Somatostatin Receptor Imaging in Differentiated Thyroid Cancer
Most of the thyroid cancers consist of differentiated thyroid cancers (DTCs). Generally having a good prognosis, with the surgery and radioactive iodine (RAI) treatment in selected patients, a good outcome can be obtained. In contrast, some DTC patients are resistant to RAI (RAI-R). Treatment options for RAI-R patients are restricted. On the other hand, local limited RAI-R DTC patients have a chance of surgical operation and external radiotherapy. In addition, early detection of lesions and initial surgery are critical points in the management of the disease. FDG-PET imaging is a modality used in high-risk patients with elevated Tg. However, FDG-PET imaging in some patients may fail to detect the lesion.
The monitoring of somatostatin receptor (SSTR) expression in DTC cells allows the use of somatostatin receptor scintigraphy in DTC patients. Somatostatin receptor scintigraphy demonstrated to be positive in FDG-negative DTC patients provided an effective imaging method for lesion detection in those patients. In addition, patients with positive Tc-99m-labeled somatostatin receptor imaging have an operative chance with an intraoperative gamma probe. This modality increases the chances of success in patients with a history of multiple operations. Also in patients with positive somatostatin receptor scintigraphy, Lu-177-labeled or Y-90-labeled somatostatin analogs constitute a new treatment option.
KeywordsRAI RAI-R Refractory SSTRs PRRT Lu-177 DOTA-TATE DOTATOC HYNIC
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