Abstract
Simple SummaryAccording to the American Cancer Society, approximately 53,000 new cases of thyroid cancer were diagnosed and more than 2200 people died from the disease in 2020. New developments in molecular imaging are significantly improving thyroid cancer diagnostics and therapy. Continuous research in molecular imaging techniques additionally contributes to an understanding of a variety of diseases and enables more efficient care of thyroid cancer patients. Molecular imaging-based personalized therapy has been a fascinating concept for individualized therapeutic strategy, which is able to attain the highest efficacy and reduce adverse effects in certain patients. Theragnostics, which integrates diagnostic testing to detect molecular targets for particular therapeutic modalities, is one of the key technologies that contributes to the success of personalized medicine. This review details the inception of molecular imaging and theragnostic applications for thyroid cancer management.Molecular imaging plays an important role in the evaluation and management of different thyroid cancer histotypes. The existing risk stratification models can be refined, by incorporation of tumor-specific molecular markers that have theranostic power, to optimize patient-specific (individualized) treatment decisions. Molecular imaging with varying radioisotopes of iodine (i.e., 131I, 123I, 124I) is an indispensable component of dynamic and theragnostic risk stratification of differentiated carcinoma (DTC) while [18F]F-fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) helps in addressing disease aggressiveness, detects distant metastases, and risk-stratifies patients with radioiodine-refractory DTC, poorly differentiated and anaplastic thyroid cancers. For medullary thyroid cancer (MTC), a neuroendocrine tumor derived from thyroid C-cells, [18F]F-dihydroxyphenylalanine (6-[18F]FDOPA) PET/CT and/or [18F]FDG PET/CT can be used dependent on serum markers levels and kinetics. In addition to radioiodine therapy for DTC, some theragnostic approaches are promising for metastatic MTC as well. Moreover, new redifferentiation strategies are now available to restore uptake in radioiodine-refractory DTC while new theragnostic approaches showed promising preliminary results for advanced and aggressive forms of follicular-cell derived thyroid cancers (i.e., peptide receptor radiotherapy). In order to help clinicians put the role of molecular imaging into perspective, the appropriate role and emerging opportunities for molecular imaging and theragnostics in thyroid cancer are discussed in our present review.
Highlights
Thyroid cancers account for about 1% of all cancer cases, being the most frequent endocrine malignancy
Treatment of relapsing and advanced differentiated thyroid cancer (DTC) may benefit from radioiodine therapy (RAI) while Thyrosin-Kinase Inhibitors (TKI) can be employed in patients affected by advanced radioiodine-refractory DTC and medullary thyroid carcinoma (MTC), respectively [1,7,8]
This review focuses on how molecular imaging influences the diagnosis, staging, prognostic stratification, and management of thyroid cancers
Summary
Thyroid cancers account for about 1% of all cancer cases, being the most frequent endocrine malignancy. Among cancers derived from the follicular thyroid cell, the most frequent (80–85% of cases) differentiated thyroid cancer (DTC) usually has a favorable prognosis while the anaplastic form (ATC) evolves rapidly to the fatal outcome in approximately all cases [1]. The 5-year disease-specific mortality rate of poorly differentiated thyroid carcinoma (PDTC) and medullary thyroid carcinoma (MTC), a neuroendocrine tumor derived by the parafollicular C-cells, is ~50% [2]. Postoperative radioiodine therapy (RAI) may be administered in DTC patients to ablate thyroid remnants, reduce the risk of recurrence and disease-related death or treat known structural disease [4]. Postoperative monitoring of most DTC and MTC patients relies on serum tumor markers and neck ultrasound, with additional imaging added in cases of suspicious spread of the disease [5,6]. The role of molecular imaging-based theragnostics applications is discussed
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