A Joint Statement from the American Thyroid Association, the European Association of Nuclear Medicine, the European Thyroid Association, the Society of Nuclear Medicine and Molecular Imaging on Current Diagnostic and Theranostic Approaches in the Management of Thyroid Cancer

Abstract

Background: The American Thyroid Association (ATA), the European Association of Nuclear Medicine, the European Thyroid Association, and the Society of Nuclear Medicine and Molecular Imaging have established an intersocietal working group to address the current controversies and evolving concepts in thyroid cancer management and therapy. The working group annually identifies topics that may significantly impact clinical practice and publishes expert opinion articles reflecting intersocietal collaboration, consensus, and suggestions for further research to address these important management issues. Summary: In 2019, the intersocietal working group identified the following topics for review and interdisciplinary discussion: (i) perioperative risk stratification, (ii) the role of diagnostic radioactive iodine (RAI) imaging in initial staging, and (iii) indicators of response to RAI therapy. Conclusions: The intersocietal working group agreed that (i) initial patient management decisions should be guided by perioperative risk stratification that should include the eighth edition American Joint Committee on Cancer staging system to predict disease specific mortality, the modified 2009 ATA risk stratification system to

Shared Decision Making for Radioiodine Therapy and the Actual Pattern of Care in Intermediate-Risk Differentiated Thyroid Carcinoma

“…In a recent statement, the Martinique group advocates the additional use of pretherapeutic diagnostic whole body scans in selected patients in the intermediate-risk category (30). One argument for a diagnostic whole-body scan with 131 I prior to therapy might be staging for example from an M0 to a M1 status which may lead to a change in the treatment plan.…”

“…One argument for a diagnostic whole-body scan with 131 I prior to therapy might be staging for example from an M0 to a M1 status which may lead to a change in the treatment plan. However, it should be emphasized that diagnostic 131 I scans with low activity even including SPECT/CT imaging have lower sensitivity than post therapy scans, the limitations are also addressed by the group (30). Agate et al showed in 545 low-and intermediaterisk patients, that less that 2% post-therapy scans showed distant metastases (31), which makes it obvious that only few patients may be "upgraded" by such imaging.…”

Management of Differentiated Thyroid Cancer: The Standard of Care

“…DTC is biologically and functionally heterogeneous, with different molecular pathways impacting cancer cell biology. In particular, BRAF V600E mutation is associated with reduced expression of all thyroid-specific genes involved in iodine metabolism, resulting in variable decreased responsiveness to 131 I therapy (2). The clinical, pathologic, and molecular characteristics of DTC are summarized in Supplemental Table 1 (supplemental materials are available at http://jnm.snmjournals.org) (3).…”

Advances in Functional Imaging of Differentiated Thyroid Cancer

“…Intermediate-risk patients represent a heterogeneous group of patients, and their management is still under debate. RAI treatment should be planned according to risk factors and post-operative findings [ 105 ]. A longitudinal and observational study compared the outcomes of low and lower-intermediate risk (minimal extra-thyroid extension or ≤5 central compartment lymph node metastases) DTC patients undergoing either systematic or selective use of RAI treatment [ 106 ].…”

“…At the present time, d-WBS is less frequently performed: post-operative administration of 131 I is mostly based on the surgical report, on prognostic indicators and on post-operative serum Tg level and neck US findings; additionally, the completeness of total thyroidectomy is improved, leaving in most patients only small remnants of non-tumoral thyroid tissue and in this condition the post-therapy WBS is frequently more informative than the d-WBS that is currently not routinely performed in many centers in low risk patients. A recent statement proposed that a d-WBS might be selectively performed in intermediate risk patients in the post-operative staging to guide, in addition to clinical and surgical data the decision of a therapeutic RAI administration and select a personalized patient-based activity [105]; however, in the absence of prospective data, the benefits afforded by the d-WBS remain uncertain. A randomized trial in lower-intermediate risk DTC patients (estimated risk of recurrence about 8%) comparing systematic RAI administration (3700 MBq) to a selective RAI administration based on post-operative rhTSH stimulated Tg, neck US and RAI d-WBS is ongoing in France (INTERMEDIATE trial, NCT04290663).…”