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Lyssens A, van den Berg MF, Peremans K, Vandermeulen E, Daminet S. 131 treatment in dogs with hyperthyroidism caused by a non-resectable ectopic thyroid tumour: 5 cases (2008-2019). J Small Anim Pract 2020; 62:137-144. [PMID: 33150621 DOI: 10.1111/jsap.13255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 09/01/2020] [Accepted: 10/06/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to describe the clinical and diagnostic characteristics, as well as outcomes of radioiodine treatment in dogs with hyperthyroidism caused by a non-resectable ectopic thyroid tumour. MATERIALS AND METHODS This retrospective study reviewed the medical records between 2008 and 2018 of dogs diagnosed with hyperthyroidism secondary to a non-resectable ectopic thyroid tumour and treated with radioiodine. RESULTS Five dogs were included in the study. Three dogs had sublingual ectopic tumours, of which one also had a unilateral cervical thyroid tumour. The remaining two dogs were diagnosed with an ectopic thyroid tumour at the level of the caudal pharynx and the heart base, respectively. All cases were treated with radioiodine. The size of the ectopic masses decreased after radioiodine treatment. Total thyroxine concentrations returned to reference ranges in all dogs. Further, clinical signs of hyperthyroidism disappeared after treatment in all patients. One dog developed myelosuppression secondary to radioiodine treatment. The dog with metastasis had a very short survival compared to the four dogs without metastasis (3 months compared to 7, 36, 50 and 24 months, respectively) and succumbed most likely to thyroid-related problems. In the remaining four dogs, their quality of life improved. They died due to diseases unrelated to the ectopic thyroid tumour. CLINICAL SIGNIFICANCE Radioiodine therapy should be considered as a treatment option in dogs diagnosed with hyperthyroidism due to a non-resectable ectopic thyroid tumour.
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Affiliation(s)
- A Lyssens
- Department of Small Animals, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke, 9820, Belgium
| | - M F van den Berg
- Department of Small Animals, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke, 9820, Belgium
| | - K Peremans
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke, 9820, Belgium
| | - E Vandermeulen
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke, 9820, Belgium
| | - S Daminet
- Department of Small Animals, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke, 9820, Belgium
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Larg MI, Barbus E, Gabora K, Pestean C, Cheptea M, Piciu D. 18F-FDG PET/CT IN DIFFERENTIATED THYROID CARCINOMA. ACTA ENDOCRINOLOGICA-BUCHAREST 2019; 15:203-208. [PMID: 31508177 DOI: 10.4183/aeb.2019.203] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Aim Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) become an important tool in oncology by combining the metabolic information from 18F-FDG PET with the morphological information of CT. The main objective of this study was to assess the diagnostic value of PET/CT in patients with differentiated thyroid carcinoma (DTC). Material and Methods We analyzed 173 PET/CT scans of patients with DTC presenting elevated thyroglobulin (Tg) levels, negative Tg-antibodies levels, negative Iodine-131 whole-body scanning (I-131 WBS) and without any signs of clinical or other imaging technique for tumor recurrence/metastases. Results PET/CT scans were positive in 38% of cases (65/173). The sensitivity, specificity, positive predictive values and the accuracy of PET/CT imaging were 88.09%, 98.6%, 93.1% respectively 96.53%. After the PET/CT scan 29 patients underwent surgery, 24 of them continued radio-iodine therapy, 5 patients initiated tyrosine kinase inhibitors treatment and external radiotherapy. Conclusion 18F-FDG PET/CT is a valuable imaging technique which has the capability of identifying those cases of thyroid recurrence/metastases with elevated Tg levels and negative I-131 WBS. The treatment strategy was changed in 89.2% cases of positive PET/CT scans which shows us that 18F-FDG PET/CT imaging should be integrated into the follow-up programs for DTC patients.
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Affiliation(s)
- M I Larg
- "Prof. Dr. Ion Chiricuta" Oncology Institute - Nuclear Medicine Department, Cluj-Napoca, Romania.,"Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - E Barbus
- "Prof. Dr. Ion Chiricuta" Oncology Institute - Nuclear Medicine Department, Cluj-Napoca, Romania.,"Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - K Gabora
- "Prof. Dr. Ion Chiricuta" Oncology Institute - Nuclear Medicine Department, Cluj-Napoca, Romania.,"Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - C Pestean
- "Prof. Dr. Ion Chiricuta" Oncology Institute - Nuclear Medicine Department, Cluj-Napoca, Romania.,"Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - M Cheptea
- "Prof. Dr. Ion Chiricuta" Oncology Institute - Nuclear Medicine Department, Cluj-Napoca, Romania
| | - D Piciu
- "Prof. Dr. Ion Chiricuta" Oncology Institute - Nuclear Medicine Department, Cluj-Napoca, Romania.,"Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Recent Development of Nuclear Molecular Imaging in Thyroid Cancer. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2149532. [PMID: 29951528 PMCID: PMC5987314 DOI: 10.1155/2018/2149532] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 03/25/2018] [Accepted: 04/02/2018] [Indexed: 12/21/2022]
Abstract
Therapies targeting specific tumor pathways are easy to enter the clinic. To monitor molecular changes, cellular processes, and tumor microenvironment, molecular imaging is becoming the key technology for personalized medicine because of its high efficacy and low side effects. Thyroid cancer is the most common endocrine malignancy, and its theranostic radioiodine has been widely used to diagnose or treat differentiated thyroid cancer. This article summarizes recent development of molecular imaging in thyroid cancer, which may accelerate the development of personalized thyroid cancer therapy.
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Zilioli V, Peli A, Panarotto MB, Magri G, Alkraisheh A, Wiefels C, Rodella C, Giubbini R. Differentiated thyroid carcinoma: Incremental diagnostic value of 131I SPECT/CT over planar whole body scan after radioiodine therapy. Endocrine 2017; 56:551-559. [PMID: 27709475 DOI: 10.1007/s12020-016-1086-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/10/2016] [Indexed: 12/13/2022]
Abstract
The purpose of this prospective study was to determine the incremental diagnostic value of single photon emission computed tomography/computed tomography with iodine-131 over planar whole body scan in the staging of patients with differentiated thyroid carcinoma. A total of 365 patients (270 female, 95 male) with differentiated thyroid carcinoma were treated with radioiodine therapy for thyroid remnant ablation with radical intent after thyroidectomy between January 2013 and November 2014. In addition to planar whole body scan, single photon emission computed tomography/computed tomography of neck and chest were performed. Each radioactive focus at whole body scan was classified as positive or equivocal with respect of specific territories: thyroid bed, cervical lymph nodes and distant metastases.Whole-body scan detected focal uptake in 353 patients and no uptake in 12. The location was considered equivocal in 100. Single photon emission computed tomography/computed tomography detected focal uptake in 356 patients and no uptake in nine. In three patients with negative wholebody scan, single photon emission computed tomography/computed tomography provided information about residual activity in the thyroid bed. By single photon emission computed tomography/computed tomography the location was equivocal in 18 patients only. Single photon emission computed tomography/computed tomography was helpful in 82 out of 100 patients with equivocal findings by whole body scan allowing a correct identification of the uptake sites. In a great number of equivocal whole body scan, due to high remnant activity, single photon emission computed tomography/computed tomography was able to differentiate between thyroid remnant and lymph nodes uptake. In 22 out of 100 patients with doubtful whole body scan, single photon emission computed tomography/computed tomography correctly identified nodal or distant metastases, and in 2/100 patients, focal uptake classified as metastatic by whole body scan was reclassified as para-physiological by single photon emission computed tomography/computed tomography. The TNM classification changed in 13 out of 22 patients. Single photon emission computed tomography/computed tomography improves detection and localization of the iodine-131 uptake after thyroidectomy in patients with differentiated thyroid carcinoma and it is more accurate than whole body scan to evaluate lymph nodes and to identify and characterize distant metastases. Single photon emission computed tomography/computed tomography aids assessment of lower/upper stage in a significant number of patients with differentiated thyroid carcinoma and it can affect therapy decision-making and patient management.
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MESH Headings
- Adenocarcinoma, Follicular/diagnostic imaging
- Adenocarcinoma, Follicular/pathology
- Adenocarcinoma, Follicular/radiotherapy
- Adenocarcinoma, Follicular/surgery
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Papillary/diagnostic imaging
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/radiotherapy
- Carcinoma, Papillary/surgery
- Carcinoma, Papillary, Follicular/diagnostic imaging
- Carcinoma, Papillary, Follicular/pathology
- Carcinoma, Papillary, Follicular/radiotherapy
- Carcinoma, Papillary, Follicular/surgery
- Female
- Humans
- Iodine Radioisotopes/therapeutic use
- Male
- Middle Aged
- Neoplasm Staging
- Radiotherapy Dosage
- Single Photon Emission Computed Tomography Computed Tomography/methods
- Thyroid Neoplasms/diagnostic imaging
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/radiotherapy
- Thyroid Neoplasms/surgery
- Thyroidectomy
- Whole Body Imaging/methods
- Young Adult
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Affiliation(s)
- Valentina Zilioli
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Spedali Civili and University of Brescia, Brescia, Italy
| | - Alessia Peli
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Spedali Civili and University of Brescia, Brescia, Italy
| | - Maria Beatrice Panarotto
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Spedali Civili and University of Brescia, Brescia, Italy
| | - Giancarlo Magri
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Spedali Civili and University of Brescia, Brescia, Italy
| | - Ahmed Alkraisheh
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Spedali Civili and University of Brescia, Brescia, Italy
| | - Christiane Wiefels
- Chair of Nuclear Medicine, Federal Fluminense University, Rio de Janeiro, Brazil
| | - Carlo Rodella
- Medical Physics Department, Spedali Civili di Brescia, Brescia, Italy
| | - Raffaele Giubbini
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Spedali Civili and University of Brescia, Brescia, Italy.
- Chair of Nuclear Medicine, Federal Fluminense University, Rio de Janeiro, Brazil.
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Value of 18F-FDG PET negativity and Tg suppressibility as markers of prognosis in patients with elevated Tg and 131I-negative differentiated thyroid carcinoma (TENIS syndrome). Nucl Med Commun 2015; 36:1014-20. [PMID: 26049373 DOI: 10.1097/mnm.0000000000000350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIMS The aim of the study was to investigate the prognostic value of fluorine-18 fluorodeoxyglucose (18F-FDG) PET negativity and thyroglobulin (Tg) suppressibility in differentiated thyroid carcinoma patients with elevated Tg and a negative radioiodine scan. MATERIALS AND METHODS The study population was selected from thyroid cancer patients registered at a large tertiary cancer care center for management and consisted of patients with metastatic thyroid cancer with elevated Tg on follow-up, negative 131I whole-body scan and negative 18F-FDG PET/computed tomography (CT) study. Patients with thyroid carcinoma were subjected to a thyroid-stimulating hormone-stimulated assessment on the basis of a 131I whole-body scan, serum Tg level and whole-body 18F-FDG PET/CT scan for evaluation of metastatic disease burden. The same patients were subjected to a follow-up evaluation of serum Tg and whole-body 18F-FDG PET/CT scan under thyroid-stimulating hormone suppression while on thyroxine sodium. Comparison was also made between the findings of 18F-FDG PET/CT in patients demonstrating suppressible Tg. RESULTS A total of 40 (25 male and 15 female) patients were included in the study. All patients had a negative whole-body 18F-FDG PET/CT study but had stimulated Tg more than 5 ng/dl (range: 5.1-> 250 ng/ml), indicating the presence of disease. The patients demonstrated variable Tg suppressibility and were classified on the basis of the extent of Tg suppressibility (%Tg suppressibility > 90% in 21 patients; %Tg suppressibility 65-90% in 12 patients; and %Tg suppressibility < 65% in five patients; and no suppressibility in two patients). 18F-FDG PET was normal in all of these patients both on stimulation and on suppression. All patients were asymptomatic during this period. No definite correlation could be established between the status of metastasis or the histopathology and suppressibility of Tg. The average follow-up data available were for more than 3 years in 26 patients (two patients had no Tg suppressibility in this group), for 1-3 years in 10 patients and for less than 1 year in four patients. At the time of analysis in this study the patients were asymptomatic during the aforementioned follow-up periods (based upon follow-up data available). CONCLUSION In this study, we observed that 'elevated Tg but normal 18F-FDG PET' exists as a definitive entity in differentiated thyroid carcinoma. On the basis of the studied follow-up, a negative 18F-FDG PET in the setting of elevated Tg level could be regarded as a favorable prognostic indicator to predict symptom-free status during the follow-up period in this group of patients. Suppressibility of Tg (> 65%) is observed in a significant fraction of these patients, which appears to be independent of the status of metastasis or the histopathology. Also patients who show no Tg suppressibility but had a negative 18F-FDG PET/CT scan still had a better prognosis indicated by the disease-free interval in these patients as indicated in our study. Whether there exists any relation between the extent of suppressibility and their long-term outcome requires to be further examined in future prospective studies.
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Wang CY, Xiao BR, Shen MJ, Shen Y, Cui KW. 99mTcO 4- scintigraphic detection of follicular thyroid cancer and multiple metastatic lesions: A case report. Oncol Lett 2013; 6:1729-1732. [PMID: 24273606 PMCID: PMC3835315 DOI: 10.3892/ol.2013.1639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 10/16/2013] [Indexed: 11/21/2022] Open
Abstract
99mTcO4− thyroid imaging is often used to detect thyroid diseases that are confined to the neck. However, this examination is not frequently used to detect metastatic lesions of thyroid cancer in the whole body, while 131I imaging is often used to detect the metastases of differentiated thyroid cancers. The present study performed 99mTcO4− thyroid imaging for a 69-year-old patient with a thyroid nodule and incidentally identified a lesion with abnormally increased 99mTcO4− uptake in the chest of the patient. Furthermore, a whole-body scan was performed for this patient and multiple lesions with increased 99mTcO4− uptake were identified. The results confirmed that these lesions were follicular thyroid cancer and the metastatic lesions were distributed in numerous locations. The results revealed that analysis of the whole body is significant when regional lesions with abnormally increased 99mTcO4− uptake outside of thyroid tissues are identified by routine 99mTcO4− thyroid imaging.
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Affiliation(s)
- Chang-Yin Wang
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P.R. China
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7
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131I SPECT/CT: a one-station imaging modality in the management of differentiated thyroid cancer. Clin Transl Imaging 2013. [DOI: 10.1007/s40336-013-0020-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pach D, Sowa-Staszczak A, Jabrocka-Hybel A, Stefańska A, Tomaszuk M, Mikołajczak R, Janota B, Trofimiuk-Müldner M, Przybylik-Mazurek E, Hubalewska-Dydejczyk A. Glucagon-Like Peptide-1 Receptor Imaging with [Lys (40) (Ahx-HYNIC- (99 m) Tc/EDDA)NH 2 ]-Exendin-4 for the Diagnosis of Recurrence or Dissemination of Medullary Thyroid Cancer: A Preliminary Report. Int J Endocrinol 2013; 2013:384508. [PMID: 23606839 PMCID: PMC3626320 DOI: 10.1155/2013/384508] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 02/14/2013] [Accepted: 03/13/2013] [Indexed: 12/21/2022] Open
Abstract
Introduction. Epidemiological studies on medullary thyroid cancer (MTC) have shown that neither a change in stage at diagnosis nor improvement in survival has occurred during the past 30 years. In patients with detectable serum calcitonin and no clinically apparent disease, a careful search for local recurrence, and nodal or distant metastases, should be performed. Conventional imaging modalities will not show any disease until basal serum calcitonin is at least 150 pg/mL. The objective of the study was to present the first experience with labelled glucagon-like peptide-1 (GLP-1) analogue [Lys(40)(Ahx-HYNIC-(99m)Tc/EDDA)NH2]-exendin-4 in the visualisation of MTC in humans. Material and Method. Four patients aged 22-74 years (two with sporadic and two with MEN2 syndrome-related disseminated MTC) were enrolled in the study. In all patients, GLP-1 receptor imaging was performed. Results. High-quality images were obtained in all patients. All previously known MTC lesions have been confirmed in GLP-1 scintigraphy. Moreover, one additional liver lesion was detected in sporadic MTC male patient. Conclusions. GLP-1 receptor imaging with [Lys(40)(Ahx-HYNIC-(99m)Tc/EDDA)NH2]-exendin-4 is able to detect MTC lesions. GLP-1 scintigraphy can serve as a confirmatory test in MTC patients, in whom other imaging procedures are inconsistent.
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Affiliation(s)
- D. Pach
- Department of Endocrinology, Jagiellonian University Medical College, Kopernika 17, 31-501 Krakow, Poland
| | - A. Sowa-Staszczak
- Department of Endocrinology, Jagiellonian University Medical College, Kopernika 17, 31-501 Krakow, Poland
| | - A. Jabrocka-Hybel
- Department of Endocrinology, Jagiellonian University Medical College, Kopernika 17, 31-501 Krakow, Poland
| | - A. Stefańska
- Department of Endocrinology, Jagiellonian University Medical College, Kopernika 17, 31-501 Krakow, Poland
| | - M. Tomaszuk
- Department of Endocrinology, Jagiellonian University Medical College, Kopernika 17, 31-501 Krakow, Poland
| | - R. Mikołajczak
- Radioisotope Center POLATOM, National Centre for Nuclear Research, 05-400 Otwock, Poland
| | - B. Janota
- Radioisotope Center POLATOM, National Centre for Nuclear Research, 05-400 Otwock, Poland
| | - M. Trofimiuk-Müldner
- Department of Endocrinology, Jagiellonian University Medical College, Kopernika 17, 31-501 Krakow, Poland
| | - E. Przybylik-Mazurek
- Department of Endocrinology, Jagiellonian University Medical College, Kopernika 17, 31-501 Krakow, Poland
| | - A. Hubalewska-Dydejczyk
- Department of Endocrinology, Jagiellonian University Medical College, Kopernika 17, 31-501 Krakow, Poland
- *A. Hubalewska-Dydejczyk:
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Hasbek Z, Turgut B, Erselcan T, Koyuncu A, Fatih Börksüz M, Turgut NH, Yumuk F. The Evaluation of Microcarcinoma in Differentiated Thyroid Cancers According to Old and New TNM Classification. Mol Imaging Radionucl Ther 2011; 20:94-9. [PMID: 23486990 PMCID: PMC3590954 DOI: 10.4274/mirt.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 10/24/2011] [Indexed: 12/01/2022] Open
Abstract
Objective: In this study, we aimed to evaluate the tumor size for proximal and distant metastases when the new and old TNM classification is taken into account in differentiated thyroid cancers. Material and Methods: Two hundred sixty eight patients diagnosed with thyroid carcinoma, undergoing bilateral total or subtotal thyroidectomy treated with high doses of I-131 were examined retrospectively. The data of these patients were compared after classification, according to tumor size <1 cm and <2 cm, lymph node metastases thyroid and tumor capsule invasion at the time of diagnosis, and accumulation of abnormal activity in post I-131 treatment whole-body scan. I-131 uptakes besides physiological and thyroid bed were considered as abnormal activity uptakes. Results: A total of 268 patients with average age of 19-82 yrs (mean: 47.0±13.8 yrs) were included in the study. At postoperative histopathological evaluation, 228 (85.1%) of patients were reported as papillary, 13 (4.9%) as follicular, 23 (8.6%) as well differentiated tumor of unknown malignant potential, 2 (0.7%) as insular and 2 (0.7%) as Hürthle-cell carcinoma. In patients with known tumor size, 96 of 207 (46.4%) patients' tumor size was <1 cm and in 111 (53.6%) >1 cm. In the same group, according to the revised TNM classification, in 149 of 207 patients (72%) the tumor size was <2 cm, whereas in 58 (28%) >2 cm. Of 187 patients with negative lymph nodes, 15 (8%) showed abnormal activity accumulation in the first post I-131 treatment whole-body scan and 10 (40% of 25 patients) positive lymph node (p<0.05) involvement. Conclusion: Since the treatment of patients with microcarcinoma is controversial, tumor size should not be the only factor considered in patients with differentiated thyroid cancer Tissue tumor invasion, age, gender and multifocality should also be taken into account. Conflict of interest:None declared.
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Affiliation(s)
- Zekiye Hasbek
- Cumhuriyet University, School of Medicine, Department of Nuclear Medicine, Sivas, Turkey
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The Relevance of PET in Diagnostic Oncology. Clin Nucl Med 2008. [DOI: 10.1007/978-3-540-28026-2_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Taeymans O, Peremans K, Saunders J. Thyroid Imaging in the Dog: Current Status and Future Directions. J Vet Intern Med 2007. [DOI: 10.1111/j.1939-1676.2007.tb03008.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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12
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Kohlfuerst S, Igerc I, Gallowitsch HJ, Gomez I, Kresnik E, Matschnig S, Lind P. Is there a role for sandostatin treatment in patients with progressive thyroid cancer and iodine-negative but somatostatin-receptor-positive metastases? Thyroid 2006; 16:1113-9. [PMID: 17123338 DOI: 10.1089/thy.2006.16.1113] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The aim of our study was to determine whether treatment with a long-acting somatostatin-receptor analogue is effective in patients with (131)I-negative but somatostatin-receptor-positive metastases from dedifferentiated and anaplastic thyroid cancer. MATERIALS AND METHODS Twelve patients were screened for the study. All of them showed progressive disease confirmed by radiologic evaluation, increasing serum thyroglobulin (Tg), and negative diagnostic or posttherapeutic (131)I whole-body scans (WBS). Eight of 12 patients (4 males and 4 females; age range, 57-89 years; 1 papillary thyroid cancer; 4 poorly differentiated follicular thyroid cancer; 1 follicular and anaplastic thyroid cancer; 2 anaplastic thyroid cancer) showed positive somatosatin-receptor expression in Tc-99m depreotide WBS/SPECT (Tc-99m Dep.WBS). Initially, in all patients fluorine-18 2-fluoro-2- D-glucose-positron emission tomography-computed tomography ((18)F-FDG-PET-CT), Tc-99m Dep.WBS, and Tg measurements were performed. In the case of positive receptor scintigraphy, patients were treated with 20mg Sandostatin LAR (Novartis Pharmaceuticals, Basel, Switzerland) once per month intramuscularly over a period of 6 months followed by repeated (18)F-FDG-PET-CT, Tc-99m Dep.WBS, and Tg measurement to determine metabolic activity and tumor size. In case of tumor progression, the dose was increased to 30mg of Sandostatin LAR once per month. RESULTS Only 3 patients were able to undergo long-term treatment. Two patients were treated with octreotide long-acting release (LAR) for 1 year and 1 patient for 1(1/2) years. All patients showed progressive disease during the treatment: an increase of serum Tg on one hand and an increase in the number of lesions and extent in tumor size visible on FDG-PET-CT and Tc-99m Dep.WBS on the other. During the treatment there was no change in receptor expression, nevertheless, clear tumor progression under therapy with a somatostatin analogue was visible in FDG-PET-CT and in Tc-99m Dep.WBS. CONCLUSION Our data demonstrate that all of our patients treated with a somatostatin analogue showed clinical progression and that our attempt to achieve a stabilization of the disease failed.
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MESH Headings
- Adenocarcinoma, Follicular/diagnostic imaging
- Adenocarcinoma, Follicular/drug therapy
- Adenocarcinoma, Follicular/secondary
- Aged
- Aged, 80 and over
- Antineoplastic Agents, Hormonal/administration & dosage
- Antineoplastic Agents, Hormonal/adverse effects
- Carcinoma/diagnostic imaging
- Carcinoma/drug therapy
- Carcinoma/secondary
- Carcinoma, Papillary/diagnostic imaging
- Carcinoma, Papillary/drug therapy
- Carcinoma, Papillary/secondary
- Female
- Fluorodeoxyglucose F18
- Humans
- Iodine Radioisotopes
- Male
- Middle Aged
- Octreotide/administration & dosage
- Octreotide/adverse effects
- Organotechnetium Compounds
- Radiopharmaceuticals
- Receptors, Somatostatin/metabolism
- Somatostatin/analogs & derivatives
- Thyroid Neoplasms/diagnostic imaging
- Thyroid Neoplasms/drug therapy
- Thyroid Neoplasms/pathology
- Tomography, Emission-Computed, Single-Photon
- Treatment Failure
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Affiliation(s)
- Susanne Kohlfuerst
- Department of Nuclear Medicine, and Endocrinology, PET-CT Center Klagenfurt, LKH Klagenfurt, Klagenfurt, Austria.
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Phitayakorn R, McHenry CR. Follicular and Hürthle cell carcinoma of the thyroid gland. Surg Oncol Clin N Am 2006; 15:603-23, ix-x. [PMID: 16882500 DOI: 10.1016/j.soc.2006.05.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Follicular and Hürthle cell carcinoma of the thyroid gland are uncommon tumors that are genotypically similar. Current and future diagnostic adjuncts, treatment, and postoperative follow-up for patients with follicular and Hürthle cell cancer are outlined. Risk factors for recurrence and mortality and the reported outcomes of treatment of follicular and Hürthle cell carcinoma are reviewed.
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Affiliation(s)
- Roy Phitayakorn
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
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Fattori B, Grosso M, Nacci A, Bianchi F, Cosottini M, Ursino F, Manca G, Rubello D, Strauss HW, Mariani G. The role of 99mTc-tetrofosmin scintigraphy for staging patients with laryngeal cancer. Cancer Biother Radiopharm 2005; 20:27-35. [PMID: 15778576 DOI: 10.1089/cbr.2005.20.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Diagnosis and staging of laryngeal cancer is currently based on physical examination, endoscopy, and imaging techniques such as computed tomography (CT) and/or magnetic resonance (MR) and histology. While imaging techniques have a pivotal role for defining the size of the primary tumor, they are less accurate for defining metastatic involvement of regional lymph nodes, especially if lymph nodes are smaller than 10-15 mm. The aim of this study was to comparatively assess the relevance of (99m)Tc-tetrofosmin scintigraphy for the staging of laryngeal tumors versus the CT scan. We evaluated the sensitivity of imaging with (99m)Tc-tetrofosmin in 28 consecutively enrolled patients with squamous cell laryngeal carcinoma. Total-body scintigraphy with 99mTc-tetrofosmin was performed preoperatively, and the results were compared to CT images of the neck and mediastinum. CT and (99m)Tc-tetrofosmin scintigraphy were equally sensitive (96%) in identifying the primary tumor. While CT was more sensitive for detecting metastatic lymph nodes (100% versus 50%), (99m)Tc-tetrofosmin scintigraphy was more specific (100% versus 56%; p < 0.04). The overall diagnostic capabilities of the two techniques for detecting lymph node metastases were comparable (Youden Index: J = 0.56 for CT and J = 0.50 for (99m)Tc-tetrofosmin scintigraphy). (99m)Tc-tetrofosmin scintigraphy is a useful complement to CT for staging laryngeal tumors, especially for detecting metastatic lymph nodes and distant metastases.
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Affiliation(s)
- Bruno Fattori
- Ear, Nose and Throat Unit, Department of Neurosciences, University of Pisa Medical School, Pisa, Italy
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Rosário PWS, Maia FCP, Barroso AL, Purisch S. Abordagem dos pacientes com carcinoma diferenciado de tireóide com tireoglobulina sérica elevada e pesquisa de corpo inteiro negativa. ACTA ACUST UNITED AC 2005; 49:246-52. [PMID: 16184253 DOI: 10.1590/s0004-27302005000200011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
No seguimento do carcinoma diferenciado de tireóide (CDT), o achado de tireoglobulina (Tg) elevada e pesquisa de corpo inteiro (PCI) diagnóstica negativa não é incomum. Em 12% dos nossos pacientes tratados com tireoidectomia e radioiodo com Tg >10ng/ml em hipotireoidismo apresentou PCI diagnóstica negativa. Este achado geralmente indica resultado falso-negativo da PCI. Devem ser excluídos exposição inadequada ao excesso de iodo e elevação insuficiente do TSH. Micrometástases que não captam o suficiente para serem detectadas com baixa atividade de radioiodo e perda da capacidade de expressar o simportador sódio/iodeto (NIS) também explicam alguns casos. Em pacientes com Tg elevada, metástases podem ser reveladas após uma dose terapêutica de radioiodo (100mCi ou mais), estando esta indicada nos casos com Tg maior que 10ng/ml em hipotireoidismo ou 5ng/ml com TSH recombinante, após exclusão de macrometástases pulmonares e cervicais. Cinco de 7 pacientes com estes critérios apresentaram captação ectópica na PCI pós-dose em nossa série. Se a PCI pós-dose for negativa ou revelar captação discreta em leito tireoidiano, outros métodos, por exemplo FDG-PET, podem ser utilizados, não se insisitindo na radioiodoterapia. Para estes casos, outras modalidades terapêuticas (cirurgia, radioterapia, quimioterapia, ácido retinóico) podem ser utilizadas. Se a PCI revelar metástases linfonodais, cirurgia é a terapia mais adequada; enquanto para metástases pulmonares difusas indica-se a radioiodoterapia até a negativação da PCI pós-dose ou normalização da Tg com TSH elevado. Pacientes com PCI pós-dose positiva podem apresentar redução significativa da Tg e até remissão completa com radioidodoterapia em alguns casos, mas o impacto deste tratamento na mortalidade permanece indefinido.
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Affiliation(s)
- Pedro Weslley S Rosário
- Departamento de Tireóide, Serviço de Endocrinologia e Metabologia, Serviço de Medicina Nuclear, Santa Casa de Belo Horizonte, MG.
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Rosário PWSD, Barroso AL, Padrão EL, Rezende LL, Cardoso LD, Purisch S. Manifestações clínicas e diagnóstico de metástases distantes de carcinoma diferenciado de tireóide após a terapia inicial. ACTA ACUST UNITED AC 2004; 48:861-6. [PMID: 15761561 DOI: 10.1590/s0004-27302004000600013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Avaliamos 58 pacientes com metástases distantes de carcinoma de tireóide diagnosticadas após a terapia inicial. Metástases linfonodais na apresentação inicial foram verificadas em 65%. Todas as metástases linfonodais, 90% das pulmonares e apenas 25% das metástases ósseas eram assintomáticas. Radiografia revelou metástases líticas em todos os casos com acometimento ósseo; foi normal em 39,6%, mostrou micrometástases em 34,5% e macrometástases em 25,8% nos pacientes com doença pulmonar. A tireoglobulina (Tg) em uso de tiroxina foi detectável (> 1ng/ml) em todos sem anticorpos anti-tireoglobulina (TgAb), > 5ng/ml em 90% e > 10ng/ml em 80% e, após a suspensão da terapia, > 5ng/ml em 100% e > 10ng/ml em 94%. Nos pacientes com TgAb (13,8%), Tg foi indetectável em metade. Varredura diagnóstica com 5mCi de iodo 131 foi positiva em 83% e 77,6% dos pacientes com metástases ósseas e pulmonares, respectivamente e após dose ablativa, a sensibilidade foi de 100 e 93%. Dos pacientes com varredura diagnóstica negativa, 85% tinham metástases pulmonares visíveis na radiografia. Concluímos que a Tg é o método mais sensível, seguro e de menor custo no seguimento de câncer diferenciado de tireóide, e reforçamos a administração direta de uma dose ablativa de radioiodo com realização de varredura pós-dose quando a Tg estiver elevada.
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AL-Nahhas A. Dedifferentiated thyroid carcinoma: the imaging role of 18F-FDG PET and non-iodine radiopharmaceuticals. Nucl Med Commun 2004; 25:891-5. [PMID: 15319593 DOI: 10.1097/00006231-200409000-00005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Adil AL-Nahhas
- Department of Nuclear Medicine, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK.
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Rosário PWS, Cardoso LD, Fagundes TA, Barroso AL, Padrão EL, Rezende LL, Purisch S. Revisitando a tireoglobulina sérica no seguimento de pacientes com carcinoma diferenciado de tireóide. ACTA ACUST UNITED AC 2004; 48:480-6. [PMID: 15761510 DOI: 10.1590/s0004-27302004000400007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Este estudo avaliou a tireoglobulina (Tg) sérica dosada em hipotireoidismo em 207 pacientes com carcinoma diferenciado de tireóide tratados com tireoidectomia total e ablação com radioiodo e anticorpos anti-Tg indetectáveis. O estadiamento da doença foi definido pelo exame clínico, Tg estimulada, varredura com radioiodo pré e/ou pós-terapia ablativa e outros métodos de imagem (RX, US, TC e varredura com sestamibi). O intervalo médio desde a terapia inicial foi de 2,3 anos. Dos pacientes, 153 (74%) não apresentavam doença evidente, 34 (16,4%) tinham metástases (Mt) cervicais ou mediastinais e 20 (9,6%) Mt distantes. O valor de 1ng/ml da Tg foi o que melhor discriminou pacientes com e sem doença aparente, com 100% de sensibilidade para Mt distantes, 88,2% para doença em leito tireoidiano ou linfonodos e especificidade de 88,8% para Mt de qualquer natureza, e 74,8% considerando apenas Mt distantes. Dos pacientes com Tg <1ng/ml, 2,8% apresentavam Mt cervicais. Doença cervical ou mediastinal representou 26% dos casos com valores de Tg entre 1 e 5ng/ml. Tg entre 5 e 10ng/ml foi associada a Mt distantes em 14,2% dos casos, os demais apresentavam Mt linfonodais. Mt distantes foram diagnosticadas em 51,3% dos pacientes com Tg >10ng/ml. Sugerimos a necessidade de US cervical mesmo em pacientes com Tg <1ng/ml; que pacientes com Tg <5ng/ml sejam investigados apenas com US cervical e TC de mediastino; e que a terapia empírica fique reservada aos casos com Tg no mínimo >5ng/ml.
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Affiliation(s)
- Pedro Weslley S Rosário
- Departamento de Tireóide, Serviço de Endocrinologia e Metabologia, Santa Casa de Belo Horizonte, Belo Horizonte, MG.
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Abstract
This review aims at fostering comprehension and knowledge not only for expert physicians who can skillfully handle various techniques for tumor imaging but also for young practitioners in the field of nuclear medicine. As image processing software and hardware become smaller, faster and better, SPECT will adapt and incorporate these advances. A principal advantage of SPECT over PET is the more widespread availability of the equipment and lower cost for the introduction of the system in community-based facilities. Moreover, SPECT has become less dependent on a limited number of acknowledged experts for its interpretation owing to a variety of handy computer tools for imaging analyses. The increasing use of PET in tumor imaging is not necessarily proportional to the decline of SPECT. General physicians' attention to SPECT technology would also increase more by evoking their interest in "tracer imaging."
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Affiliation(s)
- Mitsutaka Fukumoto
- Department of Tumor Radiology, Program of Tumor Biology and Regulation, Kochi Medical School, Kochi University, Nankoku, Japan
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Mackenzie EJ, Mortimer RH. 6: Thyroid nodules and thyroid cancer. Med J Aust 2004; 180:242-7. [PMID: 14984346 DOI: 10.5694/j.1326-5377.2004.tb05894.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2003] [Accepted: 01/14/2004] [Indexed: 11/17/2022]
Abstract
Thyroid nodules are common clinically (prevalence, about 5%) and even more common on ultrasound examination (about 25%). About 5% of thyroid nodules are malignant. Most thyroid cancers are well-differentiated papillary or follicular tumours with an excellent prognosis (10-year survival, 80%-95%). The incidence of papillary thyroid cancer appears to be increasing on the east coast of Australia. Fine-needle aspiration biopsy of the thyroid is the most cost-effective diagnostic tool. Recommended initial management of all follicular carcinomas and of papillary carcinomas > 1.0 cm is total thyroidectomy followed by radioiodine ablation. Most patients should be managed postoperatively with doses of thyroid hormone sufficient to suppress plasma levels of thyroid-stimulating hormone. Recurrences can occur many years after initial therapy, and follow-up should be lifelong. Thyroid nodules are very common, but have a relatively low risk of malignancy
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Affiliation(s)
- Emily J Mackenzie
- Department of Endocrinology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
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Wu HS, Liu FY, Huang WS, Liu YC, Chang CT, Kao CH. Technetium-99m Tetrofosmin Single Photon Emission Computed Tomography to Detect Metastatic Papillary Thyroid Carcinoma in Patients with Elevated Human Serum Thyroglobulin Levels but Negative I-131 Whole Body Scan. Clin Radiol 2003; 58:787-90. [PMID: 14521888 DOI: 10.1016/s0009-9260(03)00256-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM The aim of this study was to evaluate the effectiveness of technetium-99m tetrofosmin (Tc-99m TF) single photon emission computed tomography (SPECT) of the neck and chest to detect metastatic lesions in papillary thyroid carcinoma (PTC) after near total thyroidectomy and radioiodine (I-131) treatment in patients who present with elevated serum human thyroglobulin (hTg) levels but negative I-131 whole body scan (WBS). MATERIALS AND METHODS Twenty patients with PTC treated by near total thyroidectomy and I-131 treatments were included in this study. All 20 patients had negative I-131 WBS results and elevated hTg levels (hTg 2.0 microIU/ml) under thyroid-stimulating hormone (TSH) stimulation (TSH 30 microIU/ml). Nineteen of the 20 cases were confirmed to have metastases by operation/biopsy histopathological findings or clinical follow-up longer than 1 year by additional morphological imaging techniques. The remaining patient has been followed up closely and has been disease free for 10 months. Tc-99m TF SPECT was performed to detect metastatic lesions. RESULTS Tc-99m TF SPECT demonstrated lesions in 11/19 patients; a sensitivity of 57.9%. Tc-99m TF SPECT failed to demonstrate lesions in eight patients including smaller lymph nodes and miliary lung metastases. CONCLUSIONS We conclude that Tc-99m TF SPECT is a useful additional tool to detect metastatic lesions in PTC with elevated hTg but negative I-131 WBS. However, smaller lymph nodes and miliary lung metastases may be missed.
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Affiliation(s)
- H-S Wu
- Department of Surgery, Show Chwan Memorial Hospital, Changhua, Taiwan, ROC
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Chen YK, Liu FY, Yen RF, Kao CH. Compare FDG-PET and Tc-99m tetrofosmin SPECT to detect metastatic thyroid carcinoma. Acad Radiol 2003; 10:835-9. [PMID: 12945916 DOI: 10.1016/s1076-6332(03)00014-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES The effectiveness of 18-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) and technetium-99m tetrofosmin (Tc-99m TF) single photon emission computed tomography (SPECT) of neck and chest was evaluated to detect metastatic lesions in well-differentiated thyroid carcinoma after nearly total thyroidectomy and radioiodine (I-131) treatment who present with elevated serum human thyroglobulin levels but negative I-131 whole body scan. MATERIALS AND METHODS Twenty-three patients with differentiated thyroid carcinoma who underwent nearly total thyroidectomy and I-131 treatments were included in this study. RESULTS All of the 23 patients had negative I-131 whole body scan and elevated human thyroglobulin levels under thyroid-stimulating hormone stimulation. Metastatic lesions were detected by FDG-PET in 20 patients, while Tc-99m TF SPECT revealed metastatic lesions in only 11 of the 20 patients. Both FDG-PET and Tc-99m TF SPECT failed to demonstrate miliary pulmonary metastases in two of the remaining three patients. The other patient did not show any lesion on FDG-PET, Tc-99m TF SPECT, chest computed tomography, or other imaging techniques. CONCLUSION This study demonstrated that FDG-PET is more sensitive than Tc-99m TF SPECT to detect metastatic lesions in differentiated thyroid carcinoma with elevated human thyroglobulin but negative I-131 whole body scan. However, miliary pulmonary metastases could be missed by the both techniques.
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Affiliation(s)
- Yen-Kung Chen
- Department of Nuclear Medicine, PET Center, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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Sarlis NJ, Gourgiotis L, Guthrie LC, Galen B, Skarulis MC, Shawker TH, Patronas NJ, Reynolds JC. In-111 DTPA-octreotide scintigraphy for disease detection in metastatic thyroid cancer: comparison with F-18 FDG positron emission tomography and extensive conventional radiographic imaging. Clin Nucl Med 2003; 28:208-17. [PMID: 12592128 DOI: 10.1097/01.rlu.0000053409.18088.46] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The utility of In-111 DTPA octreotide scintigraphy (SRS) for disease detection in patients with metastatic thyroid carcinoma (TCA) remains controversial. The authors compared the sensitivity of In-111-based SRS, F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET), and extensive conventional radiographic imaging (CRI) in this type of cancer. METHODS SRS, FDG PET, and CRI were performed concurrently in 21 patients (age, 56.4 +/- 12.9 years) who had aggressive TCA. Concordance rates % of lesion positivity among pairs of different techniques (A and B) were calculated as the ratio of the number of lesions positive with both techniques divided by the sum of the total number of lesions positive with technique A + total number of lesions positive with technique B, which was then multiplied by 200. RESULTS The combined use of CRI, FDG PET, and SRS resulted in the detection of 105 lesions, presumed to be due to metastatic deposits. Sensitivities for SRS and FDG-PET imaging were 49.5% and 67.6%, respectively. The lesion detection concordance rates were as follows: CRI versus FDG PET, 80.8%; CRI versus SRS, 74.2%; and FDG-PET versus SRS, 58.6%. Importantly, SRS detected five unexpected lesions, which were negative by both CRI and FDG-PET imaging. In two representative patients, a positive correlation (Spearman's rank = 0.71; = 0.0576) existed between the percentage of lesional In-111 DTPA octreotide uptake and the standard uptake value in eight concordant lesions. CONCLUSION Although SRS has only moderate sensitivity for disease detection in metastatic TCA, sometimes it can reveal lesions that otherwise would be undetectable by either CRI or FDG-PET imaging.
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Affiliation(s)
- Nicholas J Sarlis
- Division of Intramural Research, National Institutes of Diabetes, Bethesda, Maryland, USA.
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Bentley AA, Gillespie C, Malis D. Evaluation and management of a solitary thyroid nodule in a child. Otolaryngol Clin North Am 2003; 36:117-28. [PMID: 12803013 DOI: 10.1016/s0030-6665(02)00131-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Although an uncommon clinical entity, a pediatric patient with a solitary thyroid nodule requires a thorough assessment because of the increased incidence of thyroid carcinoma in this population. In the future, one may expect the widespread clinical use of genetic markers in identifying children, who are at risk for, or who have developed, thyroid carcinomas, with the hopes that these molecular markers will lead to the prevention, or earlier detection and cure, of these malignancies.
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MESH Headings
- Adenocarcinoma, Follicular/etiology
- Adenocarcinoma, Follicular/pathology
- Adenocarcinoma, Follicular/therapy
- Adenocarcinoma, Papillary/etiology
- Adenocarcinoma, Papillary/pathology
- Adenocarcinoma, Papillary/therapy
- Adolescent
- Carcinoma, Medullary/etiology
- Carcinoma, Medullary/pathology
- Carcinoma, Medullary/therapy
- Child
- Child, Preschool
- Humans
- Neoplasms, Radiation-Induced/epidemiology
- Neoplasms, Radiation-Induced/therapy
- Population Surveillance
- Thyroid Neoplasms/etiology
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/therapy
- Thyroid Nodule/diagnosis
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Affiliation(s)
- Anthony A Bentley
- Otolaryngology-Head and Neck Surgery Service, MCHL-SE, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Washington, DC 20307-5001, USA
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Karwowski JK, Jeffrey RB, McDougall IR, Weigel RJ. Intraoperative ultrasonography improves identification of recurrent thyroid cancer. Surgery 2002; 132:924-8; discussion 928-9. [PMID: 12490837 DOI: 10.1067/msy.2002.128478] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Surgical resection is the only curative treatment option for locoregional recurrence of well-differentiated thyroid cancer that does not trap radioiodine. We hypothesized that intraoperative ultrasonography would aid in the localization of recurrent thyroid cancer and would enhance the ability to perform a complete resection. METHODS Between June 2000 and October 2001, 13 patients with recurrent, scan-negative, papillary thyroid cancer were explored by using intraoperative ultrasonography. RESULTS All patients had identification and resection of recurrent papillary thyroid cancer. Eleven patients had a complete resection, and 2 patients had incomplete resection as a result of local invasion. Ultrasound was required for identification of tumor in 7 patients and included all patients with a history of external beam radiotherapy. In 6 of these 7 patients, the tumor was paratracheal or invasive into the trachea or thyroid cartilage. In 11 patients with detectable serum thyroglobulin preoperatively, the level demonstrated a decline in 10 patients and became undetectable in 7 patients. CONCLUSIONS Intraoperative ultrasonography is a useful method to identify nonpalpable, locoregional recurrences of thyroid cancer. Ultrasound was particularly helpful in patients who had previous external beam radiotherapy and in the identification of tumor nodules of 20 mm or less that were invasive or adherent to the airway.
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Affiliation(s)
- John K Karwowski
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
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Haugen BR, Ridgway EC, McLaughlin BA, McDermott MT. Clinical comparison of whole-body radioiodine scan and serum thyroglobulin after stimulation with recombinant human thyrotropin. Thyroid 2002; 12:37-43. [PMID: 11838729 DOI: 10.1089/105072502753451959] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Sensitive monitoring for thyroid cancer recurrence or persistence includes whole-body radioiodine scanning (WBS) and measurement of serum thyroglobulin (Tg) after endogenous or exogenous thyrotropin (TSH) stimulation. We reviewed our experience using recombinant human thyrotropin (rhTSH) in 83 patients to compare the clinical relevance of a positive WBS and/or Tg. Ten patients had a positive WBS; eight of these patients had activity limited to the thyroid bed. rhTSH-stimulated Tg was 2 ng/mL or more in 25 and 5 ng/mL or more in 13 patients. Of the patients with a negative WBS, 11 of 20 patients with a Tg 2 ng/mL or more and 7 of 9 patients with a Tg 5 ng/mL or more received therapy or further evaluation based on the Tg alone. Conversely, only 1 of 5 patients with a serum Tg less than 2 ng/mL received therapy or further evaluation based on a positive WBS alone. Three of the patients who did not receive therapy or further evaluation, had subsequent negative WBS 10-12 months later, suggesting lack of clinically significant disease. Twenty patients had a negative WBS and serum Tg 2 ng/mL or more. Eleven of 20 patients had a Tg less than 5 ng/mL and 4 of these patients had further evaluation with a neck ultrasound. One patient had a biopsy-proven recurrence (rhTSH-stimulated Tg 4 ng/mL). Subsequent evaluations (> or = 6 months later) have been negative for 8 patients. Of the nine patients with a Tg 5 ng/mL or more and a negative WBS, 7 had further evaluation and 6 of 7 had identified disease. In summary, rhTSH-stimulated WBS and Tg are complementary, but Tg is a more sensitive indicator of disease recurrence or persistence. In our practice, an rhTSH-stimulated Tg greater than 4-5 ng/mL often resulted in further evaluation, while a Tg less than 4 ng/mL rarely resulted in further immediate evaluation.
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Affiliation(s)
- Bryan R Haugen
- Department of Medicine, Division of Endocrinology, University of Colorado Health Sciences Center, Denver, USA.
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