Abstract
Traditional nuclear medicine is rapidly being transformed by the evolving concepts in molecular imaging and theranostics. The utility of new approaches in differentiated thyroid cancer (DTC) diagnostics and therapy has not been fully appreciated. The clinical information, relevant to disease management and patient care, obtained by scintigraphy is still being underestimated. There has been a trend towards moving away from the use of radioactive iodine (RAI) imaging in the management of the disease. This paradigm shift is supported by the 2015 American Thyroid Association Guidelines (1). A more systematic and comprehensive understanding of disease pathophysiology and imaging methodologies is needed for optimal utilization of different imaging modalities in the management of DTC. There have been significant developments in radiotracer and imaging technology, clinically proven to contribute to the understanding of tumor biology and the clinical assessment of patients with DTC. The research and development in the field continues to evolve, with expected emergence of many novel diagnostic and therapeutic techniques. The role for nuclear imaging applications will continue to evolve and be reconfigured in the changing paradigm. This article aims to review the clinical uses and controversies surrounding the use of scintigraphy, and the information it can provide in assisting in the management and treatment of DTC.
Highlights
SPECT and CT ImagingClinical Radioiodine ImagingOver the years, several options for imaging differentiated thyroid cancer (DTC) in nuclear medicine have been introduced, allowing for the progression in both the tracers and technology used
In the 2015 American Thyroid Association (ATA) guidelines, F-18 FDG positron emission tomography (PET)/CT is strongly recommended in high risk well-differentiated thyroid cancer (WDTC) patients with elevated serum thyroglobulin (Tg)
Specificity, positive predictive value, negative predictive value (NPV), and accuracy of FDG PET were 95%, 48%, 39%, 96%, and 60%, respectively
Summary
Arif Sheikh1, Berna Polack2, Yvette Rodriguez3, Russ Kuker4 1Columbia University Medical Center, Clinic of Radiology, New York, USA 2Dokuz Eylül University Faculty of Medicine, Department of Nuclear Medicine, İzmir, Turkey 3Florida International University, Herbert Wertheim College of Medicine, Department of Surgery, Miami, USA 4University of Miami Miller School of Medicine, Department of Radiology, Miami, USA
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