World Congress on Thyroid Cancer 4.0
July 29 – August 1, 2021
EP141 – Clinical significance of PET CT in recurrent papillary thyroid cancer
Shin, Sung-Chan1; Kang, Ji-Heon 1; Yoon, Byung-Woo1; Jung, Da-Woon1; Kim, In-Joo2; Kim, Bo Hyun2; Lee, Jin-Choon3; Lee, Byung-Joo1
1 Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea
2 Division of Endocrinology, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
3 Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Pusan National University School of Medicine, Yangsan Pusan National University Hospital, Yangsan, Gyeongsangnam-do, Republic of Korea
Introduction: 18F-FDG PET/CT has been widely accepted as an effective method for detecting PTC recurrence. This study was performed to evaluate the diagnostic value of PET/CT for PTC recurrence evaluation in patients already diagnosed as loco-regional recurrent disease and the role for predicting the prognosis.
Materials and Methods: Sixty-six recurrent patients were enrolled. 18F-FDG PET/CT was performed within the 6 month before surgery. The 18F-FDG PET/CT findings were compared with the histopathological examination results.
Results: The sensitivity, specificity, and diagnostic accuracy of whole neck level (II-VI) were 38.5%, 86.5%, and 57.4%, respectively. Corresponding values for central neck compartment were 54.8%, 66.7%, and 57.5% and values for lateral neck compartment were 59.7%, 75.0%, and 61.4%, respectively. Diagnostic values for lateral compartment tended to be higher than values for cental compartment. The diagnostic accuracy of 18F-FDG PET/CT for detecting recurrence in whole patients irrespective of Tg levels was 42.4-64.3% by levels and compartment. Patients with a Tg level ? 2 ng/ml show 26.3-75.0% of corresponding values. In addition, patients with a Tg < 2 ng/ml show 47.4-75.0% of corresponding values. In a comparison of the high FDG avidity group (SUVmax > 10) and the others, median loco-regional disease free survival time were 81.8 and 33.3.(p <.001)
Conclusion: 18F-FDG PET/CT demonstrate the comparable diagnostic value for detecting recurrence, irrelevant to WBS results and serum Tg and TgAb levels. Therefore, 18F-FDG PET/CT may also helpful for the evaluation loco-regional / distant recurrence.
- Hundahl SA, Fleming ID, et al. A National Cancer Data Base report on 53.856 cases of thyroid carcinoma treated in the U.S., 1985-1995. Cancer. 1998;83:2638-2648.
- Rivera M, Ghossein RA, et al. Histopathologic characterization of radioactive iodine-refractory fluorodeoxyglucose-positron emission tomography-positive thyroid carcinoma. Cancer. 2008;113:48-56.
- Cooper DS, Doherty GM, et al. American Thyroid Association Guidelines Taskforce: Management guidelines of patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2006;16:109-142.
- Schlumberger M, Baudin E. Serum thyroglobulin determination in the follow-up of patients with differentiated thyroid carcinoma. Eur J Endocrinol. 1998;138:249-252.
- Robbins RJ, Larson SM. The value of positron emission tomography (PET) in the management of patients with thyroid cancer. Best Pract Res Clin Endocrinol Metab 2008;22:1047-1059
- Feine U, Lietzenmayer R, et al. Fluorine-18-FDG and iodine- 131-iodide uptake in thyroid cancer. J Nucl Med. 1996;37: 1468-72.
- Braga-Basaria M, Ringel MD. Clinical review 158: beyond radioiodine: a review of potential new therapeutic approaches for thyroid cancer. J Clin Endocrinol Metab. 2003;88:1947-1960.
- Bryan R. Haugen, Erik K. Alexander, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid ©2015 American Thyroid Association DOI: 10.1089/thy.2015.0020
- Alnafisi NS, Driedger AA, et al. FDG PET of recurrent or metastatic 131I-negative papillary thyroid carcinoma. J Nucl Med. 2000;41:1010-5.
- Altenvoerde G, Lerch H, et al. Positron emission tomography with F-18-deoxyglucose in patients with differentiated thyroid carcinoma, elevated thyroglobulin levels, and negative iodine scans. Langenbecks Arch Surg. 1998;383:160-3.
- Na SJ, Yoo IeR, et al. Diagnostic accuracy of 18)F- fluorodeoxyglucose positron emission tomography / computed tomography in differentiated thyroid cancer patients with elevated thyroglobulin and negative (131) I whole body scan: evaluation by thyroglobulin level. Ann Nucl Med. 2012;26:26-34.
- Seo JH, Lee SW, et al. Recurrence detection in differentiated thyroid cancer patients with elevated serum level of TgAb: special emphasis on using (18)F-FDG PET/CT. Clin Endocrinol (Oxf). 2010;72:558-563.
- Feine U, Lietzenmayer R, et al. Fluorine-18-FDG and iodine-131- iodide uptake in thyroid cancer. J Nucl Med. 1996;37:1468-72.
- Som PM, Curtin HD, et al. Imaging-based nodal classification for evaluation of neck metastatic adenopathy. AJR Am J Roentgenol 2000;174:837-844.
- Bachelot A, Cailleux AF, et al. Relationship between tumor burden and serum thyroglobulin level in patients with papillary and follicular thyroid carcinoma. Thyroid. 2002;12:707–11.
- Mazzaferri EL, Robbins RJ, et al. A consensus report of the role of serum thyroglobulin as a monitoring method for low-risk patients with papillary thyroid carcinoma. J Clin Endocrinol Metab 2003;88:1433-1441.
- Haugen BR, Pacini F, et al. A comparison of recombinant human thyrotropin and thyroid hormone withdrawal for the detection of thyroid remnant or cancer. J Clin Endocrinol Metab 1999; 84:3877-3885.
- Pacini F, Molinaro E, et al. Recombinant human thyrotropin -stimulated serum thyroglobulin combined with neck ultrasonography has the highest sensitivity in monitoring differentiated thyroid carcinoma. J Clin Endocrinol Metab. 2003;88:3668-73.
- Leboulleux S, Schroeder PR, et al. 2007 The role of PET in follow-up of patients treated for differentiated epithelial thyroid cancers. Nat Clin Pract Endocrinol Metab 3:112-121.
- Schluter B, Bohuslavizki KH, et al. Impact of FDG PET on patients with differentiated thyroid cancer who present with elevated thyroglobulin and negative 131I scan. J Nucl Med. 2001;42:71-6.
- Stokkel MP, Duchateau CS, et al. The value of FDG PET in the follow-up of differentiated thyroid cancer: a review of the literature. Q J Nucl Med Mol Imaging. 2006;50:78-87.
- Shammas A, Degirmenci B, et al. 18F-FDG PET/CT in patients with suspected recurrent or metastatic well-differentiated thyroid cancer. J Nucl Med. 2007;48:221-6.
- Spencer CA, LoPresti JS, Fatemi S, Nicoloff JT Detection of residual and recurrent differentiated thyroid carcinoma by serum thyroglobulin measurement. Thyroid 1999:9:435-441.
- Pacini F, Mariotti S, et al. Thyroid autoantibodies in thyroid cancer : incidence and relationship with tumour outcome. Acta Endocrinol (Copenh). 1988;119:373-380.
- Rubello D, Girelli ME, et al. Usefulness of the combined antithyroglobulin antibodies and thyroglobulin assay in the follow-up of patients with differentiated thyroid cancer. J Endocrinol Invest. 1990;13:737-742.
- Rubello, D., Casara, D., Gireffi, M.E. et al. Clinical meaning of circulating antithyroglobulin antibodies in differentiated thyroid cancer: A prospective study. Journal of Nuclear Medicine, 1992:33, 1478-1480.
- Chung, J.K., Park, Y.J., et al. Clinical significance of elevated level of serum antithyroglobulin antibody in patients with differentiated thyroid cancer after thyroid ablation. Clinical Endocrinology, 2002;57; 215–221.
- Richard J. Robbins, Qiang Wan et al. Real-Time Prognosis for Metastatic Thyroid Carcinoma Based on 2-[18F]Fluoro-2-Deoxy-d- Glucose-Positron Emission Tomography Scanning. The Journal of Clinical Endocrinology & Metabolism 91(2):498–505.
- Nahas Z, Goldenberg D, et al. The role of positron emission tomography/computed tomography in the management of recurrent papillary thyroid carcinoma. Laryngoscope 2005, 115:237–-243.