Department of Nuclear Medicine, Gruppo Ospedaliero Moncucco, Lugano, Switzerland; Clinic for Nuclear Medicine, University Hospital Zürich, Zürich, Switzerland.
Department of Nuclear Medicine, Hacettepe University, Ankara, Turkey.
Semin Nucl Med. 2024 Jul;54(4):470-487. doi: 10.1053/j.semnuclmed.2024.01.011. Epub 2024 Mar 19.
Molecular imaging is pivotal in evaluating and managing patients with different thyroid cancer histotypes. The existing, pathology-based, risk stratification systems can be usefully refined, by incorporating tumor-specific molecular and molecular imaging biomarkers with theranostic value, allowing patient-specific treatment decisions. Molecular imaging with different radioactive iodine isotopes (ie, I, I, I) is a central component of differentiated carcinoma (DTC)'s risk stratification while [F]F-fluorodeoxyglucose ([F]FDG) PET/CT is interrogated about disease aggressiveness and presence of distant metastases. Moreover, it is particularly useful to assess and risk-stratify patients with radioiodine-refractory DTC, poorly differentiated, and anaplastic thyroid cancers. [F]F-dihydroxyphenylalanine (6-[F]FDOPA) PET/CT is the most specific and accurate molecular imaging procedure for patients with medullary thyroid cancer (MTC), a neuroendocrine tumor derived from thyroid C-cells. In addition, [F]FDG PET/CT can be used in patients with more aggressive clinical or biochemical (ie, serum markers levels and kinetics) MTC phenotypes. In addition to conventional radioiodine therapy for DTC, new redifferentiation strategies are now available to restore uptake in radioiodine-refractory DTC. Moreover, peptide receptor theranostics showed promising results in patients with advanced and metastatic radioiodine-refractory DTC and MTC, respectively. The current appropriate role and future perspectives of molecular imaging and theranostics in thyroid cancer are discussed in our present review.
分子成像在评估和管理不同甲状腺癌组织类型的患者中起着关键作用。现有的基于病理学的风险分层系统，可以通过纳入具有治疗诊断价值的肿瘤特异性分子和分子成像生物标志物进行有益的细化，从而实现针对患者的治疗决策。不同放射性碘同位素（即 I、I、I）的分子成像，是分化型癌（DTC）风险分层的核心组成部分，而[F]氟代脱氧葡萄糖([F]FDG) PET/CT 则用于评估疾病侵袭性和远处转移的存在。此外，它对于评估和风险分层放射性碘难治性 DTC、低分化和间变性甲状腺癌患者特别有用。[F]二羟苯丙氨酸（6-[F]FDOPA）PET/CT 是甲状腺 C 细胞来源的神经内分泌肿瘤——甲状腺髓样癌（MTC）患者最特异和准确的分子成像程序。此外，在具有侵袭性临床或生化特征（即血清标志物水平和动力学）的 MTC 患者中，也可以使用[F]FDG PET/CT。除了 DTC 的常规放射性碘治疗外，现在还可以使用新的再分化策略来恢复放射性碘难治性 DTC 中的摄取。此外，肽受体治疗学在晚期和转移性放射性碘难治性 DTC 和 MTC 患者中分别显示出有前景的结果。在我们的综述中讨论了分子成像和治疗学在甲状腺癌中的当前适当作用和未来前景。
