F-18 FDG-PET/CT Evaluation of Patients With Differentiated Thyroid Cancer With Negative I-131 Total Body Scan and High Thyroglobulin Level

Bertagna, Francesco; Bosio, Giovanni; Biasiotto, Giorgio; Rodella, Carlo; Puta, Erinda; Gabanelli, Sara Vincenzina; Lucchini, Silvia; Merli, Giuseppe; Savelli, Giordano; Giubbini, Raffaele; Rosenbaum, Joshua; Alavi, Abass

doi:10.1097/rlu.0b013e3181b7d95c

Cited by 65 publications

(49 citation statements)

References 39 publications

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“…In the context of known non-iodine-avid oligometastases, the detection of additional sites of disease is a pivotal issue in the decision-making process regarding resection. 18 F-FDG PET has been shown to be an effective tool for detecting thyroid cancer recurrence or metastases [8][9][10][11][12][13][14][15][16][17]. A recent meta-analysis of 17 studies between 1990 and 2008 including a total of 571 patients found an overall sensitivity for PET of 0.835 (95% CI 0.791-0.873) and specificity of 0.843 (95% CI 0.791-0.886) [22].…”

Section: Discussionmentioning

confidence: 99%

“…In order to make an estimate of the accuracy of PET-CT we adopted a cut-off for defining a true-negative PET-CT scan as a negative scan and no rise in thyroglobulin over at least a 12-month period following the scan with no clinical or radiological evidence of disease. Although similar to the methodology of other series [8,11,13,17,25], this definition is limited by the often indolent nature of thyroid cancer, along with the ability of exogenous thyroid hormonemediated TSH suppression to limit disease progression. It is a common clinical experience that a low level of thyroglobulin may persist for many years without any evidence of progression and negative imaging; in this situation it is not possible to be dogmatic regarding the source of the thyroglobulin.…”

Section: Discussionmentioning

confidence: 99%

“…A key difficulty in interpreting this series, and others [8,11,13,17,25], is in interpreting the disease status of patients who have a raised thyroglobulin level with negative imaging, including radioiodine whole-body scintigraphy and PET-CT. In order to make an estimate of the accuracy of PET-CT we adopted a cut-off for defining a true-negative PET-CT scan as a negative scan and no rise in thyroglobulin over at least a 12-month period following the scan with no clinical or radiological evidence of disease.…”

Section: Discussionmentioning

confidence: 99%

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Increasing the yield of recombinant thyroid-stimulating hormone-stimulated 2-(18-fluoride)-flu-2-deoxy-D-glucose positron emission tomography-CT in patients with differentiated thyroid carcinoma

Prestwich

Viner²,

Gerrard³

et al. 2012

BJR

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Objective: The aim of this study was to assess the accuracy of recombinant thyroidstimulating hormone (rTSH)-stimulated 2-(18-fluoride)-flu-2-deoxy-D-glucose ( Results: 58 rTSH PET-CT scans were performed in 47 patients with a previous thyroidectomy and radioiodine ablation. The only indication for PET-CT was a raised thyroglobulin level in 46 of 58 scans, with the remainder for characterisation of equivocal radiology or staging. 25 (43%) of PET-CT scans were positive for recurrent disease. Histological correlation was available for 21 (36%) scans. The overall sensitivity, specificity, positive predictive value and negative predictive value were 69%, 76%, 72% and 73%, respectively. Median unstimulated thyroglobulin in true-positive scans was 33 mg l 21 and 2.2 mg l 21 in the remainder (p50.12). 4 of 35 (11%) patients with unstimulated thyroglobulin levels ,10 mg l 21 had true-positive scans. Median stimulated thyroglobulin in true-positive scans was 320 mg l 21, and 10 mg l 21 in the remainder (p50.046), with no positive scans with a stimulated thyroglobulin ,8 mg l 21. PET-CT directly influenced patient management in 17/58 (29%) scans. Conclusion: rTSH PET-CT is a useful imaging technique for detecting disease recurrence in patients with iodine-resistant differentiated thyroid cancer. Low stimulated thyroglobulin levels are potentially useful in identifying patients unlikely to benefit from a PET-CT scan.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Increasing the yield of recombinant thyroid-stimulating hormone-stimulated 2-(18-fluoride)-flu-2-deoxy-D-glucose positron emission tomography-CT in patients with differentiated thyroid carcinoma

Prestwich

Viner²,

Gerrard³

et al. 2012

BJR

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“…Bertagna et al reported that F-18 FDG PET/CT positive results correlated with the serum thyroglobulin level in patients with negative I-131 whole body scan and high serum thyroglobulin level. They also reported that F-18 FDG PET/CT showed highest accuracy when the patient's thyroglobulin level was higher than 21 ng/mL (Bertagna et al, 2009). In addition to that, they also revealed that the levothyroxine therapy regimen does not influence F-18 FDG PET/CT results.…”

Section: F-18 Fluorodeoxyglucose Pet/ctmentioning

confidence: 99%

Post-Therapeutic I-131 Whole Body Scan in Patients with Differentiated Thyroid Cancer

Song¹,

Chong²

2011

12 Chapters on Nuclear Medicine

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“…Furthermore there are reports on the use of 99mTc-MIBI imaging in post-surgical evaluation of thyroid cancer, for residual tumor localization, especially when the 131I-Na whole-body scan is negative with detectable values of thyroglobulin [2]. However, this indication has been almost completely replaced by 18F-FDG PET/CT imaging [3].Treglia and colleagues reported the results of 21 studies, accurately selected by rigorous methodology out of 690 articles. The 21 pooled studies included nearly two thousand patients.…”

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confidence: 99%

99mTc-MIBI imaging in thyroid nodules: Is it useful?

Giubbini

Bertagna

2014

Endocrine

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Treglia et al. [1] have recently proposed a meta-analysis evaluating the diagnostic performance of 99mTc-MIBI scan in predicting the malignancy of thyroid nodules.99m-Tc is registered and adopted worldwide for myocardial perfusion imaging and for the diagnostic work-up of hyperparathyroidism. Furthermore there are reports on the use of 99mTc-MIBI imaging in post-surgical evaluation of thyroid cancer, for residual tumor localization, especially when the 131I-Na whole-body scan is negative with detectable values of thyroglobulin [2]. However, this indication has been almost completely replaced by 18F-FDG PET/CT imaging [3].Treglia and colleagues reported the results of 21 studies, accurately selected by rigorous methodology out of 690 articles. The 21 pooled studies included nearly two thousand patients. They have demonstrated that the 99mTc-MIBI scintigraphy has good sensitivity, although suboptimal specificity, in predicting histological malignancy of thyroid nodules. These results offer a solid background for considering the clinical usefulness of 99mTc-MIBI imaging in a clinical setting.No indications to perform a 99mTc-MIBI scintigraphy are reported in guidelines or algorithms of diagnostic workup of thyroid nodules [4], that is mainly based on the wide use of ultrasounds and cytology after echo-guided fineneedle aspiration (FNA).The question that the paper of Treglia rises is related to the additional value, if any, of molecular imaging by 99mTc-MIBI over the traditional, standardized patient work-up.FNA is frequently inconclusive when Class 3 follicularpatterned lesions are detected, including follicular neoplasms, Hürthle cell lesions, and the follicular variant of PTC. In centers with specific experience in thyroid cytology, follicular cytologic findings may be further subdivided into ''follicular lesion/atypia of undetermined significance'' and ''follicular neoplasm.'' This distinction separates two cytologic groups at different risks for thyroid malignancy but with the same operative indications [4]. Preliminary data seem to demonstrate that (99m)Tc-MIBI scintigraphy is an adjunctive method to predict preoperatively the malignant behavior of nononcocytic follicular thyroid nodules indeterminate at FNA biopsy [5], whereas it does not show same accuracy in Hürthle cell tumors [6,7]. Further, multicenter studies are required to accept this hypothesis. This is a crucial point in the diagnosis of thyroid nodules as other techniques fail to offer meaningful results. In a recent study aimed to determine the rate of malignancy and the ultrasonographic features that could be used as predictor of malignant pathologies at the nodules with indeterminate cytology, Tutuncu et al. [8] have seen that ultrasound is not accurate enough to exclude malignancy in this high-risk population. Our group has recently analyzed the clinical significance of thyroid focal uptake of 18F-FDG in patients who underwent PET/CT for nonthyroid diseases [9]. Two hundred and eleven patients (28.9 %) underwent further investigation to determi...

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F-18 FDG-PET/CT Evaluation of Patients With Differentiated Thyroid Cancer With Negative I-131 Total Body Scan and High Thyroglobulin Level

Cited by 65 publications

References 39 publications

Increasing the yield of recombinant thyroid-stimulating hormone-stimulated 2-(18-fluoride)-flu-2-deoxy-D-glucose positron emission tomography-CT in patients with differentiated thyroid carcinoma

Increasing the yield of recombinant thyroid-stimulating hormone-stimulated 2-(18-fluoride)-flu-2-deoxy-D-glucose positron emission tomography-CT in patients with differentiated thyroid carcinoma

Post-Therapeutic I-131 Whole Body Scan in Patients with Differentiated Thyroid Cancer

99mTc-MIBI imaging in thyroid nodules: Is it useful?

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