PET-CT scans in recurrent or persistent differentiated thyroid cancer: Is there added utility beyond conventional imaging?
Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA. Surgery
(Impact Factor: 3.38).
12/2010; 148(6):1082-9; discussion 1089-90. DOI: 10.1016/j.surg.2010.09.015
Integrated positron emission tomography (PET)-computed tomography (CT) may have advantages over conventional imaging in localizing recurrent or persistent differentiated thyroid cancer.
A retrospective review of patients who underwent PET-CT scans was performed. Results were compared with contrast CT, magnetic resonance imaging, ultrasonography, and radioactive iodine (RAI) scans.
Thirty patients (mean age, 49.9 ± 17 years) underwent 36 PET-CT scans, mostly for elevated thyroglobulin levels and negative RAI scans (30 scans). Fifty percent (18/36) of PET-CT scans showed increased uptake in the neck, 11 of 36 (31%) in the chest, 3 of 36 (8.3%) in bone, and 6 of 36 (16.6%) in other areas. PET-CT had overall sensitivity, specificity, and positive predictive values of 73.9%, 61.5%, and 77.3% respectively. To assess the added value of PET-CT, we focused on the 21 scans performed after conventional imaging in 20 patients. PET-CT provided additional information in 2 (10%) patients, both of whom were spared interventions. However, PET-CT underestimated extent of disease in 3 (15%) patients and led to unnecessary interventions in 3 (15%) additional patients.
PET-CT has reasonable sensitivity in the detection of recurrent thyroid cancer. However, the added value of PET-CT may be seen only in a limited number of patients after good quality, conventional imaging. Further studies are needed to determine the most cost-effective approach to managing these patients.
Available from: PubMed Central
- "They found FDG-PET/CT provided additional information in only 2/20 (10.0%) patients, both of whom required no additional intervention, but underestimated the extent of disease in 3/30 (15.0%) patients and led to unnecessary interventions (including surgery, RAI, and antibiotics) in 3/30 (15.0%) additional patients. They concluded that FDG-PET/CT has a good sensitivity in detecting recurrent or persistent DTC, but the added value over good-quality conventional imaging is very limited . Furthermore, it may lead to unnecessary interventions . "
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ABSTRACT: 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) plays an increasingly important role in the prognostication, diagnosis, and management of thyroid carcinoma. For patients diagnosed with primary or persistent/recurrent thyroid carcinoma, a finding of FDG-PET positivity implies a more aggressive tumor biology and a distinct mutational profile, both of which carry prognostic significance. Therefore, FDG-PET positivity may be a useful potential risk factor for preoperative risk stratification in primary thyroid carcinoma. This information may help in the planning of subsequent treatment strategy such as the extent of thyroidectomy, prophylactic central neck dissection, and radioiodine ablation. FDG-PET scan has also been found to be a useful adjunct in characterizing indeterminate thyroid nodules on fine needle aspiration cytology. However, larger-sized prospective studies are required to validate this finding. FDG-PET or FDG-PET/CT scan has become the imaging of choice in patients with a negative whole-body radioiodine scan, but with an abnormally raised thyroglobulin level after total thyroidectomy and radioiodine ablation.
Journal of Thyroid Research 01/2012; 2012(5):198313. DOI:10.1155/2012/198313
Available from: ncbi.nlm.nih.gov
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ABSTRACT: (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has established itself as an important imaging modality in many oncological and nononcological specialties and, as a consequence, it is increasingly being used in clinical practice. Since the first report of FDG being taken up by metastatic differentiated thyroid carcinoma (DTC) cells >20 years ago, various groups of investigators have explored the potential role of FDG-PET scanning in patients with benign and malignant thyroid neoplasms. With the increasing demand for FDG-PET scanning, clinicians are faced with the challenge of managing an increasing number of FDG-PET-detected thyroid incidentalomas because their significance remains unclear. The aims of this review are to address some of these issues, specifically, the clinical significance of FDG-PET-detected thyroid incidentalomas, the ability of FDG-PET to characterize thyroid nodules, especially those with indeterminate fine needle aspiration cytology results, and the role of FDG-PET in patients with confirmed primary DTC and with suspected recurrent DTC, by reviewing the current literature.
The Oncologist 03/2011; 16(4):458-66. DOI:10.1634/theoncologist.2010-0256 · 4.87 Impact Factor
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ABSTRACT: Fluorodeoxyglucose-positron emission tomography (FDG-PET)/computed tomography (CT) is able to localize persistent or recurrent disease in differentiated thyroid carcinoma (DTC). The aim of the study was to correlate PET/CT results with precise intraoperative localization of persistent or recurrent papillary and follicular thyroid carcinoma. Patients with differentiated thyroid carcinoma who received FDG-PET scans were prospectively documented. The PET/CT results were correlated with other localization studies (neck ultrasound, 131I whole-body scan) and accurately compared to intraoperative findings and histopathological examinations. FDG-PET/CT scans were performed in 18 patients, between 16 and 84 years of age, from December 2008 to June 2011. Fourteen patients had papillary thyroid carcinomas and 4 had follicular thyroid carcinomas. All patients had a previous thyroidectomy and radioiodine ablation. Before cervical re-exploration, FDG-PET/CT-positive findings were reported in 14 individuals, whereas 4 PET scans provided no evidence of disease. Intraoperatively, 13 of 14 FDG-PET/CT-positive localizations of recurrent or persistent thyroid carcinomas were verified and confirmed by histopathology (sensitivity 93%). In another patient lymph node metastases of lung cancer were detected intraoperatively. However, FDG-PET/CT underestimated the number of lesions in 5 of 6 patients undergoing systematic lymphadenectomy. No lymph node or soft tissue metastases were found intraoperatively in 3 of the 4 patients with negative FDG-PET scans. A solitary cystic lymph node metastasis was found in the fourth patient but was not detected by FDG-PET/CT (specificity 75%). FDG-PET/CT has high sensitivity and specificity for the detection of persistent or recurrent differentiated thyroid carcinoma. FDG-PET/CT helps to select patients who might benefit from surgery because it provides precise anatomical details.
Hormone and Metabolic Research 07/2012; 44(12). DOI:10.1055/s-0032-1316351 · 2.12 Impact Factor
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