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Rao M, Xie J, Zhang H, Tian Y, Cai L. Localized 131 I Uptake in the Deltoid Muscle Bilaterally After Parathyroid Transplantation. Clin Nucl Med 2024; 49:993-994. [PMID: 39150363 DOI: 10.1097/rlu.0000000000005431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
ABSTRACT A 49-year-old woman patient with thyroid cancer accepted thyroidectomy and parathyroid transplantation. One month later, localized 131 I uptake in the deltoid muscle bilaterally was detected by 131 I whole-body imaging performed in 2 days after 131 I administration.
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Affiliation(s)
- Maohua Rao
- From the Department of Nuclear Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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2
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Volpe F, Nappi C, Zampella E, Di Donna E, Maurea S, Cuocolo A, Klain M. Current Advances in Radioactive Iodine-Refractory Differentiated Thyroid Cancer. Curr Oncol 2024; 31:3870-3884. [PMID: 39057158 PMCID: PMC11276085 DOI: 10.3390/curroncol31070286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/28/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Differentiated thyroid cancer (DTC) patients have an outstanding overall long-term survival rate, and certain subsets of DTC patients have a very high likelihood of disease recurrence. Radioactive iodine (RAI) therapy is a cornerstone in DTC management, but cancer cells can eventually develop resistance to RAI. Radioactive iodine-refractory DTC (RAIR-DTC) is a condition defined by ATA 2015 guidelines when DTC cannot concentrate RAI ab initio or loses RAI uptake ability after the initial therapy. The RAIR condition implies that RAI cannot reveal new met-astatic foci, so RAIR-DTC metabolic imaging needs new tracers. 18F-FDG PET/CT has been widely used and has demonstrated prognostic value, but 18F-FDG DTC avidity may remain low. Fibroblast activation protein inhibitors (FA-Pi)s, prostatic-specific membrane antigen (PSMA), and somatostatin receptor (SSTR) tracers have been proposed as theragnostic agents in experimental settings and Arg-Gly-Asp (RGD) peptides in the diagnostic trial field. Multi-targeted tyrosine kinase inhibitors are relatively new drugs approved in RAIR-DTC therapy. Despite the promising targeted setting, they relate to frequent adverse-event onset. Sorafenib and trametinib have been included in re-differentiation protocols aimed at re-inducing RAI accumulation in DTC cells. Results appear promising, but not excellent. CONCLUSIONS RAIR-DTC remains a challenging nosological entity. There are still controversies on RAIR-DTC definition and post-RAI therapy evaluation, with post-therapy whole-body scan (PT-WBS) the only validated criterion of response. The recent introduction of multiple diagnostic and therapeutic agents obliges physicians to pursue a multidisciplinary approach aiming to correct drug introduction and timing choice.
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Affiliation(s)
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80138 Naples, Italy; (F.V.); (E.Z.); (E.D.D.); (S.M.); (A.C.); (M.K.)
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3
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Bellini P, Dondi F, Gatta E, Zilioli V, Albano D, Cappelli C, Bertagna F. Prognostic role and characteristics of the indeterminate response in differentiated thyroid cancer: a systematic review. Endocrine 2024; 84:812-821. [PMID: 38265607 DOI: 10.1007/s12020-024-03688-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/06/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE The management of differentiated thyroid cancer (DTC) is actually based on a dynamic risk stratification based on classes of response to the therapy. Indeterminate response (IR) includes a heterogeneous group of patients with different characteristics, particularly different Tg and AbTg levels and/or imaging findings. The aim of systematic review (SR) is to evaluate the prognosis, diagnostic findings and other characteristics of patients in the IR class. METHODS A wide literature search in the Scopus, PubMed/MEDLINE and Web of Science databases was performed to find published articles on patients with DTC and IR after treatment. The quality assessment of studies was carried out using QUADAS-2 evaluation. RESULTS Eight articles were included in the systematic review. Six studies evaluated the prognosis and the prognostic factor in patients with IR, one study evaluated the role of 2-[18F]FDG PET-CT in the management of patients with IR and biochemical incomplete response and one study the risk factors for IR. CONCLUSION Patients with DTC and IR to therapy have a probability of disease relapse < 15%. Tg value could be a predictor of disease progression. The role of 2-[18F]FDG PET-CT needs to be further investigated.
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Affiliation(s)
- P Bellini
- S.C. Medicina Nucleare, ASST Spedali Civili di Brescia, Brescia, Italy.
| | - F Dondi
- S.C. Medicina Nucleare, Università degli studi di Brescia and ASST Spedali Civili di Brescia, Brescia, Italy
| | - E Gatta
- S.S.D. Endocrinologia, Università degli studi di Brescia and ASST Spedali Civili di Brescia, Brescia, Italy
| | - V Zilioli
- S.C. Medicina Nucleare, ASST Spedali Civili di Brescia, Brescia, Italy
| | - D Albano
- S.C. Medicina Nucleare, Università degli studi di Brescia and ASST Spedali Civili di Brescia, Brescia, Italy
| | - C Cappelli
- S.S.D. Endocrinologia, Università degli studi di Brescia and ASST Spedali Civili di Brescia, Brescia, Italy
| | - F Bertagna
- S.C. Medicina Nucleare, Università degli studi di Brescia and ASST Spedali Civili di Brescia, Brescia, Italy
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4
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Makarewicz J, Rudzki J. Beard Contamination With 131I Diagnosed by SPECT/CT in a Patient With Differentiated Thyroid Cancer. Clin Nucl Med 2024:00003072-990000000-01114. [PMID: 38768062 DOI: 10.1097/rlu.0000000000005282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
ABSTRACT Abnormal focal accumulation of 131I is generally a reliable indicator of differentiated thyroid cancer metastases. However, many examples of false-positive 131I uptake were reported, some of them of unusual nature. We report a case of 32-year-old man with differentiated thyroid cancer who underwent thyroid remnants ablation with radioiodine. An area of considerable 131I uptake projecting onto lateral cervical areas was detected on posttherapy planar whole-body scan. Neck SPECT/CT scan was done to elucidate localization of the uptake, and activity was found in the patient's beard.
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Affiliation(s)
| | - Jan Rudzki
- From the Department of Nuclear Medicine and Oncological Endocrinology, Maria Sklodowska-Curie Memorial District Hospital, Zgierz, Poland
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5
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Chong A, Seo Y, Bang JI, Park S, Kim K, Hong CM, Choi M, Oh SW, Lee SW. Clinical Implications of Adding SPECT/CT to Radioiodine Whole-Body Scan in Patients With Differentiated Thyroid Cancer: A Systematic Review and Meta-analysis. Clin Nucl Med 2024; 49:215-225. [PMID: 38048517 DOI: 10.1097/rlu.0000000000004953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
PURPOSE This study aimed to determine the usefulness of adding SPECT/CT to radioiodine whole-body scans (WBSs) for the treatment of differentiated thyroid cancer (DTC). PATIENTS AND METHODS A systematic review and meta-analysis were performed following the PRISMA guidelines (PROSPERO registration: CRD42022341732) to compare the feasibility of conclusive readings and the frequency of changes in treatment plans in patients with DTC undergoing WBS + SPECT/CT versus WBS. MEDLINE, EMBASE, and Cochrane databases were searched to identify relevant articles concerning thyroid cancer, radioactive iodine, and SPECT/CT or SPECT, published before August 16, 2023. Studies not comparing WBS + SPECT/CT with WBS, those lacking target outcomes, and those not involving human subjects were excluded. The risk of bias was assessed using the RoBANS 2.0 (Risk of Bias Assessment Tool for Nonrandomized Studies) tool. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system was used to evaluate the quality of evidence and strength of recommendations. RESULTS A total of 30 studies (prospective n = 9, retrospective n = 21) were included in the meta-analyses. Adding SPECT/CT to WBS was shown to increase conclusive readings for cervical lesions, extracervical lesions, and all regions. Lesion-based analyses showed improvements of 14%, 20%, and 18%, respectively, whereas scan-based analyses showed improvements of 27%, 9%, and 34%. The addition of SPECT/CT to WBS led to changes in 30% of treatment plans after diagnostic scans and 9% of treatment plans after posttherapeutic scans. The quality of evidence and strength of recommendations were low. CONCLUSIONS Compelling evidence demonstrates that the addition of SPECT/CT to WBS improves lesion localization, diagnostic performance, and therapy plan for patients with DTC.
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Affiliation(s)
- Ari Chong
- From the Department of Nuclear Medicine, Chosun University, College of Medicine and Chosun University Hospital, Gwangju
| | - Youngduk Seo
- Department of Nuclear Medicine, Chungnam National University Sejong Hospital, Sejong
| | - Ji-In Bang
- Department of Nuclear Medicine, CHA Bundang Medical Center, CHA University, Pocheon
| | - Sohyun Park
- Department of Nuclear Medicine, Hospital, National Cancer Center, Goyang
| | - Keunyoung Kim
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital and School of Medicine, Pusan National University, Busan
| | - Chae Moon Hong
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu
| | - Miyoung Choi
- Division of Health Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency
| | - So Won Oh
- Department of Nuclear Medicine, Seoul National University Boramae Medical Center, Seoul
| | - Sang-Woo Lee
- Department of Nuclear Medicine, Kyungpook National University, School of Medicine and Chilgok Hospital, Daegu, South Korea
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Dai H, Qi Z, Huang S, Qi M, Huang R. Comparative Study of Initial Post-Therapeutic 131I Single-Photon Emission Computed Tomography/Computed Tomography and Reoperation for the Detection of Residual Lymph Node Metastasis in Patients With Papillary Thyroid Cancer. Endocr Pract 2023; 29:97-103. [PMID: 36356838 DOI: 10.1016/j.eprac.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the diagnostic performance of initial post-therapeutic 131I single-photon emission computed tomography/computed tomography (SPECT/CT) compared with that of reoperation in detecting residual lymph node metastasis (LNM). METHODS Patients with iodine-avid LNM detected on the initial post-therapeutic 131I SPECT/CT and who underwent reoperative dissection within 6 months were included. LNMs (numbers and locations) detected via both methods were compared. The American Thyroid Association dynamic risk stratification was performed for patients receiving second radioactive iodine therapy after reoperation. RESULTS Fifty-three patients with 95 iodine-avid LNMs detected by 131I SPECT/CT were enrolled. Fifty-one (96.2%) patients had 212 LNMs confirmed by reoperation (P = .004). The sensitivity and specificity of 131I SPECT/CT in detecting LNM were 44.8% (95/212) and 91.6% (87/95), respectively. The location frequency of residual LNMs found by 131I SPECT/CT was similar to that of reoperation (P = .057). Thirty-two patients received a second radioactive iodine treatment, and 6 (18.8%) patients still had residual iodine-avid LNM on SPECT/CT. Therapeutic response was evaluated by American Thyroid Association dynamic risk stratification in 16 patients. The number of patients with structural incomplete response, biochemical incomplete response, indeterminate response, and excellent response was 4 (23.5%), 4 (23.5%), 5 (29.4%), and 3 (17.6%), respectively. CONCLUSION 131I SPECT/CT has high specificity but relatively low sensitivity in detecting all residual LNMs. Approximately 80% of patients were rendered structurally disease free after reoperation.
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Affiliation(s)
- Hongyuan Dai
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Zhibing Qi
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China; Department of Nuclear Medicine, Jiujiang First People's Hospital, Jiujiang, Jiangxi, People's Republic of China
| | - Shuhui Huang
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Mengfang Qi
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Rui Huang
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China.
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7
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Rohani MFM, Sohaimi WFW, Nawi NM, Sapiai NA, Daud MAM, Sohaimi WHW. Pulmonary sequestration: a rare cause of false-positive uptake in Iodine-131 whole-body scan. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00723-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
High-dose radioactive iodine-131 (I-131) is generally used post-total or subtotal thyroidectomy in differentiated thyroid cancer (DTC) patients. I-131 whole-body scan (WBS) is performed to localize I-131 accumulation in the body and for restaging after therapy. Nonetheless, there are numerous causes of false-positive uptake in I-131 WBS in the absence of residual thyroid tissue or thyroid cancer metastasis.
Case presentation
We present a case of 51-year-old lady with false-positive uptake in I-131 WBS mimicking lung metastasis. Patient underwent total thyroidectomy, and histopathological examination showed well-differentiated papillary thyroid microcarcinoma. Diagnostic I-131 WBS followed by two subsequent high-dose radioiodine ablation showed persistent I-131 uptake in the left lower lung field. However, the serum thyroglobulin (Tg) is incessantly undetectable (< 0.04 μg/ml) with negative anti-thyroglobulin antibody (anti-TgAb). Three serial CT scans over the course of treatment coupled with MRI of the thoracolumbar region revealed stable lung lesion in the posterior segment of left lower lobe which signifies pulmonary sequestration. Based on the clinical assessment, imaging findings and blood investigations, patient was no longer subjected to I-131 therapy and is maintained on TSH suppression with L-thyroxine. After due consideration of the pros and cons of surgical intervention, the patient opted against surgical removal of the pulmonary sequestration.
Conclusions
Meticulous assessment of patient with suspected disease recurrence or metastasis in thyroid carcinoma is essential to avoid unnecessary I-131 ablation or surgical intervention. In this case, the positive I-131 imaging is associated with undetectable serum Tg (with negative anti-TgAb). Albeit uncommon, pulmonary sequestration should be taken into consideration as one of the differentials in false-positive findings of an I-131 WBS.
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8
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Zhang Q, Xu W. Correlation analysis of I-131 SPECT/CT uptake parameters with the success ablation treatment of thyroid remnant in patients with low-intermediate-risk differentiated thyroid cancer. Nucl Med Commun 2022; 43:1051-1057. [PMID: 35972341 DOI: 10.1097/mnm.0000000000001604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To predict the successful outcome of radioactive iodine-131 (I-131) ablation treatment for differentiated thyroid cancer (DTC) patients using quantitative parameters from therapeutic I-131 SPECT/CT. METHODS This retrospective study enrolled 145 DTC patients (41 males and 104 females) who had radioactive iodine-131 (I-131) (RAI) ablation therapy following thyroidectomy surgery from July 2020 to May 2021. The median age was 47 years (24-65 years). All the patients underwent therapeutic I-131 thyroid SPECT/CT scan after RAI ablation. The I-131 uptake quantitative parameters SUV max , SUV mean %ID and ∆Tg (defined as the Tg level before RAI ablation minus the Tg level after six months) were assessem. Successful ablation treatment was defined as the level of TSH-stimulated Tg≤1 ng/mL and the disappearance of the thyroid bed on a whole-body I-131 scan six months or later after ablation treatment. RESULTS The quantitative parameters from therapeutic I-131 SPECT/CT of the successful ablation (n=130) group with SUV max 7.74 (3.84, 18.78) g/ml, SUV mean 4.02 (2.11, 6.39) g/ml and %ID 2.21% (0.67%, 7.30%) were significantly higher than those of the unsuccessful (n=15) group 0.75 (0.53, 1.28) g/ml, 0.44 (0.29, 0.79) g/ml and 0.16% (0.06%, 1.48%) (Z=-5.87, -5.71 and -4.99, all P < 0.001). SUV max , SUV mean and %ID were positively correlated with ΔTg (all P < 0.001). Receiver operating characteristics curve analysis showed that %ID performed better predict value than either SUV max (AUC=0.914, and 0.874, P=0.009) or SUV mean (AUC= 0.863 P=0.002). SUV max , SUV mean and%ID (OR =1.50, 2.85 and 1.01 all P < 0.001) were all independent predictors of successful RAI ablation. CONCLUSION The quantitative parameters of therapeutic I-131 SPECT/CT were related to the efficacy of ablation treatment, and %ID could predict the successful outcome of ablation treatment for DTC patients.
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Affiliation(s)
- Qian Zhang
- Department of Nuclear Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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9
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Ahmadi S, Coleman A, de Morais NS, Landa I, Pappa T, Kang A, Kim MI, Marqusee E, Alexander EK. Clinical experience following implementation of routine SPECT-CT imaging following 131-iodine administration for thyroid cancer. Endocr Connect 2022; 11:e210371. [PMID: 35521806 PMCID: PMC9175585 DOI: 10.1530/ec-21-0371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/22/2022] [Indexed: 11/18/2022]
Abstract
Background Planar scintigraphy has long been indicated in patients receiving I-131 therapy for thyroid cancer to determine the anatomic location of metastases. We studied our experience upon implementing additional single-photon emission (SPECT)-CT scanning in these patients. Method We performed a retrospective study of consecutive adult patients with newly diagnosed thyroid cancer treated with I-131 between 2011 and 2017. Radiologic findings detected with planar scintigraphy alone vs those identified with SPECT-CT scanning were primary endpoints. Result In this study, 212 consecutive patients with thyroid cancer were analyzed in two separate cohorts (107 planar scintigraphy alone and 105 planar scintigraphy with SPECT-CT). The addition of SPECT-CT resulted in more findings, both thyroid-related and incidental. However, we identified only 3 of 21 cases in which SPECT-CT provided an unequivocal additional benefit by changing clinical management beyond planar scintigraphy alone. No difference in the detection of distant metastatic disease or outcome was identified between cohorts. Conclusion Synergistic SPECT-CT imaging in addition to planar nuclear scintigraphy adds limited clinical value to thyroid cancer patients harboring a low risk of distant metastases, while frequently identifying clinically insignificant findings. These data from a typical cohort of patients receiving standard thyroid cancer care provide insight into the routine use of SPECT-CT in such patients.
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Affiliation(s)
- Sara Ahmadi
- Thyroid Section Brigham & Women’s Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Alexandra Coleman
- Thyroid Section Brigham & Women’s Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Nathalie Silva de Morais
- Thyroid Section Brigham & Women’s Hospital & Harvard Medical School, Boston, Massachusetts, USA
- Endocrinology Service, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Iñigo Landa
- Thyroid Section Brigham & Women’s Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Theodora Pappa
- Thyroid Section Brigham & Women’s Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Alex Kang
- Thyroid Section Brigham & Women’s Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew I Kim
- Thyroid Section Brigham & Women’s Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Ellen Marqusee
- Thyroid Section Brigham & Women’s Hospital & Harvard Medical School, Boston, Massachusetts, USA
| | - Erik K Alexander
- Thyroid Section Brigham & Women’s Hospital & Harvard Medical School, Boston, Massachusetts, USA
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10
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Tuncel M, Vrachimis A, Campenni A, de Keizer B, Verburg FA, Kreissl MC, Ovcaricek PP, Geliashvili T, Giovanella L. To give or not to give? A critical appraisal of a clinical trial on radioiodine treatment. Eur J Nucl Med Mol Imaging 2022; 49:3316-3319. [PMID: 35581502 DOI: 10.1007/s00259-022-05841-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Murat Tuncel
- EANM Thyroid Committee, Vienna, Austria. .,Department of Nuclear Medicine, Hacettepe University, Ankara, Turkey.
| | - Alexis Vrachimis
- EANM Thyroid Committee, Vienna, Austria.,Department of Nuclear Medicine, German Oncology Center, University Hospital of the European University, Limassol, Cyprus
| | - Alfredo Campenni
- EANM Thyroid Committee, Vienna, Austria.,Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Unit of Nuclear Medicine, University of Messina, Messina, Italy
| | - Bart de Keizer
- EANM Thyroid Committee, Vienna, Austria.,Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Frederik A Verburg
- Departments of Radiology and Nuclear Medicine, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - Michael C Kreissl
- EANM Thyroid Committee, Vienna, Austria.,Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Otto-Von-Guericke University, Magdeburg, Germany
| | - Petra Petranovic Ovcaricek
- EANM Thyroid Committee, Vienna, Austria.,Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Tamara Geliashvili
- EANM Thyroid Committee, Vienna, Austria.,Department of Radionuclide Therapy, Research Institute of Clinical and Experimental Radiology of the N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia
| | - Luca Giovanella
- EANM Thyroid Committee, Vienna, Austria.,Clinic for Nuclear Medicine, Ente Ospedaliero Cantonale, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
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11
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Wang H, Lv M, Huang Y, Pan X, Wei C. Identification of Circulating Tumor Cell Phenotype in Differentiated Thyroid Carcinoma. J BIOMATER TISS ENG 2022. [DOI: 10.1166/jbt.2022.2957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective: Circulating tumor cells (CTCs) have been considered as the origin of tumor metastasis and recurrence, which always indicate a poor prognosis. There are three phenotypes of CTCs according on different epithelial-to-mesenchymal transition (EMT) markers, including epithelial,
mesenchymal, and epithelial/mesenchymal (mixed phenotypic) CTCs. We intended to explore the relationship among CTC phenotypes and the clinicopathological characteristics of patients with differentiated thyroid carcinoma (DTC). Methods: Peripheral blood samples from 58 patients with
DTC were collected, and CTCs were isolated by cell sizes. To identify phenotypes of CTCs, branched DNA signal amplification technology was adopted to capture and amplify target sequences, and then multiplex RNA-in situ hybridization (RNA-ISH) assay was used to identify CTC phenotypes
depended on epithelial-mesenchymal transition (EMT) markers. Results: The positive rate of CTCs was 77.59% in 58 DTC patients. Totally, 488 CTCs with detective phenotype were found. Among them, there were 121 (24.80%) epithelial CTCs, 67 (13.72%) mesenchymal CTCs, and 300 (61.48%) mixed
phenotypic CTCs. An obvious increased epithelial CTCs was observed in male patients compared with female. Notably, CTCs were more prevailing in younger male patients with ETI and bilateral focus. Conclusions: The CTCs are common in DTC patients, and mixed phenotypic is the major phenotype,
indicating that EMT is prevalent in DTC even though its prognosis was better than other epithelial tumors. Detection of CTC and its phenotypes might independently predict the prognosis of DTC.
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Affiliation(s)
- Huiling Wang
- Department of Breast Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, People’s Republic of China
| | - Mian Lv
- Department of Breast and Thyroid Surgery, The Second People’s Hospital of Nanning City, The Third Affiliated Hospital of Guangxi Medical University, Guangxi, Nanning, 530021, P. R. China
| | - Yonghong Huang
- Department of Breast and Thyroid Surgery, The Second People’s Hospital of Nanning City, The Third Affiliated Hospital of Guangxi Medical University, Guangxi, Nanning, 530021, P. R. China
| | - Xiaoming Pan
- Department of Breast and Thyroid Surgery, The Second People’s Hospital of Nanning City, The Third Affiliated Hospital of Guangxi Medical University, Guangxi, Nanning, 530021, P. R. China
| | - Changyuan Wei
- Department of Breast Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, People’s Republic of China
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12
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Lin S, Wei YR, Yao HX. Global Hotspots and Prospects of I-131 Therapy in Thyroid Carcinoma via Bibliometric Analysis. Int J Gen Med 2021; 14:9707-9718. [PMID: 34934347 PMCID: PMC8684403 DOI: 10.2147/ijgm.s339946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background Hundreds of studies have reported the application of iodine-131 (I-131) in thyroid carcinoma (THCA) in past years. However, the status of research in the field and other related topics have not been investigated. This study aimed to identify the cooperation of authors, countries, and institutions, as well as explore the hot topics and prospects regarding I-131 therapy in THCA based on previous studies. Methods Publications from 2010 to 2020 were retrieved from Web of Science Core Collection according to research strategy. Bibliometric analyses were performed using VOSviewer 1.6.15 and CiteSpace 5.7.3 to evaluate and visualize the cooperation network, hot topic, and research frontier. Results The number of publications showed a trend of fluctuation between 2010 and 2020. We identified 1387 publications related to I-131 therapy in THCA, which were published by 1628 institutions from 82 countries. The largest proportion of publications were emanated from the USA, and the majority of papers were published by Thyroid. Shanghai Jiao Tong University of China contributed the most papers. Although many authors participated in the research of this field, high-yield authors were few. Co-occurrence analysis classified keywords into five clusters, including assessment, efficacy measurement, monitoring, hormone regulation, and guidelines of I-131 therapy. The terms “bone marrow dosimetry and time” were among the latest hotspots. The research frontier topic in I-131 therapy focused on the “P53 and anti-Müllerian hormone”. Conclusion The attention to I-131 therapy in THCA should be increased considerably. It was necessary to construct active co-operations between authors, countries, and institutions to promote the development of this field. Recent researches referred to the timing and dose assessment of I-131 therapy in THCA. Future studies likely focused on targeted therapy and adverse effects evaluation were worthy of research as well.
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Affiliation(s)
- Shang Lin
- Department of Nuclear Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325002, People's Republic of China
| | - Ya-Ru Wei
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325002, People's Republic of China
| | - Hong-Xiang Yao
- Department of Interventional Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325002, People's Republic of China
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Barca C, Griessinger CM, Faust A, Depke D, Essler M, Windhorst AD, Devoogdt N, Brindle KM, Schäfers M, Zinnhardt B, Jacobs AH. Expanding Theranostic Radiopharmaceuticals for Tumor Diagnosis and Therapy. Pharmaceuticals (Basel) 2021; 15:13. [PMID: 35056071 PMCID: PMC8780589 DOI: 10.3390/ph15010013] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/16/2021] [Accepted: 12/16/2021] [Indexed: 02/06/2023] Open
Abstract
Radioligand theranostics (RT) in oncology use cancer-type specific biomarkers and molecular imaging (MI), including positron emission tomography (PET), single-photon emission computed tomography (SPECT) and planar scintigraphy, for patient diagnosis, therapy, and personalized management. While the definition of theranostics was initially restricted to a single compound allowing visualization and therapy simultaneously, the concept has been widened with the development of theranostic pairs and the combination of nuclear medicine with different types of cancer therapies. Here, we review the clinical applications of different theranostic radiopharmaceuticals in managing different tumor types (differentiated thyroid, neuroendocrine prostate, and breast cancer) that support the combination of innovative oncological therapies such as gene and cell-based therapies with RT.
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Affiliation(s)
- Cristina Barca
- European Institute for Molecular Imaging, University of Münster, D-48149 Münster, Germany; (A.F.); (D.D.); (M.S.); (B.Z.)
| | - Christoph M. Griessinger
- Roche Innovation Center, Early Clinical Development Oncology, Roche Pharmaceutical Research and Early Development, CH-4070 Basel, Switzerland;
| | - Andreas Faust
- European Institute for Molecular Imaging, University of Münster, D-48149 Münster, Germany; (A.F.); (D.D.); (M.S.); (B.Z.)
- Department of Nuclear Medicine, University Hospital Münster, D-48149 Münster, Germany
| | - Dominic Depke
- European Institute for Molecular Imaging, University of Münster, D-48149 Münster, Germany; (A.F.); (D.D.); (M.S.); (B.Z.)
| | - Markus Essler
- Department of Nuclear Medicine, University Hospital Bonn, D-53127 Bonn, Germany;
| | - Albert D. Windhorst
- Department Radiology & Nuclear Medicine, Amsterdam UMC, Vrije Universiteit, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands;
| | - Nick Devoogdt
- In Vivo Cellular and Molecular Imaging Laboratory, Vrije Universiteit Brussel, B-1090 Brussel, Belgium;
| | - Kevin M. Brindle
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge CB2 ORE, UK;
| | - Michael Schäfers
- European Institute for Molecular Imaging, University of Münster, D-48149 Münster, Germany; (A.F.); (D.D.); (M.S.); (B.Z.)
- Department of Nuclear Medicine, University Hospital Münster, D-48149 Münster, Germany
| | - Bastian Zinnhardt
- European Institute for Molecular Imaging, University of Münster, D-48149 Münster, Germany; (A.F.); (D.D.); (M.S.); (B.Z.)
- Department of Nuclear Medicine, University Hospital Münster, D-48149 Münster, Germany
- Biomarkers and Translational Technologies, Pharma Research and Early Development, F. Hoffmann-La Roche Ltd., CH-4070 Basel, Switzerland
| | - Andreas H. Jacobs
- European Institute for Molecular Imaging, University of Münster, D-48149 Münster, Germany; (A.F.); (D.D.); (M.S.); (B.Z.)
- Department of Geriatrics and Neurology, Johanniter Hospital, D-53113 Bonn, Germany
- Centre of Integrated Oncology, University Hospital Bonn, D-53127 Bonn, Germany
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Jiang L, Xiang Y, Huang R, Tian R, Liu B. Clinical applications of single-photon emission computed tomography/computed tomography in post-ablation 131iodine scintigraphy in children and young adults with differentiated thyroid carcinoma. Pediatr Radiol 2021; 51:1724-1731. [PMID: 33759024 DOI: 10.1007/s00247-021-05039-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/29/2020] [Accepted: 02/28/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The utility of integrated single-photon emission computed tomography/computed tomography (SPECT/CT) in children and young adults with differentiated thyroid carcinoma is incompletely studied. OBJECTIVE To determine the value of adding SPECT/CT to conventional whole-body scintigraphy in post-ablation iodine-131 (131I) scintigraphy for children and young adults with differentiated thyroid carcinoma. MATERIALS AND METHODS Planar scintigraphy and SPECT/CT were performed on 42 post-surgical children and young adults (32 female, 10 male; mean age 14.3±4.9 years, range 7-20 years) with differentiated thyroid carcinoma (39 papillary, 2 follicular, 1 mixed) 5 days after the therapeutic administration of 1.9-7.4 GBq of 131I. Planar and SPECT/CT images were interpreted independently, and sites of uptake were categorized as positive or equivocal with respect to thyroid bed, lymph node and distant metastasis uptake. An experienced thyroid endocrinologist used a combination of surgical histopathology and scintigraphic findings to determine whether the addition of SPECT/CT would change patient management. RESULTS Planar scintigraphy evidenced 88 radioiodine-avid foci and SPECT/CT confirmed all foci. No additional foci were disclosed by SPECT/CT. SPECT/CT correctly classified 16/88 (18%) foci that were unclear or wrongly classified at planar scintigraphy. Globally, SPECT/CT showed an incremental value over planar scintigraphy in 9 (21.4%) patients and changed therapeutic management in 3 (7.1%; 95% confidence interval, 2-20%) patients. CONCLUSION SPECT/CT improved localization and characterization of focal 131I uptake on post-ablation whole-body scintigraphy in children and young adults with differentiated thyroid carcinoma. Further prospective evaluation in a larger series is justified to prove the effect of post-ablation SPECT/CT-based management decisions.
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Affiliation(s)
- Lisha Jiang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, No 37. Guoxue Alley, Chengdu, 610041, China
| | - Yongzhao Xiang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, No 37. Guoxue Alley, Chengdu, 610041, China
| | - Rui Huang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, No 37. Guoxue Alley, Chengdu, 610041, China
| | - Rong Tian
- Department of Nuclear Medicine, West China Hospital, Sichuan University, No 37. Guoxue Alley, Chengdu, 610041, China
| | - Bin Liu
- Department of Nuclear Medicine, West China Hospital, Sichuan University, No 37. Guoxue Alley, Chengdu, 610041, China.
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15
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Bartel Chair TB, Magerefteh S, Avram AM, Balon HR, De Blanche LE, Dadparvar S, Johnston M, Moreau S. SNMMI Procedure Standard for Scintigraphy for Differentiated Thyroid Cancer. J Nucl Med Technol 2021; 48:202-209. [PMID: 32883775 DOI: 10.2967/jnmt.120.243626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | - Anca M Avram
- University of Michigan Medical Center, Ann Arbor, Michigan
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Wang F, Nie H, Li W, Zhang R, Li W. The clinical significance of remnant thyroid tissue in thyroidectomized differentiated thyroid cancer patients on 131I-SPECT/CT. BMC Med Imaging 2021; 21:78. [PMID: 33964885 PMCID: PMC8105984 DOI: 10.1186/s12880-021-00612-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To explore the 131I-SPECT/CT characteristics of remnant thyroid tissue (RTT) in differentiated thyroid cancer (DTC), further assess the risk factors and clinical significance. METHODS 52 DTC patients after total thyroidectomy had undergone neck 131I-SPECT/CT before 131I ablation. The diagnosis of RTT was based on SPECT/CT and follow-up at least 3 months. The anatomic locations and features of SPECT/CT of RTT were assessed by reviewers. The risk factors of RTT with CT positive were analyzed by the chi-square test. RESULTS A total of 80 lesions of RTT were diagnosed in this study, most of them were mainly located in the regions adjacent to trachea cartilage (37/80) or lamina of thyroid cartilage (17/80). On SPECT/CT of RTT, low, moderate and high uptake were respectively noted in 10, 24 and 46 lesions, definite positive, suspected positive and negative CT findings were respectively noted in 10, 21 and 49. The RTT lesions with definite positive CT findings were mainly located adjacent to lamina of thyroid cartilage (5/10). Primary thyroid tumor (P = 0.029) and T stage (P = 0.000) were the effective risk factors of CT positive RTT. CONCLUSIONS RTT has certain characteristic distribution and appearances on SPECT/CT. Most of RTT with definite CT abnormalities located adjacent to lamina of thyroid cartilage, which suggest surgeons should strengthen the careful removal in this region, especially primary thyroid tumor involving bilateral and T4 stage. This study can provide a certain value for the improvement of thyroidectomy quality in DTC patients.
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Affiliation(s)
- Feng Wang
- Department of Nuclear Medicine, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, 510095, Guangdong Province, China
| | - Hui Nie
- Department of Health Care, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, 510095, Guangdong Province, China
| | - Wei Li
- Department of Nuclear Medicine, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, 510095, Guangdong Province, China.
| | - Rusen Zhang
- Department of Nuclear Medicine, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, 510095, Guangdong Province, China
| | - Wen Li
- Department of Nuclear Medicine, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, 510095, Guangdong Province, China
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Iwano S, Ito S, Kamiya S, Ito R, Kato K, Naganawa S. Unexpected radioactive iodine accumulation on whole-body scan after I-131 ablation therapy for differentiated thyroid cancer. NAGOYA JOURNAL OF MEDICAL SCIENCE 2021; 82:205-215. [PMID: 32581401 PMCID: PMC7276407 DOI: 10.18999/nagjms.82.2.205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We retrospectively evaluated the frequency of unexpected accumulation of radioactive iodine on the post-therapy whole-body scan (Rx-WBS) after radioactive iodine (RAI) ablation therapy in patients with differentiated thyroid cancer (DTC). We searched our institutional database for Rx-WBSs of DTC patients who underwent RAI ablation or adjuvant therapy between 2012 and 2019. Patients with distant metastasis diagnosed by CT or PET/CT before therapy, and those had previously received RAI therapy were excluded. In total, 293 patients (201 female and 92 male, median age 54 years) were selected. Two nuclear medicine physicians interpreted the Rx-WBS images by determining the visual intensity of radioiodine uptake by the thyroid bed, cervical and mediastinal lymph nodes, lungs, and bone. Clinical features of the patients with and without the metastatic accumulation were compared by chi-square test and median test. Logistic regression analyses were performed to compare the association between the presence of metastatic accumulation and these clinical factors. Eighty-four of 293 patients (28.7%) showed metastatic accumulation. Patients with metastatic RAI accumulation showed a significantly higher frequency of pathological N1 (pN1) and serum thyroglobulin (Tg) > 1.5 ng/ml under TSH stimulation (p = 0.035 and p = 0.031, respectively). Logistic regression analysis indicated that a serum Tg > 1.5 ng/ml was significantly correlated with the presence of metastatic accumulation (odds ratio = 1.985; p = 0.033). In conclusion, Patients with Tg > 1.5 ng/ml were more likely to show metastatic accumulation. In addition, the presence of lymph node metastasis at the initial thyroid surgery was also associated with this unexpected metastatic accumulation.
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Affiliation(s)
- Shingo Iwano
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinji Ito
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinichiro Kamiya
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Rintaro Ito
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Katsuhiko Kato
- Department of Radiological and Medical Laboratory Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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18
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Albano D, Bonacina M, Durmo R, Bertagna F, Giubbini R. Efficacy of low radioiodine activity versus intermediate-high activity in the ablation of low-risk differentiated thyroid cancer. Endocrine 2020; 68:124-131. [PMID: 31784881 DOI: 10.1007/s12020-019-02148-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/20/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE The aim of our study was to compare the efficacy of thyroid remnant ablation using low (1.1 GBq) and intermediate-high radioiodine (RAI) activity (1.85-3.7 GBq) in low-risk differentiated thyroid carcinoma (DTC) and to evaluate the staging role of the whole body scan (WBS) in detection extrathyroidal disease. MATERIALS AND METHODS We retrospectively included 277 patients who underwent total thyroidectomy and RAI for low-risk DTC and divided them in two groups according to RAI activity at ablation: group 1 (n = 174) treated with low activity (1.1 GBq), and group 2 (n = 103) with intermediate-high activity (1.85-3.7 GBq). To evaluate the successful ablation rate, the WBS 1 year after RAI was visually interpreted using a three-point scale: score 0 in case of absence of visible RAI uptake in thyroid bed; score 1 in presence of faint uptake in the thyroid bed; and score 2 in case of significant RAI uptake in thyroid bed. RESULTS The success ablation rate was significantly higher in group 2 than group 1 (p < 0.001) with the presence of a positive WBS (score 1-2) in 65% low-activity group and 33% in intermediate-high group. Considering response to therapy categories, excellent response rate was significantly higher in group 2 (p = 0.020), while indeterminate response was higher in group 1 (p value = 0.005). Post RAI imaging revealed extrathyroidal uptake in 27 cases: 17 laterocervical nodal and 10 distant metastases. In both groups similar detection rate of nodal and distant metastases were recognized without any statistical difference. CONCLUSIONS The ablation rate with intermediate-high RAI activity (1.85-3.7 GBq) was better than with a low activity (1.1 GBq). First WBS may help to recognize nodal and distant metastases in about 10% of cases changing clinical stage and subsequent management.
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Affiliation(s)
- Domenico Albano
- Nuclear Medicine, University of Brescia, Brescia, Italy.
- Nuclear Medicine, Spedali Civili Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.
| | - Mattia Bonacina
- Nuclear Medicine, Spedali Civili Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
| | - Rexhep Durmo
- Nuclear Medicine, Spedali Civili Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
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19
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Filippi L, Chiaravalloti A, Schillaci O, Cianni R, Bagni O. Theranostic approaches in nuclear medicine: current status and future prospects. Expert Rev Med Devices 2020; 17:331-343. [PMID: 32157920 DOI: 10.1080/17434440.2020.1741348] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Theranostics is an emerging field in which diagnosis and specific targeted therapy are combined to achieve a personalized treatment approach to the patient. In nuclear medicine clinical practice, theranostics is often performed utilizing the same molecule labeled with two different radionuclides, one radionuclide for imaging and another for therapy.Areas covered: The authors review the clinical applications of different radiopharmaceuticals in the field of interest, including the well-established use of radioactive iodine in differentiated thyroid cancer, radiolabeled metaiodobenzylguanidine (MIBG) in neuroblastoma and the clinical impact of peptide radionuclide receptorial therapy (PRRT) in the management of neuroendocrine tumors. Furthermore, the more cutting-edge and recently introduced theranostic approaches will be reviewed, such as the radioligand therapy with 177Lu-prostate specific membrane antigen (PSMA) and targeted alpha therapy in castration-resistant prostate cancer. Finally, the main applications of PET for the imaging of biomarkers suitable for the non-radionuclide targeted therapy will be covered.Expert opinion: Theranostics is envisaging a revolutionary clinical approach which is deeply connected with the concept of personalized medicine and ruled by a 'patient-centered' vision. In this perspective, the theranostic applications will need well-trained specialists, capable to manage not only the technological aspects of the discipline, but also to deal with the more innovative oncological therapies in a multidisciplinary setting.
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Affiliation(s)
- Luca Filippi
- Department of Nuclear Medicine, Santa Maria Goretti Hospital, Latina, Italy
| | - Agostino Chiaravalloti
- Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Roberto Cianni
- Department of Interventional Radiology, S. Camillo Hospital, Rome, Italy
| | - Oreste Bagni
- Department of Nuclear Medicine, Santa Maria Goretti Hospital, Latina, Italy
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20
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Malamitsi JV, Koutsikos JT, Giourgouli SI, Zachaki SF, Pipikos TA, Vlachou FJ, Prassopoulos VK. I-131 Postablation SPECT/CT Predicts Relapse of Papillary Thyroid Carcinoma more Accurately than Whole Body Scan. In Vivo 2019; 33:2255-2263. [PMID: 31662565 DOI: 10.21873/invivo.11731] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 07/25/2019] [Accepted: 07/31/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The aim of the study was to prospectively compare I-131 postablation Whole Body scan (WBS) and Single Photon Emission Computerized Tomography/Computerized Tomography (SPECT/CT) scan on thyroid cancer patients. PATIENTS AND METHODS Overall, 58 patients with papillary thyroid carcinoma were submitted to total thyroidectomy and I-131 remnant ablation. Post-ablation WBS and SPECT/CT scans performed on the same day were compared. Results of SPECT/CT were confirmed by neck and upper mediastinum ultrasound scan and on specific cases by a fully diagnostic CT scan, other tests and definitive histology acting as the gold standard. A total of 36/58 patients were followed-up for 5 years to detect relapse. RESULTS Mac Nemar Chi square and Fisher's exact tests disclosed statistically significant differences between WBS and SPECT/CT scan, concerning cervical lymphadenopathy detection (p=0.031) and relapse prediction by NM stage (p=0.033), respectively; SPECT/CT was more accurate in both comparisons. CONCLUSION In papillary thyroid carcinoma I-131 post-ablation SPECT/CT scan detects cervical lymphadenopathy and predicts relapse by NM stage more accurately than WBS.
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Affiliation(s)
- Julia V Malamitsi
- Department of Medical Physics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - John T Koutsikos
- Department of Nuclear Medicine, Army Share Fund Hospital (417 NIMTS), Athens Greece and Department of Nuclear Medicine, Henry Dunant Hospital Centre, Athens, Greece
| | - Stamatia I Giourgouli
- Department of Medical Physics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sophia F Zachaki
- Laboratory of Health Physics, Radiobiology and Cytogenetics, National Centre for Scientific Research (NCSR) "Demokritos", Athens, Greece
| | | | - Fani J Vlachou
- Nuclear Medicine Department, Hygeia Hospital, Maroussi, Greece
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21
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GARCÍA-TALAVERA P, DIAZ-GONZÁLEZ LG, MARTÍN-GÓMEZ E, PEÑAHERRERA-CEPEDA AC, LÓPEZ-PUCHE S, TAMAYO-ALONSO P. Medicina Nuclear. Diagnóstico de la patología de tiroides y paratiroides. REVISTA ORL 2019. [DOI: 10.14201/orl.21496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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22
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Israel O, Pellet O, Biassoni L, De Palma D, Estrada-Lobato E, Gnanasegaran G, Kuwert T, la Fougère C, Mariani G, Massalha S, Paez D, Giammarile F. Two decades of SPECT/CT - the coming of age of a technology: An updated review of literature evidence. Eur J Nucl Med Mol Imaging 2019; 46:1990-2012. [PMID: 31273437 PMCID: PMC6667427 DOI: 10.1007/s00259-019-04404-6] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/14/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE Single-photon emission computed tomography (SPECT) combined with computed tomography (CT) was introduced as a hybrid SPECT/CT imaging modality two decades ago. The main advantage of SPECT/CT is the increased specificity achieved through a more precise localization and characterization of functional findings. The improved diagnostic accuracy is also associated with greater diagnostic confidence and better inter-specialty communication. METHODS This review presents a critical assessment of the relevant literature published so far on the role of SPECT/CT in a variety of clinical conditions. It also includes an update on the established evidence demonstrating both the advantages and limitations of this modality. CONCLUSIONS For the majority of applications, SPECT/CT should be a routine imaging technique, fully integrated into the clinical decision-making process, including oncology, endocrinology, orthopaedics, paediatrics, and cardiology. Large-scale prospective studies are lacking, however, on the use of SPECT/CT in certain clinical domains such as neurology and lung disorders. The review also presents data on the complementary role of SPECT/CT with other imaging modalities and a comparative analysis, where available.
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Affiliation(s)
- Ora Israel
- Rappaport School of Medicine, Israel Institute of Technology, Haifa, Israel.
| | - O Pellet
- Nuclear Medicine and Diagnostic Imaging Section International Atomic Energy Agency, Vienna, Austria
| | - L Biassoni
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - D De Palma
- Nuclear Medicine Unit, Circolo Hospital, ASST-Settelaghi, Varese, Italy
| | - E Estrada-Lobato
- Nuclear Medicine and Diagnostic Imaging Section International Atomic Energy Agency, Vienna, Austria
| | - G Gnanasegaran
- Department of Nuclear Medicine, Royal Free NHS Foundation Trust, London, UK
| | - T Kuwert
- Clinic of Nuclear Medicine, University Hospital, Erlangen, Germany
| | - C la Fougère
- Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University Hospital, Tubingen, Germany
| | - G Mariani
- Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy
| | - S Massalha
- Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada
- Department of Nuclear Medicine, Rambam Healthcare Campus, Haifa, Israel
| | - D Paez
- Nuclear Medicine and Diagnostic Imaging Section International Atomic Energy Agency, Vienna, Austria
| | - F Giammarile
- Nuclear Medicine and Diagnostic Imaging Section International Atomic Energy Agency, Vienna, Austria
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23
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Santhanam P, Ladenson PW. Surveillance for Differentiated Thyroid Cancer Recurrence. Endocrinol Metab Clin North Am 2019; 48:239-252. [PMID: 30717906 DOI: 10.1016/j.ecl.2018.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Serum thyroglobulin monitoring along with anatomic and functional imaging play key roles in the surveillance of patients with differentiated thyroid cancer after initial treatment. Among patients with a disease stage justifying thyroid remnant ablation or with suspected metastatic disease, radioiodine whole-body scans are essential in the months after surgery. For patients with low to moderate-risk cancers, ultrasonography of the neck (with measurement of serum thyroglobulin on thyroid hormone replacement) are the best initial diagnostic modalities, and are often the only tests required. In individuals suspected of having distant metastases, CT, MRI, and 18F-FDG PET can make important contributions in localizing residual disease and monitoring its progression and responses to therapy, provided they are used in the appropriate setting.
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Affiliation(s)
- Prasanna Santhanam
- Division of Endocrinology, Metabolism and Diabetes, Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle, Suite 3 B 73, Baltimore, MD 21224, USA.
| | - Paul W Ladenson
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, MD 21287, USA
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24
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Choudhury PS, Gupta M. Differentiated thyroid cancer theranostics: radioiodine and beyond. Br J Radiol 2018; 91:20180136. [PMID: 30260232 PMCID: PMC6475953 DOI: 10.1259/bjr.20180136] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 09/17/2018] [Accepted: 09/20/2018] [Indexed: 02/07/2023] Open
Abstract
The term theranostics is the combination of a diagnostic tool that helps to define the right therapeutic tool for specific disease. It signifies the "we know which sites require treatment (diagnostic scan) and confirm that those sites have been treated (post-therapy scan)" demonstrating the achievable tumor dose concept. This term was first used by John Funkhouser at the beginning of the 90s, at the same time the concept of personalized medicine appeared. In nuclear medicine, theranostics is easy to apply and understand because of an easy switch from diagnosis to therapy with the same vector. It helps in maximizing tumor dose and sparing normal tissue with high specific and rapid uptake in metastasis. The oldest application of this concept is radioactive iodine I-131 (RAI). The first treatment based on the theranostic concept was performed on thyroid cancer patients with RAI in 1946. From then on management of differentiated thyroid cancer (DTC) has evolved on the multimodality concept. We now use the term "our" patient instead of "my" patient to signify this. However, the initial surgical management followed by RAI as per the theranostics has remained the mainstay in achieving a cure in most of DTC patients. The normal thyroid cells metabolise iodine, the principle of which is utilized in imaging of the thyroid gland with isotopes of iodine. RAI treatment of DTC is based on the principle of sodium iodide symporter (NIS) expressing thyroid cells with DTC cells having the ability of trapping circulating RAI successfully helping in treatment of residual and metastatic disease. NIS is usually negative in poorly differentiated cells and is inversely proportional to Glucose transporter receptor Type 1 expression. Both positive and negative NIS are the key components of the theranostic approach in treatment of DTC. Presence or absence of NIS is documented by either whole body iodine scintigraphy (WBS) or 2-deoxy-2(18F) fludeoxyglucose (FDG) positron emission tomography computed tomography (PET-CT). Currently, single photon emission CT and CT (SPECT-CT) has significantly improved the precision and sensitivity of whole body iodine scintigraphy with its capability of accurate localization of disease foci whether iodine avid or non-avid. This has helped in a more personalized approach in treatment. This review will give an overview of the role of NIS in the theranostic approach to management with RAI, its current status and also the molecular approach to treatment in RAI refractory disease.
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Affiliation(s)
| | - Manoj Gupta
- Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India
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25
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Albano D, Bertagna F, Bonacina M, Durmo R, Cerudelli E, Gazzilli M, Panarotto MB, Formenti AM, Mazziotti G, Giustina A, Giubbini R. Possible delayed diagnosis and treatment of metastatic differentiated thyroid cancer by adopting the 2015 ATA guidelines. Eur J Endocrinol 2018; 179:143-151. [PMID: 29899030 DOI: 10.1530/eje-18-0253] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 06/07/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE According to the 2015 American Thyroid Association (ATA) guidelines, thyroid ablation by iodine-131 (I-131) therapy is absolutely recommended only in patients with high-risk differentiated thyroid cancer (DTC). Often distant metastases are not recognized early and they can stay silent for long time. The aim of our study was to retrospectively analyze the prevalence of metastatic disease before and after I-131 and to evaluate the influence of the new ATA guidelines in the management of DTC. METHODS We retrospectively analyzed 140 patients showing distant metastases. All metastases were detected by whole-body scan after I-131 and confirmed by histology and/or other imaging modalities. RESULTS In 26/140 patients metastases were detected before I-131, while in 114/140 were discovered after I-131. Comparing patients with metastases detected before and after I-131, no differences were demonstrated considering age, sex, histotype, tumor size, multifocality of cancer and metastatic localization. Metastatic DTC discovered before radioiodine had higher thyroglobulin and received a higher radioiodine total activity and number of treatments. Considering patients with distant metastases, according to the 2015 ATA guidelines, 38 patients would have been categorized as high risk, 22 as low risk and 80 as intermediate risk. Among intermediate-risk patients, only in 25 cases (31%) I-131 treatment would have been appropriate according to 2015 ATA recommendations; in the remaining 56 cases (69%), I-131 would not have been recommended. CONCLUSIONS According to the 2015 ATA guidelines, most of metastatic patients would not have been treated after surgery, with the risk of late diagnosis and delayed treatment.
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Affiliation(s)
| | - Francesco Bertagna
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy
| | | | - Rexhep Durmo
- Nuclear Medicine, Spedali Civili Brescia, Brescia, Italy
| | | | - Maria Gazzilli
- Nuclear Medicine, Spedali Civili Brescia, Brescia, Italy
| | | | | | | | - Andrea Giustina
- Endocrinology, Vita-Salute San Raffaele University, Milan, Italy
| | - Raffaele Giubbini
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy
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26
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Iodine/FDG "Flip-Flop" Phenomenon Inside a Large Metastatic Thyroid Cancer Lesion Better Characterized on SPECT/CT and PET/CT Studies. Clin Nucl Med 2018. [PMID: 29517543 DOI: 10.1097/rlu.0000000000002046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Iodine/FDG "flip-flop" phenomenon inside large metastatic thyroid cancer lesions has been rarely described. We present a case of this phenomenon better characterized using SPECT/CT and PET/CT studies.
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27
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Fundakowski CE, Hales NW, Agrawal N, Barczyński M, Camacho PM, Hartl DM, Kandil E, Liddy WE, McKenzie TJ, Morris JC, Ridge JA, Schneider R, Serpell J, Sinclair CF, Snyder SK, Terris DJ, Tuttle RM, Wu CW, Wong RJ, Zafereo M, Randolph GW. Surgical management of the recurrent laryngeal nerve in thyroidectomy: American Head and Neck Society Consensus Statement. Head Neck 2018; 40:663-675. [PMID: 29461666 DOI: 10.1002/hed.24928] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 07/20/2017] [Indexed: 01/25/2023] Open
Abstract
"I have noticed in operations of this kind, which I have seen performed by others upon the living, and in a number of excisions, which I have myself performed on the dead body, that most of the difficulty in the separation of the tumor has occurred in the region of these ligaments…. This difficulty, I believe, to be a very frequent source of that accident, which so commonly occurs in removal of goiter, I mean division of the recurrent laryngeal nerve." Sir James Berry (1887).
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Affiliation(s)
- Christopher E Fundakowski
- Department of Otolaryngology, Temple University, Philadelphia, Pennsylvania.,Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Nathan W Hales
- Department of Otolaryngology, Uniformed Services of the Health Sciences, San Antonio, Texas.,San Antonio Head and Neck, San Antonio, Texas
| | - Nishant Agrawal
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Marcin Barczyński
- Department of Endocrine Surgery, Jagiellonian University, Kraków, Poland
| | | | - Dana M Hartl
- Department of Head and Neck Oncology - Institut de Cancérologie Gustave Roussy, Villejuif, France
| | - Emad Kandil
- Department of Surgery, Tulane University, New Orleans, Louisiana
| | - Whitney E Liddy
- Department of Otolaryngology, Northwestern University, Chicago, Illinois
| | | | - John C Morris
- Department of Endocrinology, Mayo Clinic, Rochester, Minnesota
| | - John A Ridge
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Rick Schneider
- Department of General, Visceral, and Vascular Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Jonathan Serpell
- Department of Surgery, Monash University, The Alfred Hospital, Prahran, Victoria, Australia
| | - Catherine F Sinclair
- Department of Ear, Nose, and Throat - Head and Neck Surgery, Mount Sinai Health System, New York, New York
| | | | - David J Terris
- Department of Otolaryngology, Augusta University, Augusta, Georgia
| | - R Michael Tuttle
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Che-Wei Wu
- Department of Otolaryngology - Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Richard J Wong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mark Zafereo
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
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