Sensitivities evaluation of five radiopharmaceuticals in four common medullary thyroid carcinoma metastatic sites on PET/CT: a network meta-analysis and systematic review

Abstract

Objectives Detecting medullary thyroid carcinoma (MTC) metastatic lesions accurately is still a challenge for clinicians. PET/computed tomography (PET/CT) seems to be the most effective method in recent years. However, the sensitivity of each radiopharmaceutical varies greatly in different metastatic sites. We aim to investigate and compare five novel and common PET or PET/CT radiopharmaceutical sensitivities at the four most frequent metastatic sites by network meta-analysis. Methods We searched for studies evaluating PET/CT radiopharmaceutical sensitivities at different metastatic sites in PubMed, Web of Science, Embase, and Cochrane Library. The risk bias was analyzed, and publication bias was accessed by funnel plot asymmetry tests. We performed both global inconsistency and local inconsistency tests by evaluating the agreement between direct and indirect comparisons. Then, we made pairwise meta-analyses and network meta-analyses for each metastatic site. Finally, we performed the surface under the cumulative ranking curves (SUCRA) and calculated the SUCRA values to rank the probability of each radiopharmaceutical being the most sensitive method. Results In our results, 243 patients from 9 clinical studies which accessed sensitivities of different radiopharmaceuticals in MTC metastatic sites were included. For lymph nodes and liver, TF2/68Ga-SSM288 showed the highest SUCRA values (0.974 in lymph nodes, 0.979 in liver). The SUCRA values for 18F-DOPA and 68Ga-SSA for bone metastatic lesions were nearly identical (0.301 and 0.319, respectively) and were higher than the other three radiopharmaceuticals. For lung lesions, 11C-methionine had the highest SUCRA value (0.412). Conclusion TF2/68Ga-SSM288 had the best sensitivity in lymph nodes and liver lesions. 11C-methionine was most sensitive in lung lesions. While 18F-DOPA and 68Ga-SSA had familiar sensitivities to be the best two radiopharmaceuticals.

Endocrinology application of molecular imaging: current role of PET/CT

“…Medullary thyroid cancer Medullary thyroid carcinoma (MTC) originates from the parafollicular C cells of the thyroid gland and correct staging and risk assessment are crucial to choose the most appropriate therapeutic approach [50]. With regard to MTC, the most appropriate use of [ 18 F] FDOPA and [ 18 F]FDG PET/CT depends on serum calcitonin and carcinoembryonic antigen (CEA) levels [51].…”

“…However [ 18 F]FDG may characterize less differentiated lesions (as observed in patients with predominant increase in serum CEA compared to CT) informing changes in therapy lines. As the very least, somatostatin analogs (SSA) are also proposed for MTC restaging but their sensitivity and accuracy are significantly lower to both [ 18 F] FDOPA and [ 18 F]FDG, respectively [50]. Several experimental nuclear medicine therapeutic options are currently being evaluated in metastatic MTC [52].…”