Multiparametric PET imaging in thyroid malignancy characterizing tumour heterogeneity: somatostatin receptors and glucose metabolism
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Radiolabelled somatostatin (SST) analogues have proven useful in diagnosing tumours positive for SST receptor (SSTR). As different subtypes of SSTR are expressed on the tumour cell surface, the choice of appropriate therapeutic SST analogue is crucial. We evaluated the SSTR status of thyroid cancer patients who had signs of progressive disease comparing different SSTR ligands for PET imaging to evaluate possible further therapeutic options.
PET with 68Ga-radiolabelled SSTR ligands DOTA lanreotide (DOTA-LAN), DOTA-Tyr3 octreotide (DOTA-TOC) and 18F-FDG was performed in 31 patients with thyroid cancer (TC). These 31 patients comprised 18 with radioiodine non-avid differentiated TC (DTC) including 6 papillary TC (PTC), 8 follicular TC (FTC) and 4 oxyphilic TC (oxyTC), 5 with anaplastic TC (ATC), and 8 with medullary TC (MTC). The PET results were compared in a region-based evaluation.
All patients underwent a PET study with 68Ga-DOTA-LAN, 28 patients with 68Ga-DOTA-TOC and 28 patients with 18F-FDG. A lack of SSTR expression was found in 13 of the 31 patients (42 %) with negative results with both SSTR tracers in 12 patients. Ambiguous results with both SSTR tracers were observed in one patient. High tracer uptake in SSTR PET images was seen in seven DTC patients (39 %; two PTC, three FTC, two oxyTC), in four ATC patients (80 %) and in six MTC patients (75 %). Lesions showing aerobic glycolysis on 18F-FDG PET were found in 24 of 28 patients (86 %) with corresponding positive results with 68Ga-DOTA-LAN in 35 % and with 68Ga-DOTA-TOC in 29 %.
The heterogeneous SSTR profile of TC tumour lesions needs to be evaluated using different SSTR PET tracers to characterize more closely the SSTR subtype affinities in patients with progressive TC in order to further stratify therapy with SSTR therapeutics.
Keywords68Ga-DOTA-LAN 68Ga-DOTA-TOC Thyroid cancer Somatostatin receptor PET imaging
Compliance with ethical standards
Conflicts of Interest
This study was retrospective in nature and formal consent was not required. All patients gave written informed consent before undergoing each of the imaging modalities according to institutional guidelines.
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