The 2015 Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma: the “evidence-based” refusal to endorse them by EANM due to the “not evidence-based” marginalization of the role of Nuclear Medicine

Abstract

In 2007, the American Thyroid Association (ATA) assembled a group of expert clinicians and basic scientists to evaluate published papers and to develop evidence-based guidelines for the diagnosis and management of patients with medullary thyroid carcinoma (MTC). The first ATA guidelines on the management of patients with MTC were published in 2009 [1]. In 2015, ATA released the first revised version of these guidelines [2], in order to assist clinicians of all specialties in the management of these patients.The ATA Board of Directors selected the Task Force members for elaborating these revised guidelines based on published scientific data in the management of MTC, and included international scientists from the fields of endocrinology, ethics, genetics, medical oncology, molecular biology, nuclear medicine, pathology, paediatrics, radiation oncology, and surgery [2]. Task Force members reviewed relevant articles on MTC by searching MEDLINE/PubMed from January 1980 to April 2014 using specific MTC-related search terms. Task Force members also provided additional relevant articles, book chapters, and other materials. Recommendations were graded using criteria adapted from the United States Preventive Services Task Force Agency for Healthcare Research and Quality as were used in the previous MTC guidelines [1,2]. After revisions and critical reviews of a series of drafts, the Task Force developed a final document, and the ATA Board of Directors approved the revised set of guidelines [2].Compared to the earlier version [1], the 2015 revised ATA guidelines on the management of patients with MTC (now consisting of 67 recommendations and related explanatory * Giorgio Treglia giorgiomednuc@libero.it on behalf of the EANM and the EANM Thyroid Committee

Medullary Thyroid Carcinoma: An Update on Imaging

“…The maximum standardized uptake value (SUV max) has been shown to correlate with CTN levels [24, 28]. 18F-FDG PET/CT should not be considered as first-line diagnostic imaging methods in patients with suspected recurrent MTC but could be very helpful in detecting recurrence in those patients in whom a more aggressive disease is suspected [4, 29].…”

Detection rate of somatostatin receptor PET in patients with recurrent medullary thyroid carcinoma: a systematic review and a meta-analysis

“…5,35,36 Comparative analyses between 18 F-DOPA and 18 F-FDG have shown better results with 18 F-DOPA in terms of sensitivity and specificity and a complementary role of the two radiopharmaceuticals in the assessment of recurrent MTC. 5,25,37,38 The different behaviour of 18 F-DOPA and 18 F-FDG in recurrent MTC can be explained by their different uptake mechanisms that, in turn, reflect the different metabolic pathways of NET cells, including MTC cells.…”

Current Status of Radiopharmaceuticals for the Theranostics of Neuroendocrine Neoplasms

“…Long-term responses by radiotherapy or systemic therapy are uncommon [ 94 ]. Different anatomic and molecular imaging methods (e.g., PET with 18 F-DOPA or 18 F-FDG, SPECT with 99m Tc(V)-DMSA, 99m Tc-MIBI or 123 I-MIBG and PET or SPECT with radiolabeled sst analogs) have been used to localize recurrence and metastases in patients with MTC [ 95 , 96 ]. Despite these numerous diagnostic tools, there are still many patients with negative result on imaging scans and elevated post-operative calcitonin and short calcitonin doubling-time, often indicating unresectable distant metastases, including lung and liver [ 97 ].…”