Differentiated thyroid cancer and positron emission computed tomography: when, how and why?

Area of Science:

• Oncology
• Nuclear Medicine
• Radiology

Background:

• Differentiated thyroid carcinomas (DTC) are often indolent, limiting routine use of FDG PET/CT.
• Aggressive DTC subtypes benefit significantly from FDG PET/CT for detecting recurrence and metastases.

Purpose of the Study:

• To review the evolving role of FDG PET/CT in DTC management over the past 25 years.
• To highlight FDG PET/CT's utility in recurrence detection, staging, and follow-up of radioactive iodine-refractory DTC.
• To explore advancements in PET imaging, radiotracers, and theranostics for DTC.

Main Methods:

• Narrative review of literature from the PubMed database.
• Focus on articles published within the last 25 years.
• Analysis of FDG PET/CT's application in recurrence, staging, and follow-up of DTC.

Main Results:

• FDG PET/CT is recommended for high-risk DTC patients with elevated thyroglobulin and negative RAI scans (TENIS syndrome).
• Review covers advancements in PET imaging, novel radiotracers, and theranostic approaches.
• Utility in detecting recurrence and metastases in aggressive DTC is emphasized.

Conclusions:

• FDG PET/CT is crucial for aggressive DTC, particularly for recurrence and metastases detection.
• Current guidelines support its use in specific high-risk scenarios (TENIS syndrome).
• Future advancements in molecular imaging and AI promise refined, personalized DTC management, pending economic considerations.