Nuclear Molecular and Theranostic Imaging for Differentiated Thyroid Cancer

Abstract

Traditional nuclear medicine is rapidly being transformed by the evolving concepts in molecular imaging and theranostics. The utility of new approaches in differentiated thyroid cancer (DTC) diagnostics and therapy has not been fully appreciated. The clinical information, relevant to disease management and patient care, obtained by scintigraphy is still being underestimated. There has been a trend towards moving away from the use of radioactive iodine (RAI) imaging in the management of the disease. This paradigm shift is supported by the 2015 American Thyroid Association Guidelines (1). A more systematic and comprehensive understanding of disease pathophysiology and imaging methodologies is needed for optimal utilization of different imaging modalities in the management of DTC. There have been significant developments in radiotracer and imaging technology, clinically proven to contribute to the understanding of tumor biology and the clinical assessment of patients with DTC. The research and development in the field continues to evolve, with expected emergence of many novel diagnostic and therapeutic techniques. The role for nuclear imaging applications will continue to evolve and be reconfigured in the changing paradigm. This article aims to review the clinical uses and controversies surrounding the use of scintigraphy, and the information it can provide in assisting in the management and treatment of DTC.

68Ga-FAPI PET/CT in Thyroid Cancer With Thyroglobulin Elevation and Negative Iodine Scintigraphy

“…Follow-up DxWBS is still advised for high-risk patients with differentiated thyroid cancer (DTC) and plays an important role in detecting disease recurrence and metastases in DTC with elevated thyroglobulin level. [1][2][3] However, the application of this technique is limited in the situation of TENIS syndrome. 4-6 68 Ga-FAPI presents a promising alternative to 18 F-FDG for imaging of various kinds of cancer.…”

“…As such, sorafenib was selected for the subsequent treatment in this patient. Follow-up DxWBS is still advised for high-risk patients with differentiated thyroid cancer (DTC) and plays an important role in detecting disease recurrence and metastases in DTC with elevated thyroglobulin level 1–3 . However, the application of this technique is limited in the situation of TENIS syndrome 4–6 .…”

The Transareola Endoscopic Approach Yields Adequate Oncological Dissection as Open Approach in the Treatment of Papillary Thyroid Carcinoma

“…24 Accordingly, RAIU, PNITA, and PNILNSM were used to further evaluate and compare the performance of the 2 groups. 25 As shown in Table 2, there was no significant difference between the 2 groups regarding the RAIU-2h, RAIU-24h, PNITA, and number of dissected lymph nodes. Furthermore, the PNILNSM revealed no suspicious lymphatic metastasis in most of the patients, and there was no significant difference between the 2 groups.…”

Expanding Theranostic Radiopharmaceuticals for Tumor Diagnosis and Therapy

“…While 131 I SPECT-CT imaging showed better accuracy than scintigraphy, image quality is limited by the low abundance of the gamma photons. 123 I-mediated SPECT-CT imaging has increased in popularity in pre-therapy imaging due to improved resolution, higher sensitivity and lower radiation exposure compared to 131 I [20]. The use of 124 I, a potential diagnostic agent for PET imaging, is still limited in its use due to high cost and low availability.…”