Abstract
Simple SummaryThyroid cancer remains a challenging malignancy, and it is difficultt to scale appropriate monitoring and therapy. Monitoring of the outcomes of thyroid cancer treatment currently relies on invasive tissue biopsies or repeat imaging involving radiation exposure. Liquid biopsies are a novel technique, which assess for common mutations associated with cancer through a simple blood sample. This review will assess the utility of liquid biopsies in the diagnosis and management of thyroid cancer and outline future directions which may optimise patient outcomes.Liquid biopsies are a novel technique to assess for either circulating tumor cells (CTC) or circulating tumor DNA (ctDNA and microRNA (miRNA)) in peripheral blood samples of cancer patients. The diagnostic role of liquid biopsy in oncology has expanded in recent years, particularly in lung, colorectal and breast cancer. In thyroid cancer, the role of liquid biopsy in either diagnosis or prognosis is beginning to translate from the lab to the clinic. In this review, we describe the evolution of liquid biopsies in detecting CTC, ctDNA and miRNA in thyroid cancer patients, together with its limitations and future directions in clinical practice.
Highlights
Thyroid cancer is the most common endocrine malignancy, and its incidence is increasing, with approximately a quarter of million new cases diagnosed globally in 2017 [1,2]
In non-small-cell lung cancer (NSCLC), EGFR mutation testing is used by clinicians to guide patients towards EGFR tyrosine kinase inhibitors [30,31]. circulating tumor DNA (ctDNA) is effective in monitoring disease progression in metastatic breast cancer and colorectal cancers (CRC), with over 90% accuracy [32,33,34,35]
Selpercatinib resulted in 50% reduction in variant allele frequency (VAF) in 79% of sampled patients following treatment 13 patients treated with tyrosine kinase inhibitors (TKI)–8 with progressive disease developed new RET V804M mutations
Summary
Thyroid cancer is the most common endocrine malignancy, and its incidence is increasing, with approximately a quarter of million new cases diagnosed globally in 2017 [1,2]. Surveillance for thyroid cancer recurrence currently relies on serum biomarkers (including thyroglobulin in differentiated thyroid cancer (DTC) and calcitonin in medullary thyroid cancer (MTC)), radiological screening and invasive biopsies. While these modalities are the gold standard of care, they each have limitations, creating a role for new monitoring techniques in thyroid cancer management. Calcitonin (Ctn), is the gold-standard serum biomarker for monitoring MTC It is a 32 amino acid peptide that results from the cleavage of procalcitonin, which are secreted from the C cells of the thyroid gland. Ctn levels can vary with changes in physical activity, age and weight, making it difficult to monitor treatment response over time [13]
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