Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Sep 10;13(18):5362.
doi: 10.3390/jcm13185362.

Match Point: Nuclear Medicine Imaging for Recurrent Thyroid Cancer in TENIS Syndrome-Systematic Review and Meta-Analysis

Fabrizia Gelardi  1   2 , Alexandra Lazar  1 , Gaia Ninatti  2   3 , Cristiano Pini  2   3 , Arturo Chiti  1   2 , Markus Luster  4 , Friederike Eilsberger  4 , Martina Sollini  1   2   5
Affiliations
Review

Match Point: Nuclear Medicine Imaging for Recurrent Thyroid Cancer in TENIS Syndrome-Systematic Review and Meta-Analysis

Fabrizia Gelardi et al. J Clin Med. .

Abstract

Background/Objectives: Disease recurrence and resistance to radioiodine (RAI) therapy are major challenges in the management of differentiated thyroid cancer (DTC). In particular, the TENIS (Thyroglobulin Elevated Negative Iodine Scintigraphy) syndrome, characterised by elevated thyroglobulin (Tg) serum levels in addition to a negative radioiodine whole body scan (WBS), complicates disease monitoring and treatment decisions. Conventional imaging techniques often fail to detect disease in WBS-negative patients with rising Tg levels, leading to limitations in therapeutic intervention. This systematic review and meta-analysis aims to evaluate the diagnostic accuracy of nuclear imaging modalities in detecting disease recurrence in patients with the TENIS syndrome and to provide insights to guide therapeutic approaches in this complex clinical scenario. Methods: A comprehensive search of PubMed/MEDLINE and EMBASE databases up to March 2024 was performed according to PRISMA guidelines. Eligible studies were selected, and quality assessment was performed with the QUADAS-2 tool. For each study, relevant data were extracted and synthesised. A meta-analysis of the diagnostic accuracy of [18F]FDG PET/CT was performed, and patient-based pooled sensitivity and specificity were calculated using a random-effects model. Statistical heterogeneity between studies was assessed using the I2 statistic. Results: Of the 538 studies initially identified, 22 were included in the systematic review, of which 18 were eligible for meta-analysis. The eligible studies, mainly focused on [18F]FDG PET/CT, showed variable sensitivity and specificity for the detection of RAI-refractory thyroid cancer lesions. For [18F]FDG PET/CT, pooled estimates displayed a sensitivity of 0.87 (95% CI: 0.82-0.90) and a specificity of 0.76 (95% CI: 0.61-0.86), with moderate heterogeneity between studies. Conclusions: [18F]FDG PET/CT remains central in the detection of disease recurrence in patients with the TENIS syndrome. The emergence of novel radiopharmaceuticals with specific molecular targets is a promising way to overcome the limitations of [18F]FDG in these patients and to open new theranostics perspectives. This review highlights the great potential of nuclear medicine in guiding therapeutic strategies for RAI-refractory thyroid cancer.

Keywords: PET/CT; TENIS syndrome; iodine-131; nuclear medicine; theranostics; thyroid cancer.

PubMed Disclaimer

Conflict of interest statement

A.C.: speaker honorarium for AmGen, Sirtex, GE healthcare and Novartis, Advisory Board Novartis; Telix, advisory board. M.S.: speaker honorarium for Novartis. M.L.: Novartis advisory board. F.E.: speaker honorarium/advisory board for Lilly, Ipsen, IBSA, Sanofi-Aventis, and Novartis. All other authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Flow diagram of the article selection process.
Figure 2
Figure 2
QUADAS-2 quality assessment of the 22 articles included in the systematic review.
Figure 3
Figure 3
Estimated per-patient pooled sensitivity and specificity of [18F]FDG PET/CT in the detection of dedifferentiated thyroid cancer lesions in patients with TENIS syndrome, in studies included in the meta-analysis [23,25,26,27,28,29,30,31,32,33,34,35,36,38,40,41,42,44].
Figure 4
Figure 4
SROC curve of the performance of [18F]FDG PET/CT in the detection of dedifferentiated thyroid cancer lesions in patients with TENIS syndrome.
See this image and copyright information in PMC

References

    1. Surveillance Research Program, National Cancer Institute Cancer Stat Fact Sheets. Cancer Statistics, Surveillance Research Program, National Cancer Institute. [(accessed on 1 March 2024)]; Available online: http://seer.cancer.gov/statfacts.
    1. Avram A.M., Giovanella L., Greenspan B., Lawson S.A., Luster M., Van Nostrand D., Peacock J.G., Ovcaricek P.P., Silberstein E., Tulchinsky M., et al. SNMMI Procedure Standard/EANM Practice Guideline for Nuclear Medicine Evaluation and Therapy of Differentiated Thyroid Cancer: Abbreviated Version. J. Nucl. Med. 2022;63:15N–35N. - PubMed
    1. Haugen B.R., Alexander E.K., Bible K.C., Doherty G.M., Mandel S.J., Nikiforov Y.E., Pacini F., Randolph G.W., Sawka A.M., Schlumberger M., et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26:1–133. doi: 10.1089/thy.2015.0020. - DOI - PMC - PubMed
    1. Schmidt A., Iglesias L., Klain M., Pitoia F., Schlumberger M.J. Radioactive iodine-refractory differentiated thyroid cancer: An uncommon but challenging situation. Arch. Endocrinol. Metab. 2017;61:81–89. doi: 10.1590/2359-3997000000245. - DOI - PMC - PubMed
    1. Wang L.Y., Palmer F.L., Nixon I.J., Thomas D., Patel S.G., Shaha A.R., Shah J.P., Tuttle R.M., Ganly I. Multi-organ distant metastases confer worse disease-specific survival in differentiated thyroid cancer. Thyroid. 2014;24:1594–1599. doi: 10.1089/thy.2014.0173. - DOI - PubMed

LinkOut - more resources