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Nectin4 is physiologically expressed at minimal levels in most normal adult tissues; however, it is significantly upregulated in various solid tumors. It can drive cell proliferation, metastasis, angiogenesis, adhesion, recurrence, and DNA mismatch repair in tumors, leading to poor prognosis. Notably, the United States Food and Drug Administration has approved enfutumab vedotin, a novel antibody\u2013drug conjugate targeting Nectin4, for the therapy of urothelial carcinoma, highlighting the significance of Nectin4 in targeted therapy. However, accurate diagnosis and evaluation of patients is also important. Visualization of Nectin4 expression levels can be achieved with molecular imaging, including positron\u2010emission tomography, single\u2010photon emission computed tomography, and near\u2010infrared fluorescence imaging. Incorporating Nectin4\u2010targeted molecular imaging into clinical practice is vital for the diagnosis, differentiation, treatment decision, efficacy evaluation, and prognosis prediction of a broad spectrum of solid tumors. We reviewed research advances in Nectin4\u2010targeted molecular imaging, focusing on theranostic applications in different tumor types, including breast, urothelial, gastric, pancreatic, ovarian, colorectal, and other cancers. We also evaluated the present situation by investigating research progress, diagnostic performance, and limitations. 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