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

  • Arnoldo PiccardoEmail author
  • Pierpaolo Trimboli
  • Luca Foppiani
  • Giorgio Treglia
  • Giulia Ferrarazzo
  • Michela Massollo
  • Gianluca Bottoni
  • Luca Giovanella
Article

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.

Keywords

PET/CT Diagnosis Thyroid nodules Differentiated thyroid Cancer 

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

Notes

Compliance with ethical standards

Conflict of interest

The authors have nothing to disclose.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Nuclear MedicineGalliera Hospital, E.O. Ospedali GallieraGenoaItaly
  2. 2.Clinic of Nuclear Medicine and Molecular ImagingImaging Institute of Southern SwitzerlandLuganoSwitzerland
  3. 3.Department of Internal MedicineGalliera HospitalGenoaItaly
  4. 4.Health Technology Assessment Unit, General DirectorateEnte Ospedaliero CantonaleBellinzonaSwitzerland
  5. 5.Department of Nuclear Medicine and Molecular ImagingLausanne University HospitalLausanneSwitzerland

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