Grouping of Metastatic Thyroid Carcinoma by Molecular Imaging Features to Allow for Individualized Treatment, with Emphasis on the TENIS Syndrome

Abstract

The process of radioiodine ((131)I) refractoriness, dedifferentiation, and development of thyroglobulin elevation and negative iodine scintigraphy (TENIS) syndrome in metastatic differentiated thyroid carcinoma (DTC) could be viewed as a disease continuum rather than a single event or an all-or-none phenomenon. In this report, the important role of molecular functional imaging in systematically exploring the disease biology and course of metastatic DTC is presented. Making this role the base, this report proposes a novel clinical classification for TENIS syndrome using molecular functional imaging. Such an endeavor, in our view, would aid in classification into subgroups and development of an individualized treatment strategy for patients with metastatic DTC. Case illustrations are presented that substantiate this viewpoint, including the value of combined assessment in selected cases and the requirement of a multipronged treatment approach for certain case scenarios. In addition to multiple other considerations, we believe that molecular functional imaging-based characterization of metastatic lesions could evolve as an important determinant for defining the optimal treatment strategy in patients with metastatic DTC, making the clinical management more rational and scientific.

Correlation between F18-FDG PET/CT Imaging and BRAF V600E Genetic Mutation for the Early Assessment of Treatment Response in Papillary Thyroid Cancers

“…In fact, the evaluation of genetic mutations is applicable in the process of development of therapies targeting the production pathway [ 17 , 18 , 19 ]. In some studies, a better response rate to treatment has been observed in BARF+ patients, leading to the development of studies only for this category of patients [ 20 , 21 , 22 , 23 , 24 ]. So, even if we focus only on few patients, selecting their best personalized treatment option is important.…”

Follicular thyroid carcinoma metastasizing to rare sites and exhibiting variable inter-lesional heterogeneity on 18F-fluorodeoxyglucose positron emission tomography/computed tomography and 131I

“…To the best of our knowledge, only four such cases have been reported in the literature. [ 1 2 3 4 ] 18 F-fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT) scan has a valuable complementary role in the evaluation of thyroid carcinoma,[ 5 6 ] while 131 I as theranostic agent (used for both purposes of imaging and therapy) remains the cornerstone in the management of DTC. [ 7 ] The interesting feature of our case was extremely rare metastasis to the urinary bladder with multi-organ metastatic disease (including unusual sites of the right bronchus and hepatic metastases) and the observation of inter-lesional heterogeneity on molecular imaging which may guide therapeutic management and follow-up in this case with rare site metastatic disease.…”