Recent advances of nuclear medicine for tumor precision medicine

The aging population has resulted in a steady increase in the number of cancer cases, creating an urgent need for accurate tumor diagnostic technologies. Molecular imaging enables the non-invasive early detection of changes at the molecular level, which is essential for understanding disease progression and monitoring treatment effectiveness. This review highlights the transformative role of nuclear medicine innovations, including total-body Positron Emission Tomography (PET)/Computed Tomography (CT) and PET/Magnetic Resonance Imaging (PET/MRI), which enhance sensitivity, reduce radiation exposure, and enable quantitative kinetic analysis. Advances in targeted probes for human epidermal growth factor receptor 2 (HER2), prostate-specific membrane antigen (PSMA), programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1), and emerging biomarkers (e.g., 5T4, Trop2, DLL3) are systematically discussed, emphasizing their clinical applications in overcoming tumor heterogeneity and guiding immunotherapy or targeted radioligand therapies. Dual-target probes (e.g., PD-1/CTLA4, EGFR/c-MET) demonstrate improved diagnostic specificity by addressing tumor microenvironment complexity. Additionally, AI-driven radiomics optimizes image analysis, target identification, and predictive modeling, while radiomics-genomics integration refines patient stratification. Challenges such as probe cost, target coverage gaps, and standardization issues are addressed, with future directions focusing on multi-target probe development, AI-enhanced imaging protocols, and localized probe/device R&D to reduce healthcare costs. This review underscores the synergy between molecular imaging, targeted probes, and AI in advancing precision oncology toward comprehensive tumor management. • Total-body PET/CT achieves ultra-sensitive tumor imaging with 10-40x higher sensitivity and reduced radiation. • HER2/PSMA/PD-L1-targeted probes enable dynamic monitoring of tumor heterogeneity and therapy response. • Dual-target probes (e.g., PD-1/CTLA4) enhance specificity in complex tumor microenvironments. • AI-driven radiomics integrates imaging-genomics data for precision oncology and patient stratification.