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 Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Republic of Korea Division of Endocrinology, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea. 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.   References: 
    1. 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.
    2. Rivera M, Ghossein RA, et al. Histopathologic characterization of radioactive iodine-refractory fluorodeoxyglucose-positron emission tomography-positive thyroid carcinoma. Cancer. 2008;113:48-56.
    3. 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.
    4. Schlumberger M, Baudin E. Serum thyroglobulin determination in the follow-up of patients with differentiated thyroid carcinoma. Eur J Endocrinol. 1998;138:249-252.
    5. 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
    6. Feine U, Lietzenmayer R, et al. Fluorine-18-FDG and iodine- 131-iodide uptake in thyroid cancer. J Nucl Med. 1996;37: 1468-72.
    7. 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.
    8. 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
    9. Alnafisi NS, Driedger AA, et al. FDG PET of recurrent or metastatic 131I-negative papillary thyroid carcinoma. J Nucl Med. 2000;41:1010-5.
    10. 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.
    11. 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.
    12. 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.
    13. Feine U, Lietzenmayer R, et al. Fluorine-18-FDG and iodine-131- iodide uptake in thyroid cancer. J Nucl Med. 1996;37:1468-72.
    14. Som PM, Curtin HD, et al. Imaging-based nodal classification for evaluation of neck metastatic adenopathy. AJR Am J Roentgenol 2000;174:837-844.
    15. 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.
    16. 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.
    17. 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.
    18. 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.
    19. 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.
    20. 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.
    21. 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.
    22. 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.
    23. 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.
    24. Pacini F, Mariotti S, et al. Thyroid autoantibodies in thyroid cancer : incidence and relationship with tumour outcome. Acta Endocrinol (Copenh). 1988;119:373-380.
    25. 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.
    26. 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.
    27. 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.
    28. 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.
    29. 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.


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