nadel, Helen; Giovanella, Luca

doi:10.2967/jnumed.121.262402

Cited by 34 publications

(35 citation statements)

References 50 publications

(52 reference statements)

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“…Furthermore, the probability of complications is higher with this procedure than with (stand-alone) thyroidectomy, and many patients with an incidental finding of thyroid cancer will not have a lymph-node dissection. Both post-therapeutic imaging after administration of RIT and pre-therapeutic imaging using radioactive isotopes of iodine provide a highly sensitive staging in this context and can help to select patients for removal of lymph nodes pre- or post RIT 26 .…”

Section: Introductionmentioning

confidence: 99%

Individualized treatment of differentiated thyroid cancer: The value of surgery in combination with radioiodine imaging and therapy – A German position paper from Surgery and Nuclear Medicine

et al. 2022

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A consensus statement about indications for post-surgical radioiodine therapy (RIT) in differentiated thyroid cancer patients (DTC) was recently published by the European Thyroid Association (ETA) 1. This publication discusses indications for RIT on the basis of an individual risk assessment. Many of the conclusions of this consensus statement are well founded and accepted across the disciplines involved. However, especially from the perspective of nuclear medicine, as the discipline responsible for indicating and executing RIT, some of the recommendations may require further clarification with regard to their compatibility with established best practice and national standards of care. Assessment of the indications for RIT is strongly dependent on the weighing up of benefits and risks. On the basis of longstanding clinical experience in nuclear medicine, RIT represents a highly specific precision medicine procedure of proven efficacy with a favorable side-effect profile. This distinguishes RIT significantly from other adjuvant oncological therapies and has resulted in the establishment of this procedure as a usually well-tolerated, standard safety measure. With regard to its favorable risk/benefit ratio, this procedure should not be unnecessarily restricted, in the interest of offering reassurance to the patients. Both patients’ interests and regional/national differences need to be taken into account. We would therefore like to comment on the recent consensus from the perspective of authors and to provide recommendations based on the respective published data.

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Section: Introductionmentioning

confidence: 99%

Individualized treatment of differentiated thyroid cancer: The value of surgery in combination with radioiodine imaging and therapy – A German position paper from Surgery and Nuclear Medicine

et al. 2022

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“…Prophylactic central neck dissection may improve regional control for invasive tumors (T3–T4), but it is discouraged for low-risk DTC because of potential associated morbidities are not justified by a significant clinical benefit [ 5 ]. Preoperative neck US generally suffices to plan surgery, however additional cross-sectional imaging (i.e., contrast-enhanced computed tomography (ceCT), magnetic resonance imaging (MRI)) are reserved for patients with locally advanced disease or for those that are at a high risk of developing distant metastases [ 24 ]. PET/CT with [ 18 F]FDG could be performed preoperatively in aggressive DTC and anaplastic thyroid cancer (see the specific section).…”

Section: Differentiated Thyroid Cancersmentioning

confidence: 99%

“…After surgery, the risk of structural disease recurrence and/or persistence is assessed using the three-tier (low, intermediate, high) stratification recommended by ATA [ 5 ]. The goal of therapeutic 131 I administration after total thyroidectomy is outlined based on standardized definitions as follows [ 5 , 24 ]. Remnant ablation to eliminate normal thyroid tissue remnants in low risk patients, thereby ensuring undetectable or minimal serum Tg levels (in the absence of neoplastic tissue), which facilitates follow-up.…”

Section: Differentiated Thyroid Cancersmentioning

confidence: 99%

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Molecular Imaging and Theragnostics of Thyroid Cancers

Giovanella

Deandreis

Vrachims³

et al. 2022

Cancers

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Molecular imaging plays an important role in the evaluation and management of different thyroid cancer histotypes. The existing risk stratification models can be refined, by incorporation of tumor-specific molecular markers that have theranostic power, to optimize patient-specific (individualized) treatment decisions. Molecular imaging with varying radioisotopes of iodine (i.e., 131I, 123I, 124I) is an indispensable component of dynamic and theragnostic risk stratification of differentiated carcinoma (DTC) while [18F]F-fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) helps in addressing disease aggressiveness, detects distant metastases, and risk-stratifies patients with radioiodine-refractory DTC, poorly differentiated and anaplastic thyroid cancers. For medullary thyroid cancer (MTC), a neuroendocrine tumor derived from thyroid C-cells, [18F]F-dihydroxyphenylalanine (6-[18F]FDOPA) PET/CT and/or [18F]FDG PET/CT can be used dependent on serum markers levels and kinetics. In addition to radioiodine therapy for DTC, some theragnostic approaches are promising for metastatic MTC as well. Moreover, new redifferentiation strategies are now available to restore uptake in radioiodine-refractory DTC while new theragnostic approaches showed promising preliminary results for advanced and aggressive forms of follicular-cell derived thyroid cancers (i.e., peptide receptor radiotherapy). In order to help clinicians put the role of molecular imaging into perspective, the appropriate role and emerging opportunities for molecular imaging and theragnostics in thyroid cancer are discussed in our present review.

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“…In many cases, differentiated thyroid carcinoma (DTC) has an indolent course and a generally favorable prognosis. However, recurrences may occur in up to 20% of DTC patients, with 10% of them having a fatal outcome (1). Serum thyroglobulin (Tg) is the pivotal DTC biomarker during follow-up of these patients: an undetectable Tg level (after excluding interfering anti-Tg autoantibodies) is associated with excellent treatment response and favorable prognosis.…”

Section: Introductionmentioning

confidence: 99%

The role of thyroglobulin doubling time in differentiated thyroid cancer: a meta-analysis

Giovanella

Garo²,

Albano

et al. 2022

Endocrine Connections

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Objective: In patients with differentiated thyroid cancer (DTC), recurrences may occur in up to 20% and may have a fatal outcome in 10% of cases. Thyroglobulin-doubling time (Tg-DT) values may contribute to predict response to treatment and disease recurrence in DTC patients. This study aimed to address the following questions: (1) Are Tg-DT values indicative of response to treatments in patients with DTC (i.e., “treatment monitoring”)? (2) Is Tg-DT predictive of 2-[18F]fluoro-2-deoxy-D-glucose (2-[18F]FDG) positron emission tomography/computed tomography (PET/CT) in patients with DTC?; (3) Are Tg-DT values predictive of DTC prognosis (i.e., “prediction”)? Design: Systematic review and meta-analysis. Methods: Methodology was registered in the PROSPERO database (CRD42021257947). A systematic search was carried out in PubMed, Web Of Science, and Scopus from June to August 2021 without time and language restrictions. Results: Eleven studies were included for a total of 1421 patients. Positive association between Tg-DT < 1 year and recurrence or disease progression were observed. Tg-Dt was found to be (2-[18F]FDG) PET/CT results in patients with DTC. Area Under the Curve (AUC) = 0.86 (95%CI: 0.83-0.89). Sensitivity: 0.84 (0.64;0.94); Specificity: 0.71 (0.35; 0.92); DOR: 13.1 (3.1; 55.0); LR+: 2.9 (1.0; 8.1); LR-: 0.22 (0.1; 0.5). For patients with Tg-DT < 1 year (n = 247), the survival risk ratio was 2.09 [95%CI: 1.49; 2.94]. Conclusions: Tg-DT values are valuable in predicting response to treatment and disease recurrence in patients with DTC, as well as their overall survival. In addition, Tg-DT significantly increases the detection rate of 2-[18F]-FDG PET/CT.

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Management of Differentiated Thyroid Cancer: The Standard of Care

Cited by 34 publications

References 50 publications

Individualized treatment of differentiated thyroid cancer: The value of surgery in combination with radioiodine imaging and therapy – A German position paper from Surgery and Nuclear Medicine

Individualized treatment of differentiated thyroid cancer: The value of surgery in combination with radioiodine imaging and therapy – A German position paper from Surgery and Nuclear Medicine

Molecular Imaging and Theragnostics of Thyroid Cancers

The role of thyroglobulin doubling time in differentiated thyroid cancer: a meta-analysis

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