Role of PET/Computed Tomography in Elderly Thyroid Cancer

Sonavane, Sunita Nitin; Basu, Sandip

doi:10.1016/j.cpet.2022.09.005

Cited by 3 publications

(4 citation statements)

References 87 publications

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“…Despite these differences in terms of number of lesions were not statistically significant in any of the included papers, more studies are needed to assess if the increased DR of this novel imaging technique might be able to change DTC patients’ stage and, subsequently, management. The difference in terms of DR of these two instrumental examinations might underlie the variable diagnostic accuracy of [ 18 F]FDG PET in DTC, which is affected by several different clinical and histological features ( 40 – 42 ); however, since none of the included studies assessed the differences in diagnostic accuracy of both examinations based on histologic variants and clinical features; it is not feasible to validate this hypothesis. In this setting, it is noteworthy that [ 18 F]FDG has a valuable diagnostic performance in DTC patients with hematogenous metastases, as stated in a recent meta-analysis of literature ( 43 ); unfortunately, it is currently not feasible to make an indirect comparison of these two imaging techniques since the data gathered in this systematic review does not allow to pool the diagnostic accuracies reported in the included studies.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic yield of FAP-guided positron emission tomography in thyroid cancer: a systematic review

Rizzo,

Albano,

Dondi

et al. 2024

Front. Med.

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BackgroundSeveral recent studies have proposed the possible application of positron emission tomography/computed tomography (PET/CT) administering radiolabelled fibroblast-activation protein (FAP) inhibitors for various forms of thyroid cancer (TC), including differentiated TC (DTC), and medullary TC (MTC).MethodsThe authors conducted an extensive literature search of original studies examining the effectiveness of FAP-guided PET/CT in patients with TC. The papers included were original publications exploring the use of FAP-targeted molecular imaging in restaging metastatic DTC and MTC patients.ResultsA total of 6 studies concerning the diagnostic yield of FAP-targeted PET/CT in TC (274 patients, of which 247 DTC and 27 MTC) were included in this systematic review. The included articles reported high values of FAP-targeted PET/CT detection rates in TC, ranging from 81 to 100% in different anatomical sites and overall superior to the comparative imaging method.ConclusionAlthough there are promising results, the existing literature on the diagnostic accuracy of FAP-guided PET in this context is still quite limited. To thoroughly evaluate its potential significance in TC patients, it is needed to conduct prospective randomized multicentric trials.

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Section: Discussionmentioning

confidence: 99%

Diagnostic yield of FAP-guided positron emission tomography in thyroid cancer: a systematic review

Rizzo,

Albano,

Dondi

et al. 2024

Front. Med.

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“…However, more precise assessment has been offered by [(18)F]fluoro-D-glucose PET-CT, which ensures better anatomic location with active metabolic uptake detecting occult deposits[ 17 , 23 , 47 ]. It can be especially valuable in elderly patients for accurate disease setting assessment that can precisely determine the appropriate management strategy[ 22 ].…”

Section: Diagnosismentioning

confidence: 99%

“…Early diagnosis based mainly on ultrasound (US) and core needle biopsy is crucial[ 17 - 21 ]. The following staging after the initial diagnosis of anaplastic carcinoma is of great importance and can be achieved by computed tomography (CT), magnetic resonance imaging (MRI)[ 18 , 19 ], and preferably positron emission tomography/CT (PET-CT)[ 17 , 22 , 23 ]. Modern molecular testing by revealing implicated genes, basically the BRAF gene ( BRAF-V600E and BRAF wild type), and other molecules[ 24 - 27 ] can contribute to more accurate diagnosis but most importantly determine molecular pathways indicating novel treatment strategies by targeted biological factors, i.e., anti-BRAF, anti-vascular endothelial growth factor (VEGF)-A or anti-epidermal growth factor receptor (EGFR) agents[ 24 ].…”

Section: Introductionmentioning

confidence: 99%

Update on current diagnosis and management of anaplastic thyroid carcinoma

Pavlidis,

Galanis,

Pavlidis

2023

World J Clin Oncol

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Well-differentiated thyroid carcinoma has a favorable prognosis with a 5-year survival rate of over 95%. However, the undifferentiated or anaplastic type accounting for < 0.2%, usually in elderly individuals, exhibits a dismal prognosis with rapid growth and disappointing outcomes. It is the most aggressive form of thyroid carcinoma, with a median survival of 5 mo and poor quality of life (airway obstruction, dysphagia, hoarseness, persistent pain). Early diagnosis and staging are crucial. Diagnostic tools include biopsy (fine needle aspiration, core needle, open surgery), high-resolution ultrasound, computed tomography, magnetic resonance imaging, [(18)F]fluoro-D-glucose positron emission tomo-graphy/computed tomography, liquid biopsy and microRNAs. The BRAF gene (BRAF-V600E and BRAF wild type) is the most often found molecular factor. Others include the genes RET, KRAS, HRAS, and NRAS . Recent management policy is based on surgery, even debulking, chemotherapy (cisplatin or doxorubicin), radiotherapy (adjuvant or definitive), targeted biological agents and immunotherapy. The last two options constitute novel hopeful management modalities improving the overall survival in these otherwise condemned patients. Anti-programmed death-ligand 1 antibody immunotherapy, stem cell targeted therapies, nanotechnology achievements and artificial intelligence imple-mentation provide novel promising alternatives. Genetic mutations determine molecular pathways, thus indicating novel treatment strategies such as anti-BRAF, anti-vascular endothelial growth factor-A, and anti-epidermal growth factor receptor. Treatment with the combination of the BRAF inhibitor dabrafenib and the MEK inhibitor trametinib has been approved by the Food and Drug Administration in cases with BRAF-V600E gene mutations and is currently the standard care. This neoadjuvant treatment followed by surgery ensures a two-year overall survival of 80%. Prognostic factors for improved outcomes have been found to be younger age, earlier tumor stage and radiation therapy. A multidisciplinary approach is necessary, and the therapeutic plan should be individualized based on surveillance and epidemiology end results.

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“…We have developed a positron emission tomography (PET) radiopharmaceutical targeting the TSHR to address the need for new diagnostic approaches in RAI-R DTC patients. There are several strengths of imaging the TSHR as a complementary approach to existing [ 18 F]FDG imaging. − Foremost, a TSHR-targeted approach provides an opportunity to inform clinicians on the therapeutic potential of TSHR-targeted treatments and has potential for development as a theranostic treatment. In addition, numerous studies show persistent TSHR expression in up to 80% of patients with primary and metastatic DTC, ,− despite previous RAI exposure and the loss of other differentiation markers, such as the NIS. − TSHR-mediated growth signaling is also necessary for thyroid cancer to metastasize following proto-oncogene mutations. − …”

Section: Introductionmentioning

confidence: 99%

PET Imaging of Differentiated Thyroid Cancer with TSHR-Targeted [⁸⁹Zr]Zr-TR1402

Gimblet,

Houson,

Whitt

et al. 2024

Mol. Pharmaceutics

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Thyroid cancer is the most common endocrine cancer, with differentiated thyroid cancers (DTCs) accounting for 95% of diagnoses. While most DTC patients are diagnosed and treated with radioiodine (RAI), up to 20% of DTC patients become RAI refractory (RAI-R). RAI-R patients have significantly reduced survival rates compared to patients who remain RAI-avid. This study explores [ 89 Zr]Zr-TR1402 as a thyroid-stimulating hormone receptor (TSHR)targeted PET radiopharmaceutical for DTC. [ 89 Zr]Zr-TR1402 was synthesized with a molar activity of 25.9 MBq/nmol by conjugating recombinant human TSH (rhTSH) analogue TR1402 to chelator p-SCN-Bn-deferoxamine (DFO) in a molar ratio of 3:1 (DFO/TR1402) and radiolabeling with 89 Zr (t 1/2 = 78.4 h, β + = 22.7%). As TSHR is absent in commonly available DTC-derived cell lines, TSHR was reintroduced via stable transduction by delivering a lentivirus containing the full-length coding region of the human TSHR gene. Receptor-mediated uptake of [ 89 Zr]Zr-TR1402 was evaluated in vitro in stably transduced TSHR+ and wild-type TSHR− DTC cell lines. In vivo PET imaging was performed on Days 1−3 postinjection in male and female athymic nude mice bearing TSHR+ and TSHR− xenografts, along with ex vivo biodistribution on Day 3 postinjection. In vitro uptake of 1 nM [ 89 Zr]Zr-TR1402 was significantly higher in TSHR+ THJ529T (P < 0.0001) and FTC133 (P < 0.01) cells than in TSHR− THJ529T and FTC133 cells. This uptake was shown to be specific in both TSHR+ THJ529T (P < 0.0001) and TSHR+ FTC133 (P < 0.0001) cells by blocking uptake with 250 nm DFO-TR1402. In vivo PET imaging showed accumulation of [ 89 Zr]Zr-TR1402 in TSHR+ tumors, which was the highest on Day 1. In the male FTC133 xenograft model, ex vivo biodistribution confirmed a significant difference (P < 0.001) in uptake between FTC133+ (1.3 ± 0.1%ID/g) and FTC133− (0.8 ± 0.1%ID/g) tumors. A significant difference (P < 0.05) in uptake was also seen in the male THJ529T xenograft model between THJ529T+ (1.8 ± 0.6%ID/ g) and THJ529T− (0.8 ± 0.4%ID/g) tumors. The in vitro and in vivo accumulation of [ 89 Zr]Zr-TR1402 in TSHR-expressing DTC cell lines support the continued preclinical optimization of this approach.

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Role of PET/Computed Tomography in Elderly Thyroid Cancer

Cited by 3 publications

References 87 publications

Diagnostic yield of FAP-guided positron emission tomography in thyroid cancer: a systematic review

Diagnostic yield of FAP-guided positron emission tomography in thyroid cancer: a systematic review

Update on current diagnosis and management of anaplastic thyroid carcinoma

PET Imaging of Differentiated Thyroid Cancer with TSHR-Targeted [⁸⁹Zr]Zr-TR1402

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Role of PET/Computed Tomography in Elderly Thyroid Cancer

Cited by 3 publications

References 87 publications

Diagnostic yield of FAP-guided positron emission tomography in thyroid cancer: a systematic review

Diagnostic yield of FAP-guided positron emission tomography in thyroid cancer: a systematic review

Update on current diagnosis and management of anaplastic thyroid carcinoma

PET Imaging of Differentiated Thyroid Cancer with TSHR-Targeted [89Zr]Zr-TR1402

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Product

Resources

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PET Imaging of Differentiated Thyroid Cancer with TSHR-Targeted [⁸⁹Zr]Zr-TR1402