Do histological, immunohistochemical, and metabolic (radioiodine and fluorodeoxyglucose uptakes) patterns of metastatic thyroid cancer correlate with patient outcome?

Abstract

The aim of this study is to search for relationships between histology, radioiodine ( 131 I) uptake, fluorodeoxyglucose (FDG) uptake, and disease outcome in patients with metastatic thyroid cancer. Eighty patients with metastatic thyroid cancer (34 males, 46 females, mean age at the time of the diagnosis of metastases: 55 years) were retrospectively studied. All patients were treated with radioactive iodine and evaluated by FDG-positron emission tomography (PET). Primary tumor tissue sample was available in all cases. Forty-five patients (56%) had a papillary, 12 (15%) a follicular, and 23 (29%) a poorly differentiated thyroid cancer. Cellular atypias, necrosis, mitoses, thyroid capsule infiltration, and vascular invasion were frequently detected (70, 44, 52, 60, and 71% respectively). Metastases disclosed FDG uptake in 58 patients (72%) and 131 I uptake in 37 patients (45%). FDG uptake was the only significant prognostic factor for survival (PZ0.02). The maximum standardized uptake value and the number of FDG avid lesions were also related to prognosis (PZ0.03 and 0.009). Age at the time of the diagnosis of metastases (PZ0.001) and the presence of necrosis (PZ0.002) were independent predictive factors of FDG uptake. Radioiodine uptake was prognostic for stable disease (PZ0.001) and necrosis for progressive disease at 1 year (PZ0.001). Histological subtype was not correlated with in vivo tumor metabolism and prognosis. In conclusion, FDG uptake in metastatic thyroid cancer is highly prognostic for survival. Histological subtype alone does not correlate with 131 I/FDG uptake pattern and patient outcome. Well-differentiated thyroid cancer presenting histological features such as necrosis and FDG uptake on PET scan should be considered aggressive differentiated cancers.

Treatment of refractory thyroid cancer

“…Fluoro-Deoxyglucose (FDG) PET is performed in patients with distant metastases for several reasons: it may 84 reveal metastases without RAI uptake that are not visible on RAI-WBS, including in bones; RAI treatment is 85 less effective in patients with metastatic uptake of FDG and FDG uptake indicates more aggressive disease 86 (Deandreis, et al 2011a;Nascimento, et al 2015;Rivera, et al 2008;Robbins, et al 2006). However, some 87 tumor responses have been observed in patients with both RAI and FDG uptake in their metastases and the 88 decision not to treat with RAI should not be based only on the presence or intensity of FDG uptake; 89 furthermore, in a given patient, metastases with the highest FDG uptake do not have a more aggressive 90 behavior than the other metastases (Terroir, et al 2017).…”

“…However, some 87 tumor responses have been observed in patients with both RAI and FDG uptake in their metastases and the 88 decision not to treat with RAI should not be based only on the presence or intensity of FDG uptake; 89 furthermore, in a given patient, metastases with the highest FDG uptake do not have a more aggressive 90 behavior than the other metastases (Terroir, et al 2017). in those with small pulmonary metastases, who had a well-differentiated cancer and who have no or low 98 FDG uptake (Deandreis et al 2011a;Durante et al 2006;Rivera et al 2008;Robbins et al 2006). Relapse 99 after complete response occurred in less than 10% of patients, even though serum Tg levels were 100 persistently detectable in some patients (Durante et al 2006).…”

Radioactive iodine-refractory differentiated thyroid cancer: an uncommon but challenging situation

“…However, the decision to abandon RAI therapy should not be based only on the presence or intensity of 18 FDG uptake (14)(15)(16)(17).…”

The use of 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography in patients with differentiated thyroid cancer after initial treatment

“…Общий объем ФДГ-позитивных очагов, SUV max , а также количество и расположение метастазов связа-ны с исходом и выживаемостью у пациентов с ДРЩЖ [37,38]. D. Deandreis и соавт., проанализировав дан-ные 80 пациентов с метастатическим РЩЖ, сделали вывод, что только накопление ФДГ является значи-тельным прогностическим фактором для выживаемо-сти (р = 0,02) [38].…”

“…D. Deandreis и соавт., проанализировав дан-ные 80 пациентов с метастатическим РЩЖ, сделали вывод, что только накопление ФДГ является значи-тельным прогностическим фактором для выживаемо-сти (р = 0,02) [38].…”