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Ora M, Nazar AH, Pradhan PK, Mishra P, Barai S, Arya A, Dixit M, Parashar A, Gambhir S. The Utility of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Differentiated Thyroid Cancer Patients with Biochemical Recurrence and Negative Whole-Body Radioiodine Scintigraphy and Evaluation of the Possible Role of a Limited Regional Scan. Indian J Nucl Med 2020; 35:203-209. [PMID: 33082675 PMCID: PMC7537939 DOI: 10.4103/ijnm.ijnm_5_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/09/2020] [Accepted: 03/12/2020] [Indexed: 11/04/2022] Open
Abstract
Purpose of the Study 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is used in the management of recurrent differentiated thyroid cancer (DTC) patients presented with rising thyroglobulin (Tg) or anti-Tg antibody (Atg) levels and negative whole-body I-131 scan (WBS). We aimed to evaluate the utility of regional or limited PET/CT in a large population preset with variable Tg/(ATg) levels. Materials and Methods In a retrospective study, we analyzed 137 PET/CT done on DTC patients presented with raised Tg/Atg and negative WBS. Retrospective evaluation of other available clinical information was done. Results One hundred and thirty-seven patients aged 8-72 years (41 ± 17.7 years) were included in the study. Eighty-nine (64.9%) patients had positive findings on 18F-FDG PET-CT. It included thyroid bed recurrence, cervical, mediastinal lymphadenopathy, lung, and bone lesions. In addition, 36 patients had metabolically inactive lung nodules detected on CT. Serum Tg and female sex were the only predictors for a positive PET scan. In most (97.1%) of the patients, the disease was limited to the neck and thoracic region. Conclusions PET/CT is an excellent imaging modality for evaluating DTC patients presented with biochemical recurrence. It not only finds the disease in more than 80% of the patients but also detects distant metastatic disease, which precludes regional therapies. Lesions were noted mostly in the neck and thoracic region with very few distant skeletal metastases (4/137 patients). In most of the patients, routine vertex to mid-thigh imaging could be avoided.
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Affiliation(s)
- Manish Ora
- Department of Nuclear Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Aftab Hasan Nazar
- Department of Nuclear Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | | | - Prabhakar Mishra
- Department of Biostatistics and Health Informatics, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Sukanta Barai
- Department of Nuclear Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Amitabh Arya
- Department of Nuclear Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Manish Dixit
- Department of Nuclear Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Ashutosh Parashar
- Department of Nuclear Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Sanjay Gambhir
- Department of Nuclear Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
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Haslerud T, Brauckhoff K, Reisæter L, Küfner Lein R, Heinecke A, Varhaug JE, Biermann M. F18-FDG-PET for recurrent differentiated thyroid cancer: a systematic meta-analysis. Acta Radiol 2016; 57:1193-200. [PMID: 26163534 PMCID: PMC5015757 DOI: 10.1177/0284185115594645] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 06/14/2015] [Indexed: 12/05/2022]
Abstract
Background Positron emission tomography (PET) with fluor-18-deoxy-glucose (FDG) is widely used for diagnosing recurrent or metastatic disease in patients with differentiated thyroid cancer (DTC). Purpose To assess the diagnostic accuracy of FDG-PET for DTC in patients after ablative therapy. Material and Methods A systematic search was conducted in Medline/PubMed, EMBASE, Cochrane Library, Web of Science, and Open Grey looking for all English-language original articles on the performance of FDG-PET in series of at least 20 patients with DTC having undergone ablative therapy including total thyroidectomy. Diagnostic performance measures were pooled using Reitsma’s bivariate model. Results Thirty-four publications between 1996 and 2014 met the inclusion criteria. Pooled sensitivity and specificity were 79.4% (95% confidence interval [CI], 73.9–84.1) and 79.4% (95% CI, 71.2–85.4), respectively, with an area under the curve of 0.858. Conclusion F18-FDG-PET is a useful method for detecting recurrent DTC in patients having undergone ablative therapy.
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Affiliation(s)
- Torjan Haslerud
- Nuclear Medicine/PET-Center, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Katrin Brauckhoff
- Section for Endocrine Surgery, Haukeland University Hospital, Bergen, Norway
| | - Lars Reisæter
- Section for Oncological Imaging, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | | | - Achim Heinecke
- Institute of Biostatistics and Clinical Research, University of Münster, Münster/Germany
| | - Jan Erik Varhaug
- Section for Oncological Imaging, Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen/Norway
| | - Martin Biermann
- Nuclear Medicine/PET-Center, Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen/Norway
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Clinical Usefulness of F-18 FDG PET/CT in Papillary Thyroid Cancer with Negative Radioiodine Scan and Elevated Thyroglobulin Level or Positive Anti-thyroglobulin Antibody. Nucl Med Mol Imaging 2015; 50:130-6. [PMID: 27275361 DOI: 10.1007/s13139-015-0378-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 09/16/2015] [Accepted: 10/02/2015] [Indexed: 10/22/2022] Open
Abstract
PURPOSE Elevated thyroglobulin (Tg) levels, along with a negative radioiodine scan, present a clinical problem for the diagnosis of recurrence in papillary thyroid cancer (PTC) patients. The purpose of this study was to assess (1) the usefulness of (18)F-fluorodeoxyglucose (F-18 FDG) positron emission tomography (PET)/computed tomography (CT) for PTC patients with negative diagnostic radioiodine scan and elevated serum Tg level or positive anti-thyroglobulin antibody (TgAb), and (2) the effect of endogenous thyroid stimulating hormone (TSH) stimulation (ETS) on detecting recurrence in these circumstances. METHODS Eighty-four patients with negative diagnostic radioiodine scan and elevated serum Tg or positive TgAb under ETS were included. Correlation with clinicopathological features and recurrence, detectability of FDG PET/CT and cut-off value of serum Tg for recurrence in PTC patients with these circumstance were assessed. In addition, detectability of F-18 FDG PET/CT under ETS and suppression were compared. RESULTS In Cox regression analysis, only serum Tg level was significantly associated with recurrence (P < 0.001, HR = 1.13; 95 % CI, 1.061-1.208). The cut-off level of Tg was 21.5 ng/mL (AUC, 0.919; P < 0.001) for discriminating the recurrence in the patients with positive PET/CT finding. The sensitivity, specificity, PPV, NPV, and accuracy of F-18 FDG PET/CT for detecting recurrence were 64 %, 94 %, 86 %, 81 %, and 83 %. In the analysis of F-18 FDG PET/CT under ETS, the sensitivity, specificity, PPV, NPV and accuracy was 64 %, 94 %, 88 %, 81 % and 83 %. Those under TSH suppression were 67 %, 92 %, 80 %, 85 % and 83 %. CONCLUSIONS F-18 FDG PET/CT, although less sensitive, showed high specificity, PPV, NPV, and accuracy and therefore can be useful for the patients with negative diagnostic radioiodine scan and elevated serum Tg or positive TgAb. In addition, FDG PET/CT under ETS does not seem to have an additive role in detecting recurrence in these patients.
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Rapoport A, Curioni OA, Amar A, Dedivitis RA. Review of survival rates 20-years after conservative surgery for papillary thyroid carcinoma. Braz J Otorhinolaryngol 2015; 81:389-93. [PMID: 26120098 PMCID: PMC9442766 DOI: 10.1016/j.bjorl.2014.08.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 08/24/2014] [Indexed: 12/05/2022] Open
Abstract
Introduction A less extensive thyroidectomy could be used for patients in the low risk group. Objective To perform a critical follow-up after lobectomy with isthmusectomy for the treatment of papillary thyroid carcinoma in patients with a single nodule limited to the periphery of the lobe. Methods Thirty-one patients with thyroid papillary carcinoma operated on till 1993 were selected. They had undergone lobectomy with isthmusectomy. This is a retrospective cohort study in which the oncological outcome (contralateral and regional recurrence) and the reoperation complications (recurrent nerve paralysis/paresis and hypoparathyroidism) were evaluated. Descriptive analysis was employed. Results In the last decade (2003–2013), 6 (20%) contralateral recurrences were observed in the remaining lobe and in 1 of these cases (3%), contralateral lymph node metastases were noted. A completion thyroidectomy plus lymphadenectomy was performed, without modification of global survival. Conclusion Because of the rate of 20% of contralateral recurrence after a 20-year follow-up, we suggest modification of the surgical paradigm for total thyroidectomy as an initial therapy.
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Affiliation(s)
- Abrão Rapoport
- Department of Surgery, Medicine School, Universidade de São Paulo (USP), São Paulo, SP, Brazil; Department of Health, Hospital Heliópolis, São Paulo, SP, Brazil
| | - Otávio Alberto Curioni
- Lusíada Foundation (UNILUS), São Paulo, SP, Brazil; Department of Head and Neck Surgery and Otorhinolaryngology, Hospital Heliópolis, São Paulo, SP, Brazil
| | - Ali Amar
- Lusíada Foundation (UNILUS), São Paulo, SP, Brazil; Department of Head and Neck Surgery and Otorhinolaryngology, Hospital Heliópolis, São Paulo, SP, Brazil
| | - Rogério Aparecido Dedivitis
- Larynx Group, Department of Head and Neck Surgery, Hospital das Clínicas, Medicine School, Universidade de São Paulo (USP), São Paulo, SP, Brazil.
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Ciarallo A, Marcus C, Taghipour M, Subramaniam RM. Value of Fluorodeoxyglucose PET/Computed Tomography Patient Management and Outcomes in Thyroid Cancer. PET Clin 2015; 10:265-78. [DOI: 10.1016/j.cpet.2014.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Jeon TJ, Lee YS, Lee JH, Chang HS, Ryu YH. Rebound thymic hyperplasia detected by 18F-FDG PET/CT after radioactive iodine ablation therapy for thyroid cancer. Thyroid 2014; 24:1636-41. [PMID: 25065897 PMCID: PMC4229700 DOI: 10.1089/thy.2014.0164] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Rebound thymic hyperplasia (RTHP) is not an uncommon finding after radiation or chemotherapy in patients with various malignancies. However, there are limited case reports of this phenomenon after radioactive iodine ablation therapy (RIAT) in differentiated thyroid cancer (DTC). The goal of this study was to evaluate the incidence, patterns, and factors affecting RTHP after RIAT using (18)F-FDG PET/CT. METHODS The study design was a retrospective review of 2550 patients (568 men, 1982 women; age 13-79 years) who underwent FDG PET/CT imaging after total thyroidectomy and RIAT from June 2009 through June 2012. Patients were divided into four age-related subgroups. Overall incidence, age-related incidences, and sex distribution were evaluated in patients with thymic FDG uptake on PET/CT (RTHP+). The correlation between incidence of RTHP and age was assessed using the Cochran-Armitage trend test. The Wilcoxon rank-sum test and multiple regression were applied to investigate the effect of applied dose of radioactive iodine (RAI) and age on the incidence of RTHP. Correlations of standardized uptake value (SUV) and thymic volume with age and morphologic type were also evaluated. RESULTS Overall incidence of RTHP after RIAT was 1.49%, and all of the RTHP+ patients except one were female. The Cochran-Armitage trend test revealed significantly decreased incidence from the second to fifth decade (8.84%, 1.74%, 0.98%, and 0.39% respectively; p<0.001). In each age-related subgroup, the RAI dose was significantly higher in the RTHP+ than RTHP- group (p<0.001), while there was no difference in RAI dose in RTHP+ patients among age-related subgroups (p=0.838). SUVmean and SUVmax of RTHP revealed no meaningful correlation with RAI dose or age. There were no differences among morphologic patterns of RTHP in age distribution and ablation dose. CONCLUSIONS RTHP after RIAT showed a strong female predominance, despite the higher administration dose of RAI in male patients. Although the decreased incidence of RTHP after RIAT with age is similar to the pattern of RTHP induced by other causes, the fact that older patients, even sixth decade patients, can present with RTHP after RIAT is noteworthy in the management of DTC.
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Affiliation(s)
- Tae Joo Jeon
- Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Sang Lee
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Hoon Lee
- Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hang Seok Chang
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Hoon Ryu
- Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Diagnostic value of 18F-FDG PET/CT in patients with TENIS syndrome: correlation with thyroglobulin levels. Ann Nucl Med 2013; 28:241-7. [PMID: 24379008 DOI: 10.1007/s12149-013-0801-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 12/17/2013] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The aim of the study was to disclose the place of (18)F-FDG PET/CT to predict recurrent disease in patients with differentiated thyroid cancer (DTC), negative radioiodine whole-body scan (WBS) and high serum thyroglobulin (Tg). METHODS Seventy-one patients who underwent total thyroidectomy followed by radioactive iodine ablation and had negative radioiodine WBS but elevated Tg levels underwent PET/CT. They were followed up for 6-50 months (median 23) for the occurence of recurrent disease as detected by either clinical findings, other imaging modalities or histopathological examination. The place of PET/CT findings at baseline to predict the presence of recurrent disease was evaluated. Correlation between PET/CT findings and Tg levels was examined and a threshold for Tg level above which the predictive value of PET/CT was highest was determined. RESULTS PET/CT was positive for recurrent disease in 38 (53.5%) patients. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of PET/CT to predict the occurence of recurrent disease at follow-up were 68.8, 78.3, 86.8, 54.5 and 71.9%, respectively. The sensitivity, accuracy and PPV of PET/CT increased with increasing Tg levels. The highest diagnostic accuracy of PET/CT, with a sensitivity of 76.2% and a specificity of 100% to detect recurrent disease appeared to be at a Tg level greater than 29 ng/mL. CONCLUSION Our findings suggest that (18)F-FDG-PET/CT is a valuable tool to predict the occurence of recurrent disease in patients with DTC, negative WBS and elevated Tg levels. PET/CT positivity has been shown to be strongly and positively correlated with Tg levels in this patient subset.
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Correlation of 18F-FDG PET/CT findings with histopathological results in differentiated thyroid cancer patients who have increased thyroglobulin or antithyroglobulin antibody levels and negative 131I whole-body scan results. Clin Nucl Med 2013; 38:326-31. [PMID: 23486319 DOI: 10.1097/rlu.0b013e318286827b] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM This study aimed to investigate the correlation of 18F-FDG PET/CT findings with histopathological results in defining the recurrence of the disease in patients with differentiated thyroid cancer (DTC) who have increased thyroglobuline (Tg) or anti-Tg antibody (TgAb) levels and negative 131I whole-body scan (WBS) result. PATIENTS AND METHODS A total of 59 patients with DTC (44 women, 15 men; mean [SD] age, 48.2 [22.6] years) were included in the study. All of the patients had previous papillary thyroid cancer, and all of them had undergone radioiodine ablation after a total or near-total thyroidectomy. After radioiodine ablation, patients were followed up for approximately 2.5 years. In the follow-up, the patients with negative 131I-WBS results and increased Tg or TgAb levels under thyroid-stimulating hormone-stimulated conditions underwent an 18F-FDG PET/CT scan to determine any recurrence of disease. There were negative or uncertain findings in the neck ultrasonography and/or thorax CT in most of the patients. The 18F-FDG PET/CT findings were compared with the histopathological results in all patients. RESULTS Although 49 patients had increased Tg levels, the remaining 10 patients had increased TgAb levels. In patients with high Tg levels, 18F-FDG PET/CT scan results were negative in 10 and positive in 39 patients. In this patient group, 18F-FDG PET/CT findings were true positive, true negative, false positive, and false negative in 32, 3, 7, and 7 patients, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 18F-FDG PET/CT in this group were calculated as 82%, 30%, 80%, 30%, and 71%, separately. In the receiver operating characteristic analysis, a 4.5 cutoff SUV(max) was calculated with 75% sensitivity and 70% specificity for predicting disease recurrence. Cutoff Tg level was calculated as 20.7 ng/mL with 75% sensitivity and 55% specificity. In 10 patients with high TgAb levels, 18F-FDG PET/CT was true positive, true negative and false positive in 6, 2, and 2 patients, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 18F-FDG PET/CT in this patient group were calculated as 100%, 50%, 75%, 100%, and 80%, respectively. CONCLUSIONS 18F-FDG PET/CT may be a useful imaging modality in defining recurrence of the disease in patients with DTC who have increased Tg or TgAb levels, negative 131I-WBS results, and negative or suspicious neck ultrasonography and/or thorax CT results. Although 18F-FDG PET/CT seems to be a more sensitive method in patients with increased TgAb levels, the number of patients is not enough to make a substantiated comment.
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van Dijk D, Plukker JTM, Phan HTT, Muller Kobold AC, van der Horst-Schrivers ANA, Jansen L, Sluiter WJ, Brouwers AH, Links TP. 18-fluorodeoxyglucose positron emission tomography in the early diagnostic workup of differentiated thyroid cancer patients with a negative post-therapeutic iodine scan and detectable thyroglobulin. Thyroid 2013; 23:1003-9. [PMID: 23517405 DOI: 10.1089/thy.2012.0498] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Surgery and high-dose radioactive iodine ((131)I) treatment are the cornerstones in the treatment of differentiated thyroid cancer. Patients without (131)I uptake on the post-therapeutic whole body scan (WBS), but with detectable thyroglobulin (Tg) during thyroxine withdrawal (Tg-off), are evaluated with an 18-fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET) for tumor localization within three months. The yield of (18)F-FDG-PET imaging and clinical usefulness of a Tg-off cutoff value to predict a positive scan were assessed. METHODS From 2002 to 2011, 52 patients with a negative WBS and concurrent detectable Tg-off were evaluated. Thirty-five PET scans were performed during initial treatment, 17 after recurrent disease. Thirty-two patients were on substitution therapy, 17 were evaluated with endogenous thyrotropin elevation, and 3 after recombinant human thyrotropin stimulation. To determine the Tg-off cutoff value, a receiver operating characteristic curve was used. RESULTS Nine (17%) (18)F-FDG-PET scans were true positive, 3 (6%) false positive, 36 (69%) true negative, and 4 (8%) false negative (sensitivity 69%, specificity 92%). In 13%, a true-positive scan resulted in a change in the clinical management. The area under the receiver operating characteristic curve is 0.82 [CI 0.64-0.99] (p<0.01), and the Tg-off cutoff value is 38.00 ng/mL (sensitivity 67%, specificity 95%). Ninety percent of (18)F-FDG-PET true-positive patients had a Tg-off >2.00 ng/mL. CONCLUSIONS An (18)F-FDG-PET within three months after a negative WBS with detectable Tg-off showed additional tumor localization in 17% of the patients, leading to a change in clinical management in 13%. A clinically useful Tg-off cutoff value was not found, but 90% of positive (18)F-FDG-PET scans occurred in patients with a Tg-off >2.00 ng/mL.
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Affiliation(s)
- Deborah van Dijk
- Department of Endocrinology, Groningen University Medical Centre, Groningen, The Netherlands
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Lee J, Nah KY, Kim RM, Oh YJ, An YS, Yoon JK, An GI, Choi TH, Cheon GJ, Soh EY, Chung WY. Effectiveness of [(124)I]-PET/CT and [(18)F]-FDG-PET/CT for localizing recurrence in patients with differentiated thyroid carcinoma. J Korean Med Sci 2012; 27:1019-26. [PMID: 22969247 PMCID: PMC3429818 DOI: 10.3346/jkms.2012.27.9.1019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 08/02/2012] [Indexed: 11/20/2022] Open
Abstract
Although the prognosis of patients with differentiated thyroid carcinoma (DTC) is generally encouraging, a diagnostic dilemma is posed when an increasing level of serum thyroglobulin (Tg) is noted, without detection of a recurrent tumor using conventional imaging tools such as the iodine-131 whole-body scanning (the [(131)I] scan) or neck ultrasonography (US). The objective of the present study was to evaluate the diagnostic value of [(124)I]-PET/CT and [(18)F]-FDG-PET/CT in terms of accurate detection of both iodine- and non-iodine-avid recurrence, compared with that of conventional imaging such as the [(131)I] scan or neck ultrasonography (US). Between July 2009 and June 2010, we prospectively studied 19 DTC patients with elevated thyroglobulin levels but who do not show pathological lesions when conventional imaging modalities are used. All involved patients had undergone total thyroidectomy and radioiodine (RI) treatment, and who had been followed-up for a mean of 13 months (range, 6-21 months) after the last RI session. Combined [(18)F]-FDG-PET/CT and [(124)I]-PET/CT data were evaluated for detecting recurrent DTC lesions in study patients and compared with those of other radiological and/or cytological investigations. Nine of 19 patients (47.4%) showed pathological [(18)F]-FDG (5/19, 26.3%) or [(124)I]-PET (4/19, 21.1%) uptake, and were classed as true-positives. Among such patients, disease management was modified in six (66.7%) and disease was restaged in seven (77.8%). In particular, the use of the described imaging combination optimized planning of surgical resection to deal with locoregional recurrence in 21.1% (4/19) of patients, who were shown to be disease-free during follow-up after surgery. Our results indicate that combination of [(18)F]-FDG-PET/CT and [(124)I]-PET/CT affords a valuable diagnostic method that can be used to make therapeutic decisions in patients with DTC who are tumor-free on conventional imaging studies but who have high Tg levels.
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Affiliation(s)
- Jandee Lee
- Department of Surgery, Eulji Medical College Hospital, Seoul, Korea
| | - Kuk Young Nah
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Ra Mi Kim
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Yeon-Ju Oh
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Young-Sil An
- Department of Nuclear Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Joon-Kee Yoon
- Department of Nuclear Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Gwang Il An
- Department of Molecular Imaging, Korea Institute of Radiological and Medical Science, Seoul, Korea
| | - Tae Hyun Choi
- Department of Molecular Imaging, Korea Institute of Radiological and Medical Science, Seoul, Korea
| | - Gi Jeong Cheon
- Department of Molecular Imaging, Korea Institute of Radiological and Medical Science, Seoul, Korea
- Department of Nuclear Medicine, Korea University Medical Center Anam Hospital, Seoul, Korea
| | - Euy-Young Soh
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Woong Youn Chung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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Kim BS, Kim SJ, Kim IJ, Pak K, Kim K. Factors associated with positive F-18 flurodeoxyglucose positron emission tomography before thyroidectomy in patients with papillary thyroid carcinoma. Thyroid 2012; 22:725-9. [PMID: 22524470 PMCID: PMC3387768 DOI: 10.1089/thy.2011.0031] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The role for pre-thyroidectomy (pre-Tx) imaging with F-18 flurodeoxyglucose (FDG) positron emission tomography (PET), FDG PET-computed tomography (CT), in differentiated thyroid cancer is controversial as is the significance of positive and negative FDG uptake in this setting. We reviewed the records of patients with papillary thyroid carcinoma (PTC) who had pre-Tx FDG PET-CT to determine whether FDG uptake was associated with features noted on pre-Tx ultrasonography (US) and parameters determined after post-Tx. METHODS Patients were selected for a retrospective review of their records if they had a total Tx with central lymph node dissection for PTC and pre-Tx FDG PET-CT and US between 2006 and 2009. Sixty patients who met these criteria were studied. Patients who had a history of head and neck irradiation, surgery, or sclerotherapy with ethanol in the last 3 months were excluded. The clinicopathologic factors-age, sex, size, tumor-node-metastasis (TNM) staging, the presence of extrathyroidal extention, multifocality, cervical lymph node metastases (CLNM), Hashimoto thyroiditis, and US characteristics-were evaluated to determine whether they were associated with positive pre-Tx FDG uptake. RESULTS Forty-three (71.6%) of patients in the study had positive FDG uptake. Larger tumors and the presence of CLNM were associated with a greater likelihood of positive FDG uptake. The sensitivity, specificity, positive predictive value, and negative predictive value for CLNM detection by FDG PET-CT showed low statistical values. When considering the excellence of US for evaluating a thyroid nodule size and the presence of CLNM, the clinical value of pre-Tx FDG PET-CT is comparatively limited. CONCLUSION Pre-Tx FDG PET is not recommended for routine use in patients with PTC.
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Affiliation(s)
- Bum Soo Kim
- Department of Nuclear Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Seong-Jang Kim
- Department of Nuclear Medicine, Pusan National University Hospital, Busan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - In Joo Kim
- Department of Nuclear Medicine, Pusan National University Hospital, Busan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Kyounjune Pak
- Department of Nuclear Medicine, Pusan National University Hospital, Busan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Keunyoung Kim
- Department of Nuclear Medicine, Pusan National University Hospital, Busan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
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FDG-PET performed concurrently with initial I-131 ablation for differentiated thyroid cancer. Ann Nucl Med 2011; 26:207-13. [DOI: 10.1007/s12149-011-0559-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 11/15/2011] [Indexed: 11/25/2022]
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Abraham T, Schöder H. Thyroid Cancer—Indications and Opportunities for Positron Emission Tomography/Computed Tomography Imaging. Semin Nucl Med 2011; 41:121-38. [DOI: 10.1053/j.semnuclmed.2010.10.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Abstract
Accurate diagnosis and staging are essential for the optimal management of cancer patients. Positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography (18F-FDG PET/CT) has emerged as a powerful imaging tool for the detection of various cancers. The combined acquisition of PET and CT has synergistic advantages over PET or CT alone and minimizes their individual limitations. It is a valuable tool for staging and restaging of some tumors and has an important role in the detection of recurrence in asymptomatic patients with rising tumor marker levels and patients with negative or equivocal findings on conventional imaging techniques. It also allows for monitoring response to therapy and permitting timely modification of therapeutic regimens. In about 27% of the patients, the course of management is changed. This review provides guidance for oncologists/radiotherapists and clinical and surgical specialists on the use of 18F-FDG PET/CT in oncology.
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Affiliation(s)
- Ahmad Almuhaideb
- Institute of Nuclear Medicine, University College London Hospitals National Health Service Trust, London, United Kingdom
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16
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Choi JW, Yoon YH, Yoon YH, Kim SM, Koo BS. Characteristics of Primary Papillary Thyroid Carcinoma with False-Negative Findings on Initial 18F-FDG PET/CT. Ann Surg Oncol 2010; 18:1306-11. [DOI: 10.1245/s10434-010-1469-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Indexed: 11/18/2022]
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17
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Role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in patients affected by differentiated thyroid carcinoma, high thyroglobulin level, and negative 131I scan: review of the literature. Jpn J Radiol 2010; 28:629-36. [DOI: 10.1007/s11604-010-0488-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Accepted: 07/07/2010] [Indexed: 11/26/2022]
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18
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Ho Shon I, Depcynzski B, Lin M, Clark JR, Wong V, Lin P, Campbell P. Positron emission tomography in non-medullary thyroid cancer. ANZ J Surg 2010; 81:116-24. [DOI: 10.1111/j.1445-2197.2010.05538.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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19
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Vera P, Kuhn-Lansoy C, Edet-Sanson A, Hapdey S, Modzelewski R, Hitzel A, d'Anjou J, Basuyau JP. Does recombinant human thyrotropin-stimulated positron emission tomography with [18F]fluoro-2-deoxy-D-glucose improve detection of recurrence of well-differentiated thyroid carcinoma in patients with low serum thyroglobulin? Thyroid 2010; 20:15-23. [PMID: 20017617 DOI: 10.1089/thy.2008.0416] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Thyrotropin (TSH) stimulates thyrocyte metabolism, glucose transport, and glycolysis. The interest in using recombinant human TSH (rhTSH) stimulation of fluoro-2-deoxy-D-glucose (FDG) with positron emission tomography (PET) has been shown, but mainly for patients with high serum thyroglobulin (Tg) concentration. We evaluated the use of rhTSH-stimulated PET-FDG in patients with low serum Tg concentration. METHODS Sixty-one PET/computed tomography (CT)-FDG (Biograph Sensation 16; Siemens Medical Solutions, Knoxville, TN) were performed in 44 patients (28 women and 16 men; 51 +/- 16 years) with positive Tg levels, negative or no contributive iodine-131 whole-body scintigraphy results, and no contributive morphological imaging results (ultrasound, magnetic resonance imaging, and CT). Thirty-eight patients had papillary carcinoma and six had follicular thyroid carcinoma. All patients had previously undergone total thyroidectomy and postoperative iodine ablation of thyroid bed remnant tissue. The rhTSH-stimulated PET/CT-FDG (5 MBq/kg) was performed after two 0.9 mg intramuscular doses of rhTSH (Thyrogen; Genzyme) which were administered 48 and 24 hours before imaging, while patients continued levothyroxine (LT(4)). Blood sampling was performed immediately before FDG injection for measurement of serum TSH and Tg concentrations (TSH(1) and Tg(1)) and after 48 hours (TSH(2) and Tg(2)). PET/CT-FDG findings were compared with the Tg: (i) at the initial iodine treatment during T(4) withdrawal (Tg(ini)), (ii) under T(4) (Tg(T4)) within 3 months before the PET/CT-FDG, (iii) with Tg(1), and (iv) with Tg(2). PET/CT-FDG findings were correlated with the findings of histology, iodine-131 whole-body scintigraphy, morphological imaging, or clinical follow-up. RESULTS The mean Tg(ini) was 785 +/- 2707 microg/L for a TSH of 73 +/- 64 mU/L. The mean Tg(T4) was 7 +/- 15 microg/L (T(4) = 195 +/- 59 microg/day; mean TSH of 0.24 +/- 0.57 mU/L). Among the 44 patients, PET/CT-FDG findings were positive in 20 and negative in 24. Among the 61 PET/CT-FDG, 25 PET/CT-FDG were positive (41%). Among the 25 positive PET, the Tg(T4) values were less than 10 microg/L for 19, including 9 true-positive patients (20% of the 44 patients). There was no difference of PET/CT-FDG results (positive vs. negative) as related to the serum Tg concentrations (p = 0.99 for Tg(ini), p = 0.95 for Tg(T4), p = 0.07 for Tg(1), and p = 0.42 for Tg(2)). No relation was observed with PET/CT-FDG results and initial tumor size (p = 0.52) or node metastasis (p = 0.14). CONCLUSION In the diagnosis of recurrent disease in patients with differentiated thyroid carcinoma and low Tg level, the sensitivity of rhTSH-stimulated PET/CT-FDG seems to be low and no correlation was observed between PET/CT-FDG findings and Tg level. However, positive PET-FDG results have been found in 9/44 (20%) patients with serum Tg levels lower than 10 microg/L. Therefore, this series shows that a cutoff value of 10 microg/L for the Tg under T(4) is probably not the best criteria to select patient candidates for PET/CT-FDG examination to detect the recurrence of differentiated thyroid carcinoma.
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Affiliation(s)
- Pierre Vera
- Department of Nuclear Medicine, Henri Becquerel Centre and Rouen University Hospital, University of Rouen, Rouen, France.
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Chua S, Gnanasegaran G, Cook GJ. Miscellaneous Cancers (Lung, Thyroid, Renal Cancer, Myeloma, and Neuroendocrine Tumors): Role of SPECT and PET in Imaging Bone Metastases. Semin Nucl Med 2009; 39:416-30. [DOI: 10.1053/j.semnuclmed.2009.07.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Wong K, Choi FP, Lee YY, Ahuja AT. Current role of radionuclide imaging in differentiated thyroid cancer. Cancer Imaging 2008; 8:159-62. [PMID: 18818134 PMCID: PMC2556502 DOI: 10.1102/1470-7330.2008.0024] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Nuclear medicine plays an integral role in the management of differentiated thyroid cancer. This editorial aims to provide a summary of the current role of radionuclide imaging, including whole body iodine scan and fluorodeoxyglucose (FDG)-positron emission tomography (PET), in the diagnostic work-up and follow-up of patients with thyroid cancer.
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Affiliation(s)
- K.T. Wong
- Department of Diagnostic Radiology & Organ Imaging, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; Department of Radiology, North District Hospital, Hong Kong SAR
| | - Frankie P.T. Choi
- Department of Diagnostic Radiology & Organ Imaging, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; Department of Radiology, North District Hospital, Hong Kong SAR
| | - Yolanda Y.P. Lee
- Department of Diagnostic Radiology & Organ Imaging, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; Department of Radiology, North District Hospital, Hong Kong SAR
| | - Anil T. Ahuja
- Department of Diagnostic Radiology & Organ Imaging, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; Department of Radiology, North District Hospital, Hong Kong SAR
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