Giovanella Luca, Deandreis Desiree', Vrachimis Alexis, Campenni Alfredo, Petranovic Ovcaricek Petra
Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland.
Division of Nuclear Medicine, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy.
Cancers (Basel). 2022 Mar 1;14(5):1272. doi: 10.3390/cancers14051272.
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., I, I, I) is an indispensable component of dynamic and theragnostic risk stratification of differentiated carcinoma (DTC) while [F]F-fluorodeoxyglucose ([F]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, [F]F-dihydroxyphenylalanine (6-[F]FDOPA) PET/CT and/or [F]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.
分子成像在不同组织学类型甲状腺癌的评估和管理中发挥着重要作用。通过纳入具有诊疗能力的肿瘤特异性分子标志物，可以完善现有的风险分层模型，以优化针对患者个体的治疗决策。使用不同碘放射性同位素（即碘-123、碘-124、碘-131）的分子成像，是分化型甲状腺癌（DTC）动态和诊疗风险分层不可或缺的组成部分，而[氟-18]氟脱氧葡萄糖（[¹⁸F]FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）有助于评估疾病侵袭性、检测远处转移，并对碘难治性DTC、低分化和未分化甲状腺癌患者进行风险分层。对于髓样甲状腺癌（MTC），一种源自甲状腺C细胞的神经内分泌肿瘤，可根据血清标志物水平和动力学情况使用[¹⁸F]二羟基苯丙氨酸（6-[¹⁸F]FDOPA）PET/CT和/或[¹⁸F]FDG PET/CT。除了DTC的放射性碘治疗外，一些诊疗方法对转移性MTC也很有前景。此外，现在有新的再分化策略可恢复碘难治性DTC的摄取，而新的诊疗方法对晚期和侵袭性滤泡细胞源性甲状腺癌（即肽受体放疗）显示出有前景的初步结果。为了帮助临床医生正确看待分子成像的作用，我们在本综述中讨论了分子成像和诊疗在甲状腺癌中的适当作用和新出现的机会。
