Department of Radiology, Section of Nuclear Medicine, Penn State Health, the Milton S. Hershey Medical Center, Penn State University Hospital, Hershey, Pennsylvania 17033, United States.
Curr Pharm Des. 2020;26(31):3812-3827. doi: 10.2174/1381612826666200605121054.
This review of radioactive iodide treatment (RAIT) extends from historical origins to its modern utilization in differentiated thyroid cancer (DTC). The principles embedded in the radiotheragnostics (RTGs) paradigm are detailed. The diverse approaches in current practice are addressed, and this broad variability represents a major weakness that erodes our specialty's trust-based relationship with patients and referring physicians. The currently developing inter-specialty collaboration should be hailed as a positive change. It promises to clarify the target-based terminology for RAIT. It defines RAIT of post total thyroidectomy (PTT), presumably benign thyroid as 'remnant ablation' (RA). 'Adjuvant treatment' (AT) referrers to RAIT of suspected microscopic DTC that is inherently occult on diagnostic imaging. RAIT directed at DTC lesion(s) overtly seen on diagnostic imaging is termed 'treatment of known disease' (TKD). It was recently recognized that a 'recurrent' DTC is actually occult residual DTC in the majority of cases. Thyroglobulin with remnant uptake concord (TRUC) method (aka Tulchinsky method) was developed to validate that a benign remnant in the post-thyroidectomy neck bed, as quantified by the RAI uptake, is concordant with a measured thyroglobulin (Tg) level at the time of the initial post-thyroidectomy evaluation. It allows recognition of occult residual DTC contribution to post-thyroidectomy Tg. Case examples demonstrate the application of the TRUC method for a logical selection of a specific RAIT category, using imaging-guided identification and management of RAI-avid versus RAI-nonavid residual DTC, i.e. the radiotheragnostics paradigm.
这篇放射性碘治疗 (RAIT) 的综述从历史起源延伸到其在分化型甲状腺癌 (DTC) 中的现代应用。详细介绍了放射性治疗诊断学 (RTGs) 范式中嵌入的原则。讨论了当前实践中的不同方法，这种广泛的变异性代表了一个主要弱点，侵蚀了我们专业与患者和转诊医生之间基于信任的关系。目前正在发展的跨专业合作应该受到欢迎，被视为积极的变化。它有望澄清 RAIT 的基于目标的术语。它将 PTT 后假定良性甲状腺的 RAIT 定义为“残余消融”(RA)。“辅助治疗”(AT) 是指对诊断性影像学上隐匿性的疑似显微镜下 DTC 的 RAIT。针对诊断性影像学上明显可见的 DTC 病灶的 RAIT 称为“已知疾病治疗”(TKD)。最近人们认识到，大多数情况下，“复发性”DTC 实际上是隐匿性残余 DTC。残余摄取一致性 (TRUC) 方法（又名 Tulchinsky 方法）的开发是为了验证甲状腺切除术后颈部床内的良性残余物与 RAI 摄取一致，与甲状腺球蛋白 (Tg) 水平一致，该水平在初始甲状腺切除术后评估时进行了测量。它允许识别隐匿性残余 DTC 对甲状腺切除术后 Tg 的贡献。案例示例演示了如何使用成像引导的方法识别和管理 RAI 阳性与 RAI 阴性残余 DTC，即放射性治疗诊断学范式，来应用 TRUC 方法对特定 RAIT 类别进行逻辑选择。
