Advertisement

Hormones

pp 1–5 | Cite as

68Ga-PSMA PET thyroid incidentalomas

  • Francesco BertagnaEmail author
  • Domenico Albano
  • Luca Giovanella
  • Mattia Bonacina
  • Rexhep Durmo
  • Raffaele Giubbini
  • Giorgio Treglia
Review Article
  • 7 Downloads

Abstract

Introduction

Thyroid incidentaloma is defined as a thyroid lesion incidentally and newly detected by imaging techniques performed for an unrelated purpose and especially for a non-thyroid disease. The aim of this review is to evaluate the prevalence and clinical significance of focal incidental radiolabelled prostate-specific membrane antigen (PSMA) uptake in the thyroid gland [PSMA thyroid incidentaloma (PTI)] revealed by PET/CT or PET/MRI.

Methods

A comprehensive literature search of the PubMed/MEDLINE, Scopus, and Embase databases was conducted to find relevant published articles about the prevalence and clinical significance of PTIs detected by PET/CT or PET/MRI in patients studied for other oncologic purposes.

Results

Twelve articles were included in the systematic review. Among 23 PTIs, 6 were malignant (5 primary thyroid tumors and one metastasis from renal cell carcinoma), one was a follicular lesion of undetermined significance, and the rest were benign.

Conclusion

Despite being very rare, though probably underestimated, PTIs frequently signal the presence of unexpected lesions in the thyroid which differ from the indicated reason for which the patient was initially scanned and concerning which the risk of malignancy is not negligible.

Keywords

Thyroid Incidental Thyroid incidentaloma PSMA (Prostate-specific membrane antigen) PET (Positron emission tomography) 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

References

  1. 1.
    Afshar-Oromieh A, Avtzi E, Giesel FL et al (2015) The diagnostic value of PET/CT imaging with the (68)Ga-labelled PSMA ligand HBED-CC in the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging 42:197–209CrossRefGoogle Scholar
  2. 2.
    Kratochwil C, Giesel FL, Eder M et al (2015) [(177)Lu]lutetium-labelled PSMA ligand-induced remission in a patient with metastatic prostate cancer. Eur J Nucl Med Mol Imaging 42:987–988CrossRefGoogle Scholar
  3. 3.
    Chang SS, Reuter VE, HestonWD et al (1999) Five different anti-prostate-specific membrane antigen (PSMA) antibodies confirm PSMA expression in tumor-associated neovasculature. Cancer Res 59, 3192–3198Google Scholar
  4. 4.
    Haffner MC, Kronberger IE, Ross JS et al (2009) Prostate-specific membrane antigen expression in the neovasculature of gastric and colorectal cancers. Hum Pathol 40:1754–1761CrossRefGoogle Scholar
  5. 5.
    Kinoshita Y, Kuratsukuri K, Landas S et al (2006) Expression of prostate-specific membrane antigen in normal and malignant human tissues. World J Surg 30:628–636CrossRefGoogle Scholar
  6. 6.
    Hofman MS, Hicks RJ, Maurer T et al (2018) Prostate-specific membrane antigen PET: clinical utility in prostate cancer, normal patterns, pearls, and pitfalls. Radiographics 38:200–217CrossRefGoogle Scholar
  7. 7.
    Verburg FA, Krohn T, Heinzel A et al (2015) First evidence of PSMA expression in differentiated thyroid cancer using [68Ga]PSMA-HBED-CC PET/CT. Eur J Nucl Med Mol Imaging 42:1622–1623CrossRefGoogle Scholar
  8. 8.
    Taywade SK, Damle NA, Bal CS (2016) PSMA expression in papillary thyroid carcinoma opening a new horizon in management of thyroid cancer? Clin Nucl Med 41:e263–e265CrossRefGoogle Scholar
  9. 9.
    Noss KR, Wolfe SA, Grimes SR (2002) Upregulation of prostate specific membrane antigen/folate hydrolase transcription by an enhancer. Gene 285:247–256CrossRefGoogle Scholar
  10. 10.
    Bourgeois S, Gykiere P, Goethals L et al (2016) Aspecific uptake of 68GA-PSMA in Paget disease of the bone. Clin Nucl Med 41:877–878CrossRefGoogle Scholar
  11. 11.
    Damle NA, Tripathi M, Chakraborty PS et al (2016) Unusual uptake of prostate specific tracer 68Ga-PSMA-HBED-CC in a benign thyroid nodule. Nucl Med Mol Imaging 50:344–347CrossRefGoogle Scholar
  12. 12.
    Demirci E, Sahin OE, Ocak M et al (2016) Normal distribution pattern and physiological variants of 68Ga-PSMA-11 PET/CT imaging. Nucl Med Commun 37:1169–1179CrossRefGoogle Scholar
  13. 13.
    Derlin T, Kreipe HH, Schumacher U et al (2017) PSMA expression in tumor neovasculature endothelial cells of follicular thyroid adenoma as identified by molecular imaging using 68Ga-PSMA ligand PET/CT. Clin Nucl Med 42:e173–e174CrossRefGoogle Scholar
  14. 14.
    Kanthan GL, Drummond J, Schembri GP et al (2016) Follicular thyroid adenoma showing avid uptake on 68Ga PSMA-HBED-CC PET/CT. Clin Nucl Med 41:331–332CrossRefGoogle Scholar
  15. 15.
    Keidar Z, Gill R, Goshen E et al (2018) 68Ga-PSMA PET/CT in prostate cancer patients - patterns of disease, benign findings and pitfalls. Cancer Imaging 18:39CrossRefGoogle Scholar
  16. 16.
    Malik D, Sood A, Mittal BR et al (2018) Nonspecific uptake of 68Ga-prostate-specific membrane antigen in diseases other than prostate malignancy on positron emission tomography/computed tomography imaging: a pictorial assay and review of literature. Indian J Nucl Med 33:317–325CrossRefGoogle Scholar
  17. 17.
    Osman MM, Iravani A, Hicks RJ et al (2017) Detection of synchronous primary malignancies with 68Ga-labeled prostate-specific membrane antigen PET/CT in patients with prostate cancer: frequency in 764 patients. J Nucl Med 58:1938–1942CrossRefGoogle Scholar
  18. 18.
    Sager S, Vatankulu B, Uslu L et al (2016) Incidental detection of follicular thyroid carcinoma in 68Ga-PSMA PET/CT imaging. J Nucl Med Technol 44:199–200CrossRefGoogle Scholar
  19. 19.
    Singh D, Horneman R, Nagra NK (2018) More than the prostate: intrapancreatic accessory spleen and papillary thyroid cancer detected with 18F-PSMA PET/CT. Hell J Nucl Med 21:145–147Google Scholar
  20. 20.
    Zacho HD, Nielsen JB, Dettmann K et al (2017) Incidental detection of thyroid metastases from renal cell carcinoma using 68Ga-PSMA PET/CT to assess prostate cancer recurrence. Clin Nucl Med 42:221–222CrossRefGoogle Scholar
  21. 21.
    Jena A, Zaidi S, Kashyap V et al (2017) PSMA expression in multinodular thyroid neoplasm on simultaneous Ga-68-PSMA PET/MRI. Indian J Nucl Med 32:159–161CrossRefGoogle Scholar
  22. 22.
    Joshi A, Nicholson C, Rhee H et al (2017) Incidental malignancies identified during staging for prostate cancer with 68Ga prostate-specific membrane antigen HBED-CC positron emission tomography imaging. Urology 104:e3–e4CrossRefGoogle Scholar
  23. 23.
    Treglia G, Bertagna F, Sadeghi R et al (2013) Focal thyroid incidental uptake detected by 18F-fluorodeoxyglucose positron emission tomography. Meta-analysis on prevalence and malignancy risk. Nuklearmedizin 52:130–136CrossRefGoogle Scholar
  24. 24.
    Treglia G, Giovanella L, Bertagna F et al (2013) Prevalence and risk of malignancy of thyroid incidentalomas detected by (18)f-fluorodeoxyglucose positron-emission tomography. Thyroid 23:124–126CrossRefGoogle Scholar
  25. 25.
    Bertagna F, Treglia G, Piccardo A et al (2013) F18-FDG-PET/CT thyroid incidentalomas: a wide retrospective analysis in three Italian centres on the significance of focal uptake and SUV value. Endocrine 43:678–685CrossRefGoogle Scholar
  26. 26.
    Bertagna F, Treglia G, Piccardo A et al (2012) Diagnostic and clinical significance of F-18-FDG-PET/CT thyroid incidentalomas. J Clin Endocrinol Metab 97:3866–3875CrossRefGoogle Scholar
  27. 27.
    Bychkov A, Vutrapongwatana U, Tepmongkol S et al (2017) PSMA expression by microvasculature of thyroid tumors - potential implications for PSMA theranostics. Sci Rep 7:5202CrossRefGoogle Scholar
  28. 28.
    Verma P, Malhotra G, Agrawal R et al (2018) Evidence of prostate-specific membrane antigen expression in metastatic differentiated thyroid Cancer using 68Ga-PSMA-HBED-CC PET/CT. Clin Nucl Med 43:e265–e268CrossRefGoogle Scholar
  29. 29.
    Malik D, Kumar R, Mittal BR et al (2018) 68Ga-labeled PSMA uptake in nonprostatic malignancies: has the time come to remove “PS” from PSMA? Clin Nucl Med 43:529–532CrossRefGoogle Scholar
  30. 30.
    Lütje S, Gomez B, Cohnen J et al (2017) Imaging of prostate-specific membrane antigen expression in metastatic differentiated thyroid cancer using 68Ga-HBED-CC-PSMA PET/CT. Clin Nucl Med 42:20–25CrossRefGoogle Scholar
  31. 31.
    Moore M, Panjwani S, Mathew R et al (2017) Well-differentiated thyroid cancer neovasculature expresses prostate-specific membrane antigen-a possible novel therapeutic target. Endocr Pathol 28:339–344CrossRefGoogle Scholar
  32. 32.
    Damle NA, Bal C, Singh TP et al (2018) Anaplastic thyroid carcinoma on 68 Ga-PSMA PET/CT: opening new frontiers. Eur J Nucl Med Mol Imaging 45:667–668CrossRefGoogle Scholar
  33. 33.
    Luster M, Pfestroff A, Verburg FA (2017) Recent advances in nuclear medicine in endocrine oncology. Curr Opin Oncol 29:1–6CrossRefGoogle Scholar

Copyright information

© Hellenic Endocrine Society 2019

Authors and Affiliations

  • Francesco Bertagna
    • 1
    Email author
  • Domenico Albano
    • 1
  • Luca Giovanella
    • 2
  • Mattia Bonacina
    • 1
  • Rexhep Durmo
    • 1
  • Raffaele Giubbini
    • 1
  • Giorgio Treglia
    • 2
    • 3
    • 4
  1. 1.Nuclear MedicineUniversity of Brescia and Spedali Civili di BresciaBresciaItaly
  2. 2.Department of Nuclear Medicine and PET/CT CenterOncology Institute of Southern SwitzerlandBellinzonaSwitzerland
  3. 3.Department of Nuclear Medicine and Molecular ImagingLausanne University HospitalLausanneSwitzerland
  4. 4.Health Technology Assessment UnitGeneral Directorate, Ente Ospedaliero CantonaleBellinzonaSwitzerland

Personalised recommendations