Uptodate view on diagnostics and treatment of medullary thyroid cancer

Gazizova, D O; Бельцевич, Д. Г.

doi:10.14341/serg201334-21

Endocrine Surgery

2013

DOI: 10.14341/serg201334-21

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Uptodate view on diagnostics and treatment of medullary thyroid cancer

D O Gazizova¹,

Д. Г. Бельцевич²

Abstract: За последние 4 года ведущие эндокринологические сообщества разных стран выпустили рекомендации, посвященные диагностике и лечению медуллярного рака щитовидной железы. Статья охватывает большинство аспектов ведения пациентов с данной патологией.

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References 125 publications

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PET/CT with various radiopharmaceuticals in the complex diagnosis of medullary thyroid carcinoma: a review

Tsentr,

Ertman,

Ryzhkova

2023

Lučevaâ diagn. ter.

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INTRODUCTION: Medullary carcinoma is a rare malignant neuroendocrine tumor of the thyroid gland. Medullary thyroid carcinoma (MTC) has no specific clinical symptoms. Due to the absence of specific symptoms, the disease is usually diagnosed at the stage of metastatic lesions of regional lymph nodes, and sometimes, internal organs. The five- and ten-year survival after detection of distant metastases is 25% and 10%, respectively.OBJECTIVE: To analyze the available foreign and domestic literature to determine the role of PET/CT with various radiopharmaceuticals in the complex radiological diagnosis of MTC.MATERIALS AND METHODS: A search was made for scientific publications and clinical recommendations in the information and analytical systems PudMed, elibrary over the past ten years, dedicated to the diagnosis of MTC, including PET/CT with 18F-DOPA, 18F-FDG, 68Ga-DOTA peptides, etc. by keywords «medullary thyroid cancer», «medullary thyroid carcinoma», «PET/CT», «18F-L-dihydroxyphenylalanine», «18F-DOPA», «18F-DOPA», «68Ga-DOTA peptides», «68Ga-DOTA-peptides», «theranostics», «theranostics».RESULTS: The analysis of publications demonstrated the prospects for the use of PET/CT with various radiopharmaceuticals for the diagnosis of recurrent tumors and the prevalence of the process in biochemical recurrence of MTC, as well as the possibility of peptide-receptor radionuclide therapy for the treatment of advanced forms of the disease. The choice of radiopharmaceuticals is based on the results of laboratory diagnostics and conventional methods of anatomical imaging. PET/CT with 68Ga-DOTA peptides is performed to predict the effectiveness of peptide-receptor radionuclide therapy.CONCLUSION: PET/CT with various radiopharmaceuticals makes a significant contribution to the diagnosis of recurrent tumors, assessment of the prevalence of the tumor process and selection of patients for peptide-receptor radionuclide therapy.

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PET/CT with various radiopharmaceuticals in the complex diagnosis of medullary thyroid carcinoma: a review

Tsentr,

Ertman,

Ryzhkova

2023

Lučevaâ diagn. ter.

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Diagnostic capabilities of PET/CT with <sup>18</sup>F-DOPA in biochemical recurrence of medullary thyroid carcinoma: a retrospective study

Tsentr,

Zyryanova,

Rusnak

et al. 2024

Lučevaâ diagn. ter.

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INTRODUCTION: Medullary thyroid carcinoma (MTС) is a rare neuroendocrine malignant neoplasm of the thyroid gland. In most cases, sporadic MTС is diagnosed at late stages due to the absence of specific symptoms. The main method of treatment of MTС is surgical — thyroidectomy and in most cases cervical lymphodissection. Current international guidelines suggest the use of basal calcitonin levels and cancer embryonic antigen (CEA) as markers of biochemical recurrence. In biochemical recurrence of the disease, it is advisable to search for tumor foci regardless of the level of cancer markers. Positron emission tomography combined with computed tomography (PET/CT) has the highest sensitivity and specificity for searching for local recurrence and distant metastases. Anatomical imaging methods (computed tomography (CT), magnetic resonance imaging (MRI)) have suboptimal sensitivity and specificity in detection of a recurrent tumor.OBJECTIVE: To explore the diagnostic capabilities of PET/CT with 18F-DOPA in patients with biochemical recurrence of medullary thyroid carcinoma, depending on the concentration of calcitonin in blood plasma.MATERIALS AND METHODS: To evaluate the diagnostic capabilities of PET/CT with 18F-DOPA in patients with biochemical recurrence of medullary thyroid carcinoma, 81 PET/CT studies were analyzed in patients after thyroidectomy. In most cases (76/81), at the time of the study, patients had elevated basal calcitonin levels (>10 pg/ml, including in 52/81 cases >150 pg/ml), which corresponded to a biochemical recurrence of the disease. In 6 cases, the calcitonin level was <10 pg/ml. PET/CT results were processed by visual image analysis, measurement of a semi-quantitative indicator of the maximal standardized level of radiopharmaceutical accumulation normalized to lean body mass (SUVlbm max) and the total volume of PET-positive tumor tissue (metabolic tumor volume).RESULTS: In 41 studies, foci of pathological accumulation of 18F-DOPA were identified, corresponding to recurrent tumor foci. DOPA-negative results in patients with elevated calcitonin levels were regarded as false negative. The highest sensitivity of the method was achieved at calcitonin levels >150 pg/ml. A noticeable positive correlation was found between the concentration of basal serum calcitonin, the number of pathological foci of 18F-DOPA hyperaccumulation and the total metabolic volume of tumor tissue. In most cases of biochemical recurrence, the PET method was superior to the CT method in detecting recurrent tumor foci.CONCLUSION: PET/CT with 18F-DOPA is the most informative method for molecular and structural imaging in patients with biochemical recurrence of medullary thyroid carcinoma. The results of the study directly correlate with the level of basal calcitonin in the blood.

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Uptodate view on diagnostics and treatment of medullary thyroid cancer

Cited by 2 publications

References 125 publications

PET/CT with various radiopharmaceuticals in the complex diagnosis of medullary thyroid carcinoma: a review

PET/CT with various radiopharmaceuticals in the complex diagnosis of medullary thyroid carcinoma: a review

Diagnostic capabilities of PET/CT with <sup>18</sup>F-DOPA in biochemical recurrence of medullary thyroid carcinoma: a retrospective study

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