Current problems in cancer · 2026
Clinical impact of a single time-point protocol paired FDG-PET and radioactive iodine scan for comprehensive disease assessment in differentiated thyroid cancer.
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Locke Margaret, Taneja Charit, Djekidel Mehdi, Seetharamu Nagashree
Аннотация
BACKGROUND: Treatment decisions in advanced or metastatic differentiated thyroid cancer require comprehensive clinical, genomic, and imaging evaluations. FDG-PET and radioactive iodine (RAI) scans image different biological clones of tumor subsets and are frequently complementary. We describe our institutional experience utilizing an innovative single time-point paired scan protocol for comprehensive disease assessment and management.
METHODS: We reviewed all patients over age 18 who underwent single time-point paired Thyrogen-stimulated FDG-PET and RAI scans for thyroid cancer staging or restaging at our institution between January 1, 2021 and December 31, 2024.
RESULTS: 53 paired scans for 51 unique patients were included. 58.8% were female. Mean age was 61 years (range 19- 84). 80.3% of patients had papillary carcinoma, 5 had follicular carcinoma, 2 had Hurthle cell, and 2 had mixed histology. Most patients (29, 56.8%) had local disease, 21.6% had locoregional recurrence and 21.6% had distant metastasis. 34 patients had previously received RAI and 5 had received tyrosine-kinase inhibitor. Of 53 paired scans, 12 showed disease on both scans, 11 were negative on both scans, 20 showed FDG-avidity not seen on RAI scan, 9 showed RAI-avidity not seen on FDG-PET, and one showed mixed disease on both FDG-PET and RAI scans.
DISCUSSION: The combination of FDG-PET and RAI scans offers several advantages, including prognostication as imaging biomarkers, enhanced detection of disease not visible on RAI scan alone due to biological heterogeneity of lesions, guidance for novel RAI resensitization strategies and RAI augmentation schemes.
CONCLUSIONS: Single time-point paired FDG-PET and RAI scans offer critical and often complementary information to guide differentiated thyroid cancer management, especially in patients with locally advanced disease, distant metastases or RAI-refractory disease.
METHODS: We reviewed all patients over age 18 who underwent single time-point paired Thyrogen-stimulated FDG-PET and RAI scans for thyroid cancer staging or restaging at our institution between January 1, 2021 and December 31, 2024.
RESULTS: 53 paired scans for 51 unique patients were included. 58.8% were female. Mean age was 61 years (range 19- 84). 80.3% of patients had papillary carcinoma, 5 had follicular carcinoma, 2 had Hurthle cell, and 2 had mixed histology. Most patients (29, 56.8%) had local disease, 21.6% had locoregional recurrence and 21.6% had distant metastasis. 34 patients had previously received RAI and 5 had received tyrosine-kinase inhibitor. Of 53 paired scans, 12 showed disease on both scans, 11 were negative on both scans, 20 showed FDG-avidity not seen on RAI scan, 9 showed RAI-avidity not seen on FDG-PET, and one showed mixed disease on both FDG-PET and RAI scans.
DISCUSSION: The combination of FDG-PET and RAI scans offers several advantages, including prognostication as imaging biomarkers, enhanced detection of disease not visible on RAI scan alone due to biological heterogeneity of lesions, guidance for novel RAI resensitization strategies and RAI augmentation schemes.
CONCLUSIONS: Single time-point paired FDG-PET and RAI scans offer critical and often complementary information to guide differentiated thyroid cancer management, especially in patients with locally advanced disease, distant metastases or RAI-refractory disease.