Nuclear Imaging in Patients with Differentiated Thyroid Cancer and Negative Radioactive Io-dine Scan

Thyroid cancer is the most common endocrine malignancy in the world; however, these patients usually experience a high survival rate if they receive appropriate and timely treatment. Meanwhile, patients classified as having differentiated thyroid cancer with high thyroglobulin and negative iodine scan [Differentiated thyroid cancer with thyroglobulin elevation and negative iodine scintigraphy (TENIS)] are always considered a diagnostic-therapeutic challenge.

We conducted a comprehensive literature search of published papers in the PubMed/MEDLINE database regarding nuclear imaging in differentiated thyroid cancer with thyroglobulin elevation and negative iodine scintigraphy. We included all human studies in this field.

In this review, we examined four major groups of imaging studies aimed at identifying GLUT, SSTR, PSMA and FAP receptors in patients with TENIS. The diagnostic rate of 2-[18F]FDG PET/CT in these patients has been reported as 63-81% based on various studies. Also, [68Ga]Ga-DOTATATE PET/CT, [68Ga]Ga-PSMA PET/CT and [68Ga]Ga-FAPI PET/CT scans have shown good results in these patients.

[68Ga]Ga-FAPI PET/CT imaging has the highest diagnostic rate among these patients. Given the theranostic capability of FAPI and the numerous complications and limited inclusion criteria for treatment with tyrosine kinase inhibitors, it has been the next step in the treatment of patients with TENIS. Therefore, more extensive studies in this field are warranted.