ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Cancer Endocrinology
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1627500
This article is part of the Research TopicAdvances in Management of Aggressive Thyroid Cancer: Medullary and Advanced Thyroid CancerView all 11 articles
[68Ga]Ga-PSMA-11 PET/CT in Medullary Thyroid Carcinoma: Comparison with [18F]FDG PET/CT and Immunohistochemical Analysis
Provisionally accepted
Klaudia Zajkowska*
Elwira Bakuła-ZalewskaPaulina CeglaMarta Wojewódzka- MirochaPaweł OchmanAgata SackiewiczJoanna Januszkiewicz-CaulierJoanna DługosińskaMałgorzata CzetwertyńskaMarek Dedecjus- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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Introduction: Medullary thyroid carcinoma (MTC) is a rare neuroendocrine malignancy. Despite the use of various imaging modalities, including positron emission tomography combined with computed tomography (PET/CT), a significant proportion of patients with biochemical evidence of disease have no detectable lesions. Prostate-specific membrane antigen (PSMA) is expressed by the neovasculature of several solid tumours, including thyroid cancer. While case reports suggest that PSMA-targeted PET/CT may detect MTC lesions, its diagnostic value remains unverified. This study aimed to compare the clinical utility of [68Ga]Ga-PSMA-11 PET/CT with that of 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG) PET/CT in MTC patients, assess PSMA expression by immunohistochemistry, and correlate PSMA expression with [68Ga]Ga-PSMA-11 PET/CT findings. Methods: Twelve patients with MTC who had undergone total thyroidectomy and presented with elevated serum calcitonin and/or carcinoembryonic antigen levels underwent prospective evaluation with [68Ga]Ga-PSMA-11 and [18F]FDG PET/CT. Immunohistochemical staining for PSMA and CD31 was performed. Results: The detection rate by [68Ga]Ga-PSMA-11 PET/CT was 100% (8/8) for lesion-based analysis, and 36.4% (4/11) for patient-based analysis, whereas those for [18F]FDG PET/CT were 12.5% (1/8) and 9.1% (1/11), respectively. [68Ga]Ga-PSMA-11 PET/CT led to a change in the clinical management of one (8.3%) patient. TBRBlood, and TBRLiver were significantly higher on [68Ga]Ga-PSMA-11 PET/CT than on [18F]FDG PET/CT (p = 0.018 and p = 0.038, respectively). Immunohistochemistry confirmed neovascular expression of PSMA in 55% of patients. Expression was significantly higher in patients with positive [68Ga]Ga-PSMA-11 PET/CT results (p = 0.042). Conclusions: [68Ga]Ga-PSMA-11 PET/CT demonstrated higher detection rates than [18F]FDG PET/CT in both lesion-based and patient-based analyses.
Keywords: medullary thyroid carcinoma, PSMA, FDG, PET/CT, Calcitonin, Immunohistochemistry
Received: 12 May 2025; Accepted: 15 Sep 2025.
Copyright: © 2025 Zajkowska, Bakuła-Zalewska, Cegla, Wojewódzka- Mirocha, Ochman, Sackiewicz, Januszkiewicz-Caulier, Długosińska, Czetwertyńska and Dedecjus. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Klaudia Zajkowska, km.zajkowska@gmail.com
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