Article: article from journal or magazin.
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
What is currently the best radiopharmaceutical for the hybrid PET/CT detection of recurrent medullary thyroid carcinoma?
Publication types: Journal Article ; Review
Publication Status: ppublish
Publication Status: ppublish
Among thyroid malignancies, medullary thyroid carcinoma (MTC) has some very specific features. Production and secretion of large amounts of peptides occur in malignant transformed C cells with few exceptions, leading to high serum levels of calcitonin (Ctn) and carcinoembryonic antigen (CEA), that act after thyroidectomy as tumour markers warning for the presence of persistent or metastatic MTC. The availability of those serum biomarkers with an excellent sensitivity challenges medical imaging to localise the recurrent cancer tissue, since surgery is a major therapeutic option. The aims of this article are (i) to review literature evidence about the efficacy and tolerance of radiopharmaceuticals for 3 targets of PET/CT imaging (glucose metabolism, bioamines metabolism and somatostatin receptors) and also bone scintigraphy which is recommended in the Guidelines of European Society for Medical Oncology (ESMO; (ii) to compare the availability and the costs in relation with those radiopharmaceuticals, (iii) and to discuss a possible sequence of those examinations, in order to optimise spending and to minimise the overall radiation dose. In this context of recurrent MTC suspected on rising tumour markers levels after thyroidectomy, this survey of literature confirms that FDOPA is the best radiopharmaceutical for PET/CT with significant diagnostic performance if Ctn>150 pg/mL; an early image acquisition starting during the first 15 min is advised. In negative cases, FDG should be the next PET radiopharmaceutical, in particular if Ctn and CEA levels are rapidly rising, and PET with a somatostatin analogue labelled with gallium-68 when neither FDOPA nor FDG PET are conclusive. Bone scintigraphy could complement FDG-PET/CT if FDOPA is not available.
Amines/metabolism, Blood Glucose/metabolism, Bone and Bones/diagnostic imaging, Carcinoma, Neuroendocrine, Dihydroxyphenylalanine/analogs & derivatives, Fluorine Radioisotopes, Fluorodeoxyglucose F18, Humans, Multimodal Imaging/economics, Multimodal Imaging/methods, Neoplasm Recurrence, Local/diagnostic imaging, Neoplasm Recurrence, Local/economics, Positron-Emission Tomography/economics, Positron-Emission Tomography/methods, Radiation Dosage, Radiopharmaceuticals/economics, Receptors, Somatostatin/metabolism, Thyroid Neoplasms/diagnostic imaging, Thyroid Neoplasms/economics, Tomography, X-Ray Computed/economics, Tomography, X-Ray Computed/methods
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