Characteristics of Primary Papillary Thyroid Carcinoma with False-Negative Findings on Initial 18F-FDG PET/CT

Jw, Choi; Yoon, Young Hoon; Yoon, Yeo Hoon; Kim, Sang Woo; Koo, Bon Seok

doi:10.1245/s10434-010-1469-2

Cited by 32 publications

(28 citation statements)

References 14 publications

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“…Yun et al showed that positive uptake of FDG in papillary thyroid microcarcinomas was correlated with extrathyroidal extension and CLNM (7). Choi et al retrospectively reviewed false negative findings of FDG PET-CT when performed prior to Tx in patients with PTC (8). They found that negativity on initial FDG PET-CT scan correlated with the absence of perithyroidal and lymphovascular invasion.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Positive F-18 Flurodeoxyglucose Positron Emission Tomography before Thyroidectomy in Patients with Papillary Thyroid Carcinoma

Kim¹,

Kim²,

Kim³

et al. 2012

Thyroid

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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-nodemetastasis (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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Section: Discussionmentioning

confidence: 99%

Factors Associated with Positive F-18 Flurodeoxyglucose Positron Emission Tomography before Thyroidectomy in Patients with Papillary Thyroid Carcinoma

Kim¹,

Kim²,

Kim³

et al. 2012

Thyroid

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“…None of the US features were significantly correlated with FDG uptake (Kim et al 2012). Even though tumor size is known to be correlated with the standardized uptake value (SUV) in PTC (Kaida et al 2011), it is not an independent factor predictive of positive FDG uptake (Choi et al 2011a).…”

Section: Factors Associated With the Fdg Avidity Of Dtcsmentioning

confidence: 95%

“…DTCs with negative FDG uptake are smaller and less frequently have EE and lymphovascular invasion and tend to have a better prognosis (Choi et al 2011a). In other words, positive FDG uptake is associated with the presence of EE and lymphovascular invasion and a tendency to a poor prognosis.…”

Section: Prediction Of Prognosis By Fdg Pet In Patients With Dtcsmentioning

confidence: 99%

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The role of 18F-fluorodeoxyglucose positron emission tomography in differentiated thyroid cancer before surgery

Pak¹,

Kim²,

Kim³

et al. 2013

Endocrine-Related Cancer

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The incidence of thyroid cancer in both men and women is increasing faster than that of any other cancer. Although positron emission tomography (PET) using 18 F-fluorodeoxyglucose (FDG) has received much attention, the use of FDG PET for the management of thyroid cancer is limited primarily to postoperative follow-up. However, it might have a role in selected, more aggressive pathologies, and so patients at a high risk of distant metastasis may benefit from PET before surgery. As less FDG-avid thyroid cancers may lower the diagnostic accuracy of PET in preoperative assessment, an understanding of FDG avidity is important for the evaluation of thyroid cancer. FDG avidity has been shown to be associated with tumor size, lymph node metastasis, and glucose transporter expression and differentiation. As PET is commonly used in clinical practice, the detection of incidentalomas by PET is increasing. However, incidentalomas detected by PET have a high risk of malignancy. Clinicians handling cytologically indeterminate nodules face a dilemma regarding a procedure for a definitive diagnosis, usually lobectomy. With 'nondiagnostic (ND)' fine-needle biopsy (FNA), PET has shown a negative predictive value (NPV) of 100%, which indicates that negative uptake in a ND FNA procedure accurately excludes malignancy. With 'atypia of undetermined significance' or 'follicular neoplasm', the sensitivity and NPV of PET are 84 and 88%. PET does not provide additional information for the preoperative assessment of thyroid cancer. However, factors associated with FDG positivity are related to a poor prognosis; therefore, FDG PET scans before surgery may facilitate the prediction of the prognosis of differentiated thyroid cancer.

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“…Therefore, based on this initial study, FDG-PET positivity was not associated with more aggressive tumor behavior or worse tumor characteristics [13]. However, a more recent study found that for PTMCs which were FDG nonavid, they were not only significantly smaller sized tumors but also less frequent perithyroidal tumor invasion and lymphovascular invasion when compared to the PTMCs which were FDG avid [14]. This implies that FDG-PET positivity might be associated with a more aggressive tumor behavior in primary thyroid carcinoma [14].…”

Section: Prognostic Significance Of Fdg-pet Positivity In Primary mentioning

confidence: 99%

The Role of 18F-Fluorodeoxyglucose Positron Emission Tomography in the Prognostication, Diagnosis, and Management of Thyroid Carcinoma

Lang

2012

Journal of Thyroid Research

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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.

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Characteristics of Primary Papillary Thyroid Carcinoma with False-Negative Findings on Initial 18F-FDG PET/CT

Abstract: Tumor size and perithyroidal and lymphovascular invasion of papillary carcinoma can influence (18)F-FDG PET/CT findings. Absence of perithyroidal and lymphovascular invasion were independent variables for false-negative findings on initial (18)F-FDG PET/CT in patients with PTC.

Cited by 32 publications

References 14 publications

Factors Associated with Positive F-18 Flurodeoxyglucose Positron Emission Tomography before Thyroidectomy in Patients with Papillary Thyroid Carcinoma

Factors Associated with Positive F-18 Flurodeoxyglucose Positron Emission Tomography before Thyroidectomy in Patients with Papillary Thyroid Carcinoma

The role of 18F-fluorodeoxyglucose positron emission tomography in differentiated thyroid cancer before surgery

The Role of 18F-Fluorodeoxyglucose Positron Emission Tomography in the Prognostication, Diagnosis, and Management of Thyroid Carcinoma

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