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PET/CT in thyroid nodule and differentiated thyroid cancer patients. The evidence-based state of the art

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Abstract

A more conservative approach to the clinical management of thyroid nodules and differentiated thyroid cancer has recently been proposed by the 2015 ATA guidelines. In this context, fine-needle aspiration biopsy has been reserved for nodules with particular ultrasound features or dimensions that exclude low-risk thyroid lesions. Accordingly, a less aggressive surgical approach (i.e. lobectomy) has been recommended as the first-choice treatment in nodules with indeterminate cytology or in small cytologically confirmed malignant nodules. At the same time, radioactive remnant ablation has been considered only for DTC patients with concrete risks of disease persistence/relapse after thyroidectomy. In addition, further radioactive iodine therapies (RAI) have been proposed only for patients presenting unresectable and iodine-avid structural relapse. In this complex scenario, which requires attention to each clinical aspect of the patient, the introduction of accurate diagnostic tools is highly warranted. PET/CT is a very sensitive and specific diagnostic procedure that can better characterize the risk of thyroid nodules, identify DTC relapse early and predict the response to RAI. Thus, it seems essential to customize a more conservative approach to thyroid nodules and DTC patients. The aim of this review is to report the principal clinical context in which PET/CT has been used and to evaluate the evidence-based support for each diagnostic indication.

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Abbreviations

DTC:

differentiated thyroid cancer

131I:

131-iodine

124I:

Iodine-124

NPV:

negative predictive value

WBS:

whole-body scan

Tg:

thyroglobulin

TgAb:

anti-thyroglobulin autoantibodies

RAI:

radioactive iodine therapy

TKI:

tyrosine kinase inhibitor

PSMA:

68Ga-Prostate-specific membrane antigen

rhTSH:

recombinant human TSH

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Authors and Affiliations

  1. Department of Nuclear Medicine, Galliera Hospital, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy

    Arnoldo Piccardo, Giulia Ferrarazzo, Michela Massollo & Gianluca Bottoni

  2. Clinic of Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Lugano, Bellinzona, Switzerland

    Pierpaolo Trimboli, Giorgio Treglia & Luca Giovanella

  3. Department of Internal Medicine, Galliera Hospital, Genoa, Italy

    Luca Foppiani

  4. Health Technology Assessment Unit, General Directorate, Ente Ospedaliero Cantonale, Bellinzona, Switzerland

    Giorgio Treglia

  5. Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland

    Giorgio Treglia

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  1. Arnoldo Piccardo
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Piccardo, A., Trimboli, P., Foppiani, L. et al. PET/CT in thyroid nodule and differentiated thyroid cancer patients. The evidence-based state of the art. Rev Endocr Metab Disord 20, 47–64 (2019). https://doi.org/10.1007/s11154-019-09491-2

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