PET/CT in the management of differentiated thyroid cancer - 02/09/21
Highlights |
• | At initial evaluation at the time of radioiodine ablation therapy, 18F-FDG PET/CT should be performed in patients with intermediate-to-high-risk thyroid cancer owing to excellent prognostic capabilities. |
• | Patients scheduled for empiric radioiodine therapy because of strong suspicion of recurrent disease should undergo 18F-FDG PET/CT before radioiodine therapeutic administration. |
• | There are not enough data to support the routine use of 124I-PET/CT as an alternative to 131-I whole-body scan, but encouraging results have been obtained with 124I-PET/CT in dosimetric approach to radioiodine therapy. |
• | PET/MRI is a promising technique in selected patients with differentiated thyroid cancer when radiation dose should be minimized or when MRI is indicated. |
Abstract |
The standard treatment of differentiated thyroid cancer (DTC) consists of surgery followed by iodine-131 (131I) administration. Although the majority of DTC has a very good prognosis, more aggressive histologic subtypes convey a worse prognosis. Follow-up consists of periodically measurements of serum thyroglobulin, thyroglobulin antibodies and neck ultrasound and 123I/131I whole-body scan. However, undifferentiated thyroid tumors have a lower avidity for radioiodine and the ability of DTC to concentrate 131I may be lost in metastatic disease. Positron emission tomography (PET)/computed tomography (CT) has been introduced in the evaluation of patients with thyroid tumors and the 2-[18F]-fluoro-2-deoxyd-glucose (18F-FDG) has been largely validated as marker of cell's metabolism. According to the 2015 American Thyroid Association guidelines, 18F-FDG PET/CT is recommended in the follow-up of high-risk patients with elevated serum thyroglobulin and negative 131I imaging, in the assessment of metastatic patients, for lesion detection and risk stratification and in predicting the response to therapy. It should be considered that well-differentiated iodine avid lesions could not concentrate 18F-FDG, and a reciprocal pattern of iodine and 18F-FDG uptake has been observed. Beyond 18F-FDG, other tracers are available for PET imaging of thyroid tumors, such as Iodine-124 (124I), 18F-tetrafluoroborate and Gallium-68 prostate-specific membrane antigen. Moreover, the recent introduction of PET/MRI, offers now several opportunities in the field of patients with DTC. This review summarizes the evidences on the role of PET/CT in management of patients with DTC, focusing on potential applications and on elucidating some still debating points.
Le texte complet de cet article est disponible en PDF.Keywords : Positron emission tomography/computed tomography (PET/CT), Thyroid neoplasm, Fluorodeoxyglucose F18, Iodine-124, PET/MRI
Abbreviations : AJCC/UICC, ATA, DTC, FDG, MRI, NIS, PET/CT, PSMA, SUV, TFB, Tg, Tg-Ab, TNM, WBS
Plan
Vol 102 - N° 9
P. 515-523 - septembre 2021 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.