Accuracy of positron emission tomography and positron emission tomography-CT in the detection of differentiated thyroid cancer recurrence with negative<sup>131</sup>I whole-body scan results: A meta-analysis

Caetano, Rosângela; Bastos, Cláudia Regina Garcia; Oliveira, Ione Ayala Gualandi de; Silva, Rondineli Mendes da; Fortes, Clarisse Pereira Dias Drumond; Pepe, Vera Lúcia Edais; Reis, Lenice Gnocchi da Costa; Braga, José Ueleres

doi:10.1002/hed.23881

Cited by 43 publications

(29 citation statements)

References 52 publications

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“…(20). Similar data, reported by Caetano et al in 2015, was obtained from a meta-analysis evaluating the sensitivity and specificity of FDG-PET/CT in the detection of DTC recurrences to be 93 and 81% respectively (21). The sensitivity of FDG-PET/CT in our study was relatively low probably because some enrolled patients showed only a slight increase in serum Tg level.…”

Section: Discussionsupporting

confidence: 58%

The role of FDG-PET in localization of recurrent lesions of differentiated thyroid cancer (DTC) in patients with asymptomatic hyperthyroglobulinemia in a real clinical practice

Kukulska

Krajewska

Kołosza

et al. 2016

European Journal of Endocrinology

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Introduction: Available methods, including serum thyroglobulin (Tg) measurement and whole-body scan (WBS) performed after radioiodine administration, allow for a precise diagnostics in differentiated thyroid cancer (DTC). However, some asymptomatic patients demonstrate negative WBS despite a high Tg serum concentration. In these subjects, fluorodeoxyglucose-positron emission tomography (FDG-PET) should be considered. The primary aim of our study was to evaluate a diagnostic value of FDG-PET in asymptomatic hyperthyroglobulinemia. The secondary one was to determine a prognostic value of a negative FDG-PET result in DTC patients with elevated Tg level. Material: One hundred and ten FDG-PET/CT scans were retrospectively analyzed, 85 scans were done under TSH stimulation and 25 on LT 4 suppressive therapy. Follow-up ranged between 4 and 9 years. Results: The first FDG-PET/CT detected cancer foci in 49 subjects with a global sensitivity of 45%. When the sensitivity was evaluated with reference to TSH stimulation and suppression, its values were 50 and 28% respectively. In 42 patients, FDG-PET failed to diagnose the reason for elevated Tg level. During further follow-up, in 17 of them, DTC recurrence was detected by other methods (CT, MRI, US). Fourteen subjects with asymptomatic hyperthyroglobulinemia were free of DTC progression for at least 4 years. Conclusions: FDG-PET in DTC patients with asymptomatic hyperthyroglobulinemia constitutes a valuable diagnostic tool. Negative FDG-PET demonstrated a limited prognostic significance, as only every third patient did not show DTC progression. Moreover, negative FDG-PET does not justify less strict DTC monitoring, because it is related to 40% risk of relapse during the 5-year follow-up.

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Section: Discussionsupporting

confidence: 58%

The role of FDG-PET in localization of recurrent lesions of differentiated thyroid cancer (DTC) in patients with asymptomatic hyperthyroglobulinemia in a real clinical practice

Kukulska

Krajewska

Kołosza

et al. 2016

European Journal of Endocrinology

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“…For distant metastases, particularly of the lung and bones, FDG-PET/CT reaches both sensitivity and specificity up to 1.00 [14, 15, 19]. Nonetheless, the sensitivity and specificity of FDG-PET/CT for detecting locally recurrent or metastatic TC is still relatively low and ranges between 0.46 to 1.00 and 0.66 to 1.00, respectively [5, 12, 17]. Furthermore, recurrent, residual, or metastatic tissue does not always accumulate 18 FDG, and thus remains undetectable by FDG-PET/CT.…”

Section: Introductionmentioning

confidence: 99%

Impact of combined FDG-PET/CT and MRI on the detection of local recurrence and nodal metastases in thyroid cancer

et al. 2016

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BackgroundSuspected recurrence of thyroid carcinoma is a diagnostic challenge when findings of both a radio iodine whole body scan and ultrasound are negative. PET/CT and MRI have shown to be feasible for detection of recurrent disease. However, the added value of a consensus reading by the radiologist and the nuclear medicine physician, which has been deemed to be helpful in clinical routines, has not been investigated. This study aimed to investigate the impact of combined FDG-PET/ldCT and MRI on detection of locally recurrent TC and nodal metastases in high-risk patients with special focus on the value of the multidisciplinary consensus reading.Materials and methodsForty-six patients with suspected locally recurrent thyroid cancer or nodal metastases after thyroidectomy and radio-iodine therapy were retrospectively selected for analysis. Inclusion criteria comprised elevated thyroglobulin blood levels, a negative ultrasound, negative iodine whole body scan, as well as combined FDG-PET/ldCT and MRI examinations.Neck compartments in FDG-PET/ldCT and MRI examinations were independently analyzed by two blinded observers for local recurrence and nodal metastases of thyroid cancer. Consecutively, the scans were read in consensus. To explore a possible synergistic effect, FDG-PET/ldCT and MRI results were combined. Histopathology or long-term follow-up served as a gold standard.For method comparison, sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy were calculated.ResultsFDG-PET/ldCT was substantially more sensitive and more specific than MRI in detection of both local recurrence and nodal metastases. Inter-observer agreement was substantial both for local recurrence (κ = 0.71) and nodal metastasis (κ = 0.63) detection in FDG-PET/ldCT. For MRI, inter-observer agreement was substantial for local recurrence (κ = 0.69) and moderate for nodal metastasis (κ = 0.55) detection. In contrast, FDG-PET/ldCT and MRI showed only slight agreement (κ = 0.21). However, both imaging modalities identified different true positive results. Thus, the combination created a synergistic effect. The multidisciplinary consensus reading further increased sensitivity, specificity, and diagnostic accuracy.ConclusionsFDG-PET/ldCT and MRI are complementary imaging modalities and should be combined to improve detection of local recurrence and nodal metastases of thyroid cancer in high-risk patients. The multidisciplinary consensus reading is a key element in the diagnostic approach.Electronic supplementary materialThe online version of this article (doi:10.1186/s40644-016-0096-y) contains supplementary material, which is available to authorized users.

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“…In case of lower thyroglobulin levels, 18 FDG PET/CT can be false negative due to the presence of microscopic disease. The specificities of 18 FDG PET alone and PET/CT methods were similar (81-84%) (99,100). This is due to the fact that inflammation also increases FDG uptake.…”

Section: F-fluorodeoxyglucose Positron Emission Tomographymentioning

confidence: 69%

“…The combination of functional and morphologic data furnished by this approach substantially improves the anatomic localization of lesions. Two meta-analyses analyzed the diagnostic performances of 18 FDG PET and 18 FDG PET/CT for the detection of persistent/recurrent DTC in patients with detectable Tg and no evidence of RAI uptake (99,100). In both cases, the patient-based sensitivity of PET/CT was appreciably higher than PET alone (93-94% vs 83-84% for 18 FDG PET).…”

Section: F-fluorodeoxyglucose Positron Emission Tomographymentioning

confidence: 99%

ENDOCRINE TUMOURS: Imaging in the follow-up of differentiated thyroid cancer: current evidence and future perspectives for a risk-adapted approach

Lamartina¹,

Deandreis

Durante³

et al. 2016

European Journal of Endocrinology

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The clinical and epidemiological profiles of differentiated thyroid cancers (DTCs) have changed in the last three decades. Today's DTCs are more likely to be small, localized, asymptomatic papillary forms. Current practice is, though, moving toward more conservative approaches (e.g. lobectomy instead of total thyroidectomy, selective use of radioiodine). This evolution has been paralleled and partly driven by rapid technological advances in the field of diagnostic imaging. The challenge of contemporary DTCs follow-up is to tailor a risk-of-recurrence-based management, taking into account the dynamic nature of these risks, which evolve over time, spontaneously and in response to treatments. This review provides a closer look at the evolving evidence-based views on the use and utility of imaging technology in the post-treatment staging and the short-and long-term surveillance of patients with DTCs. The studies considered range from cervical US with Doppler flow analysis to an expanding palette of increasingly sophisticated second-line studies (cross-sectional, functional, combined-modality approaches), which can be used to detect disease that has spread beyond the neck and, in some cases, shed light on its probable outcome.

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Accuracy of positron emission tomography and positron emission tomography-CT in the detection of differentiated thyroid cancer recurrence with negative¹³¹I whole-body scan results: A meta-analysis

Abstract: (18) Fluorodeoxyglucose (FDG)-PET and PET-CT are highly accurate diagnostics tools for DTC recurrence in patients who present a negative whole-body scintigraphy and could impact the clinical and therapeutic management of DTC.

Cited by 43 publications

References 52 publications

The role of FDG-PET in localization of recurrent lesions of differentiated thyroid cancer (DTC) in patients with asymptomatic hyperthyroglobulinemia in a real clinical practice

The role of FDG-PET in localization of recurrent lesions of differentiated thyroid cancer (DTC) in patients with asymptomatic hyperthyroglobulinemia in a real clinical practice

Impact of combined FDG-PET/CT and MRI on the detection of local recurrence and nodal metastases in thyroid cancer

ENDOCRINE TUMOURS: Imaging in the follow-up of differentiated thyroid cancer: current evidence and future perspectives for a risk-adapted approach

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Accuracy of positron emission tomography and positron emission tomography-CT in the detection of differentiated thyroid cancer recurrence with negative131I whole-body scan results: A meta-analysis

Abstract: (18) Fluorodeoxyglucose (FDG)-PET and PET-CT are highly accurate diagnostics tools for DTC recurrence in patients who present a negative whole-body scintigraphy and could impact the clinical and therapeutic management of DTC.

Cited by 43 publications

References 52 publications

The role of FDG-PET in localization of recurrent lesions of differentiated thyroid cancer (DTC) in patients with asymptomatic hyperthyroglobulinemia in a real clinical practice

The role of FDG-PET in localization of recurrent lesions of differentiated thyroid cancer (DTC) in patients with asymptomatic hyperthyroglobulinemia in a real clinical practice

Impact of combined FDG-PET/CT and MRI on the detection of local recurrence and nodal metastases in thyroid cancer

ENDOCRINE TUMOURS: Imaging in the follow-up of differentiated thyroid cancer: current evidence and future perspectives for a risk-adapted approach

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Accuracy of positron emission tomography and positron emission tomography-CT in the detection of differentiated thyroid cancer recurrence with negative¹³¹I whole-body scan results: A meta-analysis