Correlation between Calcitonin Levels and [<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mtext>F</mml:mtext><mml:mrow><mml:mn mathvariant="bold">18</mml:mn></mml:mrow></mml:mrow></mml:math>]FDG-PET/CT in the Detection of Recurrence in Patients with Sporadic and Hereditary Medullary Thyroid Cancer

Skoura, Evangelia; Datseris, Ioannis; Rondogianni, Phivi; Tsagarakis, Stylianos; Tzanela, Marinella; Skilakaki, Maria; Exarhos, Demetrios; Alevizaki, Maria

doi:10.5402/2012/375231

Cited by 23 publications

(19 citation statements)

References 30 publications

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“…Even a low positive detection rate of 18 F-FDG-PET in such patients will affect the management of a significant number of patients. In line with this, Skoura et al [5] reported an overall per-patient sensitivity of 44.1 % in 51 MTC patients with increased Ct The meta-analysis by Treglia et al [4] reported increased detection rates of 18 F-FDG-PET/(CT) of 69 % if CEA was [5 ng/mL, 75 % if Ct was [1,000 ng/L, 76 % if Ct Dt was \12 months and as high as 91 % if CEA Dt was \24 months. In line with this, we observed a strong correlation between elevated tumor marker concentrations and 18 F-FDG PET/CT SUV max [6].…”

supporting

confidence: 66%

supporting

confidence: 54%

“…However, the same trend was observed for fluorine-18 dihydroxyphenylalanine ( 18 F-DOPA) PET/CT [6]. Skoura et al [5] reported a sensitivity of 86.7 % for Ct [1,000 ng/L and Ong et al [7] reported that the sensitivity of 18 F-FDG-PET decreases from 78 % for Ct [1,000 ng/L, to 20 % for Ct \500 ng/L. Many studies have pointed out the importance of tumor marker Dts as compared to single Ct or CEA concentrations.…”

mentioning

confidence: 50%

“…Koopmans et al [8] reported that 18 F-FDG-PET/CT seems superior to 18 F-DOPA-PET/CT if Ct Dt is short (\12 months). Further, detection rate was better with 18 F-FDG-PET/CT compared to 18 F-DOPA-PET/CT in five patients characterized by unstable CEA Dt (\24 months) [5]. Exploration of how Dt correlates with the different imaging techniques has further improved the understanding of the seemingly conflicting results of 18 F-FDG-and 18 F-DOPA-PET/CT imaging.…”

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confidence: 99%

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Is there a role for fluorine-18 fluorodeoxyglucose positron emission tomography imaging in medullary thyroid cancer?

Kauhanen

Schalin‐Jäntti

2012

Endocrine

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Medullary thyroid cancer (MTC) is an uncommon and challenging malignancy. In spite of aggressive primary treatment with total thyroidectomy and modified neck lymph node dissection, approximately 50 % of the patients have persistent or recurrent disease [1,2]. The recent European Thyroid Association guidelines [3] recommend surgery and other local treatment modalities (such as external beam radiation therapy, radiofrequency ablation, and chemoembolization) for the treatment of distant metastases in patients with low tumor burden (distant metastases limited to single organ) and stable disease, while patients with symptoms, significant tumor burden and progressive disease should receive novel targeted systemic therapies. However, imaging of recurrent disease in MTC is difficult and still poses a major problem in the management of the disease.The serum tumor markers calcitonin (Ct) and carcinoembryonic antigen (CEA) and their doubling times (Dt) are used to assess progression rate and also reflect tumor burden in MTC. However, conventional imaging (CI) is often negative in patients with Ct concentrations \150 pg/ mL [3]. It is estimated that CI identifies metastases in about 40 % of patients with biochemical evidence of recurrence. The probability of detecting metastases increases in patients with increasing Ct and CEA concentrations and shortening Dts. Of note, some patients with poorly differentiated and aggressive metastatic MTC have low Ct or discrepantly high CEA concentrations. The recommended CI protocol is extensive and comprises neck ultrasonography for detection of cervical lymph node metastases, computed tomography (CT) of thorax for lung and mediastinal lesions, magnetic resonance imaging (MRI) for liver and bone metastases of the spine and pelvis and bone scintigraphy. Modern whole body imaging with positron emission tomography (PET) and integrated CT could thus represent an alternative to CI, at least for patients with negative CI imaging.In this issue of the Endocrine, Treglia et al.[4] report a meta-analysis consisting of 24 studies comprising altogether 538 patients on the performance of fluorine-18 fluorodeoxyglucose ( 18 F-FDG) PET or PET/CT in detection of recurrent MTC. The pooled detection rate on a per patient-based analysis was 59 % (range 24-95 %). The authors conclude that 18 F-FDG-PET/(CT) is non-optimal in surveillance of MTC since about 40 % of suspected recurrences remain unidentified. Of note, the definition of false negative and true negative imaging results differed. Some considered patients with increased Ct concentrations and negative 18 F-FDG-PET/other imaging as false negative results, while other considered them as true negative. However, a detection rate of 59 % should be related to the corresponding overall detection rates of CI of about 40 %. The current meta-analysis did not present data on whether the 18 F-FDG-PET studies primarily included patients for whom CI remained negative or not. In clinical practice, 18 F-FDG-PET is performed in patients with biochemical proof of re...

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supporting

confidence: 66%

supporting

confidence: 54%

mentioning

confidence: 50%

mentioning

confidence: 99%

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Is there a role for fluorine-18 fluorodeoxyglucose positron emission tomography imaging in medullary thyroid cancer?

Kauhanen

Schalin‐Jäntti

2012

Endocrine

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“…They reported that sensitivity of 18 FDG PET-CT is 75% in patients with the calcitonin level above 1000 pg/ml and 20 to 36.8% when the calcitonin level is 500-1000 pg/ml or below 500 pg/ml. 18 FDG PET-CT has may be of value to evaluate response to applied therapy in cases with progressive disease but there is no diagnostic information for the individual somatostatin-receptor status if PRRT is considered [13].…”

Section: Discussionmentioning

confidence: 99%

SPECT-CT Modality for Imaging of Medullary Thyroid Cancer (MTC)

Sergieva¹,

Atanasova²,

Terziev³

2017

J Nucl Med Radiat Ther

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Medullary thyroid cancer (MTC) is a neuroendocrine tumor that arises from the parafollicular Calcitonin-producing C-cells of the thyroid. Typically the MTC is an extremely slow-growing cancer; however, it has a tendency of spreading distant metastases fairly early. Systemic chemotherapy and external been radiotherapy have not shown to give a good MTC response. As of date radical thyroidectomy is the main method of choice for therapy. New compounds like tyrosine kinase inhibitors (TKIs) targeting signaling pathways may have a positive outcome and be of great clinical benefits in patients with advanced and metastatic MTC. Somatostatin receptor are over expressed in MTC and thus allows the use of radiolabeled somatostatin analogues for scintigraphic imaging before and after treatment for proper staging and follow-up of these patients. SPECT-CT is used to optimize somatostatin-receptor scintigraphic protocols for MTC imaging. We have presented a case report of a patient who underwent total thyroidectomy with bilateral lymphadenectomy in August 2006 due to the diagnosed MTC. This patient was treated by chemotherapy and surgery during the period between January/2007-December/2014 because of the recurrent disease. In December 2014 the calcitonin level reached 56 000 pg/ml; whole body scan with 740 MBq 99m Tc-EDDA/HYNIC-TOC, followed by target SPECT-CT showed a total disease progression with advanced metastatic dissemination into the body. The assigned therapy was with Caprelsa ® (Vandetanib) 300 mg/d orally which was initialized from March 2015 until present. In June 2016 a control SPECT-CT somatostatinreceptor scintigraphy with 740 MBq 99m Tc-Tektrotyd was performed from which was reported a partial disease response with a reduction of about 60% in size and a decrease in the number of metastatic lesions shown to correlated with the decreased calcitonin level up to 1560 pg/ml. It can be concluded that SPECT-CT with 99m TcTektrotyd has important clinical role for re-staging and follow-up of patients with recurrent and metastatic MTC after target therapy.

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