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Feng YY, Shi YR, Xia Z, Xu L, Li WB, Pang H, Wang ZJ. The clinical signification and application value of [ 68Ga]Ga-PSMA imaging in thyroid malignancy. Endocrine 2024; 84:598-606. [PMID: 37987969 DOI: 10.1007/s12020-023-03599-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE Approximately 5% of differentiated thyroid cancers lose the ability to uptake iodine, leading to limited treatment options and poor prognosis due to invasion and distant metastasis. PSMA imaging probes have been proposed as a potential diagnostic and therapeutic tool for iodine-refractory thyroid cancer. However, there are limited reports and significant heterogeneity in patient selection, warranting further exploration of the application value of PSMA in thyroid cancer. METHODS We performed Western Blot, PCR, and [68Ga]Ga-PSMA uptake experiments on cell lines and conducted in vivo small animal imaging. Clinical and radiological results of included differentiated thyroid cancer patients were collected. (Trial registration number: 2021-669, Trial registration date: December 30, 2021). RESULTS PSMA expression levels were significantly higher in poorly differentiated thyroid cancer (7.86 ± 1.90 vs. 1.00 ± 0, P < 0.01; 7.86 ± 1.90 vs. 0.03 ± 0.02, P < 0.01), but [68Ga]Ga-PSMA imaging correlated with tumor burden, such as 18F-FDG (8.08 ± 7.74 and 5.67 ± 4.23, P = 0.01) and Tg levels (307.1 ± 183.4 vs. 118.0 ± 116.1, P = 0.002). CONCLUSION Our results showed that PSMA expression increased with the decrease of thyroid cancer differentiation. However, the level of [68Ga]Ga-PSMA uptake in thyroid cancer patients was not significantly associated with the degree of thyroid cancer differentiation, but also with the metabolism and burden of tumors such as 2-[18F]FDG and Tg levels. These findings provide additional clinical significance and application value for PSMA in thyroid cancer.
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Affiliation(s)
- Yu Yue Feng
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Chongqing, PR China
| | - Yang Rui Shi
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Chongqing, PR China
| | - Zhu Xia
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Chongqing, PR China
| | - Lu Xu
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Chongqing, PR China
| | - Wen Bo Li
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Chongqing, PR China
| | - Hua Pang
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Chongqing, PR China.
| | - Zheng Jie Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Chongqing, PR China.
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Treglia G, Goichot B, Giovanella L, Hindié E, Jha A, Pacak K, Taïeb D, Walter T, Imperiale A. Prognostic and predictive value of nuclear imaging in endocrine oncology. Endocrine 2020; 67:9-19. [PMID: 31734779 PMCID: PMC7441826 DOI: 10.1007/s12020-019-02131-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 11/02/2019] [Indexed: 12/20/2022]
Abstract
In the last few years, the role and use of medical technologies in (neuro)endocrine oncology has greatly evolved allowing not only important diagnostic information but also prognostic stratification in different clinical situations. The terms "prognostic" and "predictive" are commonly used to describe the relationships between biomarkers and patients' clinical outcomes but have quite different meaning. The present work discusses the prognostic and predictive value of nuclear medicine imaging. It critically reviews the clinical significance and potential impact of molecular examinations on follow-up and therapeutic strategies in patients with neuroendocrine neoplasms, thyroid tumors, and adrenal malignancies.
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Affiliation(s)
- Giorgio Treglia
- Clinic of Nuclear Medicine and PET/CT Center, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
- Health Technology Assessment Unit, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Clinical Trial Unit, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Bernard Goichot
- Endocrinology and Internal Medicine Department, Hautepierre Hospital, University Hospitals of Strasbourg, Strasbourg, France
| | - Luca Giovanella
- Clinic of Nuclear Medicine and PET/CT Center, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
- University Hospital and University of Zürich, Zürich, Switzerland
| | - Elif Hindié
- Nuclear Medicine Department, Haut-Lévêque Hospital, University Hospitals of Bordeaux, University of Bordeaux, Bordeaux, France
- LabEx TRAIL, University of Bordeaux, Bordeaux, France
| | - Abhishek Jha
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Karel Pacak
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - David Taïeb
- Nuclear Medicine, La Timone University Hospital, Aix-Marseille University, Marseille, France
- European Center for Research in Medical Imaging, Aix-Marseille University, Marseille, France
| | - Thomas Walter
- Medical Oncology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- University of Lyon, Université Lyon 1, Lyon, France
| | - Alessio Imperiale
- Biophysics and Nuclear Medicine, Hautepierre Hospital, University Hospitals of Strasbourg, Strasbourg University/FMTS, Strasbourg, France.
- Molecular Imaging-DRHIM, IPHC, UMR 7178, CNRS/Unistra, Strasbourg, France.
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Sollini M, di Tommaso L, Kirienko M, Piombo C, Erreni M, Lania AG, Erba PA, Antunovic L, Chiti A. PSMA expression level predicts differentiated thyroid cancer aggressiveness and patient outcome. EJNMMI Res 2019; 9:93. [PMID: 31617002 PMCID: PMC6794333 DOI: 10.1186/s13550-019-0559-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/28/2019] [Indexed: 02/07/2023] Open
Abstract
Background Prostate-specific membrane antigen (PSMA) is overexpressed on the endothelial cells of tumor neo-vessels of several solid malignancies, including differentiated thyroid cancer (DTC). We aimed to test the potential role of PSMA as a biomarker for DTC aggressiveness and outcome prediction. We retrospectively screened all patients who underwent thyroidectomy between 1 January 2010 and 31 December 2017 in our institution. Applying the inclusion (histological diagnosis of thyroid cancer and tissue availability) and exclusion criteria (no clinical or follow-up data or diagnosis of medullary thyroid cancer), a cohort of 59 patients was selected. The monoclonal mouse anti-human PSMA antibody was used to stain tissue sections. A 3-point scale was used to score PSMA positivity: 0–5% expression was considered as negative (score 0), 6–50% as moderately positive (score 1), and 51–100% as highly positive (score 2). A cumulative score (0–10%, 11–79%, and 80–100%) was also explored. Univariate and multivariate logistic regression analyses were performed to predict the presence of distant metastases, chosen as endpoint of aggressiveness. The area under the curve (AUC) was calculated. Cox models were built to predict patient outcome in terms of recurrence, iodine refractoriness, and status at last follow-up, which were calculated using the Kaplan-Meier failure function. Results At immunostaining, 12, 25, and 22 patients had scores of 0, 1, and 2, respectively. According to the cumulative score, PSMA expression was ≤ 10% in 17 cases, 11–79% in 31 cases, and ≥ 80% in 11 cases. At multivariate analysis, age, sex, histotype, vascular invasion, T and N parameters, and PSMA positivity were significant predictors of distant metastases. The AUC was 0.92. Recurrence or progression occurred in 19/59 patients. Twelve patients developed radioiodine (RAI) refractoriness, after a median time of 17 months (range 2–32). One patient died of DTC; 46 of the 58 patients alive at last follow-up were disease free. Median DFS was 23 months (range 3–82). The final multivariate model to predict RAI refractoriness included as covariates the stage, high PSMA expression (≥ 80%), and the interaction between moderate PSMA expression (11–79%) and stage. Conclusions PSMA, a marker of neovasculature formation expressed by DTC, contributes in the prediction of tumor aggressiveness and patient outcome. Electronic supplementary material The online version of this article (10.1186/s13550-019-0559-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Martina Sollini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy. .,Department of Nuclear Medicine, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy.
| | - Luca di Tommaso
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Department of Pathology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Margarita Kirienko
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Chiara Piombo
- Department of Pathology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Marco Erreni
- Department of Advanced Optical Microscopy, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Andrea Gerardo Lania
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Department of Endocrinology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Paola Anna Erba
- Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy
| | - Lidija Antunovic
- Department of Nuclear Medicine, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Arturo Chiti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Department of Nuclear Medicine, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
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Bertagna F, Albano D, Giovanella L, Bonacina M, Durmo R, Giubbini R, Treglia G. 68Ga-PSMA PET thyroid incidentalomas. Hormones (Athens) 2019; 18:145-149. [PMID: 30989578 DOI: 10.1007/s42000-019-00106-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/25/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Thyroid incidentaloma is defined as a thyroid lesion incidentally and newly detected by imaging techniques performed for an unrelated purpose and especially for a non-thyroid disease. The aim of this review is to evaluate the prevalence and clinical significance of focal incidental radiolabelled prostate-specific membrane antigen (PSMA) uptake in the thyroid gland [PSMA thyroid incidentaloma (PTI)] revealed by PET/CT or PET/MRI. METHODS A comprehensive literature search of the PubMed/MEDLINE, Scopus, and Embase databases was conducted to find relevant published articles about the prevalence and clinical significance of PTIs detected by PET/CT or PET/MRI in patients studied for other oncologic purposes. RESULTS Twelve articles were included in the systematic review. Among 23 PTIs, 6 were malignant (5 primary thyroid tumors and one metastasis from renal cell carcinoma), one was a follicular lesion of undetermined significance, and the rest were benign. CONCLUSION Despite being very rare, though probably underestimated, PTIs frequently signal the presence of unexpected lesions in the thyroid which differ from the indicated reason for which the patient was initially scanned and concerning which the risk of malignancy is not negligible.
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Affiliation(s)
- Francesco Bertagna
- Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy.
| | - Domenico Albano
- Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy
| | - Luca Giovanella
- Department of Nuclear Medicine and PET/CT Center, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Mattia Bonacina
- Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy
| | - Rexhep Durmo
- Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy
| | - Raffaele Giubbini
- Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy
| | - Giorgio Treglia
- Department of Nuclear Medicine and PET/CT Center, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
- Health Technology Assessment Unit, General Directorate, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
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PSMA expression by microvasculature of thyroid tumors - Potential implications for PSMA theranostics. Sci Rep 2017; 7:5202. [PMID: 28701709 PMCID: PMC5507885 DOI: 10.1038/s41598-017-05481-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 05/30/2017] [Indexed: 12/03/2022] Open
Abstract
Prostate-specific membrane antigen (PSMA) is overexpressed in prostate cancer epithelium, making it a promising target for molecular imaging and therapy. Recently, several studies found unexpected PSMA radiotracer uptake by thyroid tumors, including radioiodine-refractory (RAIR) cancers. PSMA expression was reported in tumor-associated endothelium of various malignancies, however it has not been systematically addressed in thyroid tumors. We found that PSMA was frequently expressed in microvessels of thyroid tumors (120/267), but not in benign thyroid tissue. PSMA expression in neovasculature was highly irregular ranging from 19% in benign tumors to over 50% in thyroid cancer. Such heterogeneity was not directly attributed to endothelial cell proliferation as confirmed by immunostaining with proliferation-associated endothelial marker CD105. PSMA expression was associated with tumor size (p = 0.02) and vascular invasion in follicular carcinoma (p = 0.03), but not with other baseline histological, and clinical parameters. Significant translational implication is that RAIR tumors and high-grade cancers maintain high level of PSMA expression, and can be targeted by PSMA ligand radiopharmaceuticals. Our study predicts several pitfalls potentially associated with PSMA imaging of the thyroid, such as low expression in oncocytic tumors, absence of organ specificity, and PSMA-positivity in dendritic cells of chronic thyroiditis, which is described for the first time.
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