Fluorodeoxyglucose positron emission tomography/computerized tomography in differentiated thyroid cancer management: Importance of clinical justification and value in predicting survival

Marcus, Charles; Antoniou, Alexander; Rahmim, Arman; Ladenson, Paul W.; Subramaniam, Rathan M.

doi:10.1111/1754-9485.12286

Cited by 20 publications

(13 citation statements)

References 25 publications

(30 reference statements)

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“…It has been reported that FDG-PET/CT is also predictive of OS in DTC patients with high serum Tg or with advanced stage cancers, [ 13 , 24 ] while in our study only Tg normalized at short-term follow-up was predictive of OS: the 9-years OS was 100% in patients with Tg normalized at short-term follow-up and 72% in those without ( P < .05). The lack of predictive value of FDG-PET/CT for OS in the our results could be due to the relatively small of number of patients, which should be acknowledged as one of the limitations of our study together with its retrospective nature.…”

Section: Discussioncontrasting

confidence: 48%

“…It is well known that FDG-PET/CT is a useful tool to individuate metastases with higher malignant histological grade, [ 5 ] and thus in our study a positive FDG-PET/CT could represent an indicator of increased aggressiveness predicting relapses. On the other hand, FDG-PET/CT is able to exclude recurrence or metastases [ 24 ] and negative FDG-PET/CT could be predictive of a very good response to therapy. [ 25 ] Similar to our findings, other retrospective studies demonstrated that a negative FDG-PET would predict an excellent outcome despite an elevated Tg value.…”

Section: Discussionmentioning

confidence: 99%

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Prognostic role of FDG PET/CT in patients with differentiated thyroid cancer treated with 131-iodine empiric therapy

et al. 2017

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Background:To assess the long-term prognostic value of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in patients with differentiated thyroid carcinoma (DTC) undergoing empiric radioiodine (RAI) therapy due to raising values of thyroglobulin (Tg).Methods:Forty-nine patients with histological diagnosis of DTC (31 with papillary and 18 with follicular carcinoma) follow-up for a mean period of 7.9 ± 5 years after empiric RAI therapy were retrospectively analyzed.Results:FDG-PET/CT was negative in 15 (30.6%) patients and positive in 34 (69.4%), whereas postradioiodine therapy whole body scan (t-WBS) was negative in 16 (32.7%) and positive in 33 (67.3%) patients. FDG-PET/CT and t-WBS were in agreement in 32 patients (7 both negative and 25 both positive); on the contrary, in 17 patients there was disagreement between FDG-PET/CT and t-WBS (P =ns). At short-term follow-up, Tg normalized in 19 (38.8%) patients and was unchanged or increased in 30 (61.2%). Of the 15 patients with negative FDG-PET/CT, 11 (73.3%) showed Tg normalization, whereas of the 34 patients with positive FDG-PET/CT, only 8 (23.5%) had Tg normalization (χ2 =8.9, P < .005). At multivariate analysis, FDG-PET/CT and Tg normalization at short-term follow-up were independent predictors of disease-free survival (χ2 =26.3, P < .0001), while Tg normalization was the only variable associated with overall survival χ2 =7.2, P < .01).Conclusion:FDG-PET/CT in association with Tg normalization at short-term follow-up may be useful for long-term prognostic stratification in DTC patients.

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Section: Discussioncontrasting

confidence: 48%

Section: Discussionmentioning

confidence: 99%

Prognostic role of FDG PET/CT in patients with differentiated thyroid cancer treated with 131-iodine empiric therapy

et al. 2017

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“…RECIST evaluation after RAI (months) 10.2 ± 1.7 10.8 ± 0.9 9.9 ± 1.3 1.000 or other conventional chemotherapy (Haugen et al, 2016;Ito et al, 2014). During recent years, 18 F-FDG PET/CT parameters have been well studied in DTC (Marcus et al, 2015). Patients with positive 18 F-FDG PET/CT may be considered candidates for surgical intervention or external radiation therapy since FDG-avid lesions have been reported to seldom improve with RAI alone (Bannas et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

Can 18F-fluorodeoxyglucose positron emission tomography predict the response to radioactive iodine therapy in metastatic differentiated thyroid carcinoma?

Zhang

Higuchi

Achmad

et al. 2018

European J Hybrid Imaging

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Background: 131 I radioactive iodine therapy (RAI) has been commonly applied for metastatic differentiated thyroid cancer (DTC) and played an adjunctive role to total thyroidectomy. However, there is no reliable method to predict therapeutic response to RAI in metastatic DTC. Several studies showed potential use of 18 F-fluorodeoxyglucose positron emission tomography (18 F-FDG PET) in lesion detection or therapeutic response prediction of DTC. Thus we aimed to evaluate the feasibility of 18 F-FDG PET for the prediction of therapeutic response to RAI in patients with metastatic DTC. Methods: We retrospectively evaluated 29 adult patients with metastatic DTC who underwent RAI after total thyroidectomy. 18 F-FDG PET/CT was performed within three months before RAI, and the maximum, average and sum of each maximum standardized uptake value (SUV max), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were assessed. Therapeutic response to RAI was categorized into the progressive disease (PD) or non-progressive disease (Non-PD), based on the Response Evaluation Criteria in Solid Tumor (RECIST) 1.1 using pre-and post-therapeutic computed tomography (CT) or magnetic resonance imaging (MRI) images. The area under curve (ROC) analyses were performed to evaluate their predictive potentials of therapeutic response to RAI. Results: Among 29 patients (12 men; median age, 62.4 y.o.; range, 26-81), eight patients were classified into PD and 21 were into Non-PD. PD patients showed a significantly higher maximum, average and sum SUV max , MTV and TLG before RAI, compared to the Non-PD group (p < 0.05). Among all the 18 F-FDG PET/CT parameters, maximum SUV max showed the highest sensitivity and positive predictive value (PPV) in predicting treatment response to RAI. With a cutoff value of 9.12, the highest area under curve (AUC) of 0.98 was obtained to differentiate between PD and Non-PD patients.

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“…In a multivariate Cox regression model, factors associated with overall survival were stage ( P < 0.0001), time to scan ( P = 0.0005) and FDG‐PET/CT result ( P < 0.0001). The authors demonstrated that FDG‐PET/CT, performed at any time after treatment completion, is a significant predictor of overall survival in patients with DTC, especially in patients with advanced stage tumours …”

Section: Prognostic Role Of Fdg‐pet/ct Performed At Restaging/follow mentioning

confidence: 99%

Prognostic role of FDG‐PET/CT in differentiated thyroid carcinoma: Where are we now?

Treglia

Giovanella

2015

J Med Imag Rad Onc

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Differentiated thyroid carcinoma (DTC) is the most common endocrine tumour with an increasing incidence worldwide whereas its mortality is stable or even decreasing. DTC has a relatively good prognosis with mortality rates less than 10%, but with an overall risk of recurrence of about 30%.To date, several studies demonstrated the usefulness of fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET/CT) in patients with DTC. In particular, according to international guidelines, the main application of FDG-PET/CT in DTC exists after thyroidectomy in patients with elevated thyroglobulin level, but negative radioiodine whole-body scan at follow up.An accelerated rate of glucose metabolism mediated by overexpression of key regulatory glycolytic enzymes and glucose transporters (GLUT1) is among the most characteristic biological signature of malignant cells. In thyroid neoplasms, more aggressive and high-grade tumours show an increased uptake of FDG compared with tumours with favourable prognosis. In fact, expression of GLUT1 on the cell membrane is closely related to the grade of malignancy in thyroid neoplasms. 1 As a consequence FDG-PET/CT could be a helpful technique in identifying DTC patients at a higher risk.There has been open debate among the experts about the clinical significance of prognostic information provided by FDG-PET/CT and its impact on DTC management, which is becoming more clearly defined.To date, some papers have assessed the prognostic role of FDG-PET or PET/CT performed at different times in patients with DTC, in particular in predicting disease persistence/progression and/or survival. Prognostic role of FDG uptake in primary DTC incidentally detected by PET/CTAn intense FDG uptake of the primary DTC incidentally detected by PET/CT is associated with persistence/ progression of disease (at Kaplan-Meier analysis), as demonstrated by a recent retrospective multicentre European study. However, when all other prognostic factors have been taken into account through a multivariate analysis, FDG uptake did not add further prognostic information; nevertheless, main conventional predictors could be obtained after surgery only. 2 Prognostic role of FDG-PET/CT performed after primary surgery in patients with DTCIn a recent study, Pace et al. demonstrated that FDG-PET/CT has an independent prognostic role in the postoperative evaluation of DTC, with a better progressionfree survival in patients with a negative scan. In DTC bs_bs_banner

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Fluorodeoxyglucose positron emission tomography/computerized tomography in differentiated thyroid cancer management: Importance of clinical justification and value in predicting survival

Abstract: FDG PET/CT performed in follow-up more than 6 months from primary treatment completion adds value to clinical judgment and a prognostic marker of overall survival in thyroid cancer patients.

Cited by 20 publications

References 25 publications

Prognostic role of FDG PET/CT in patients with differentiated thyroid cancer treated with 131-iodine empiric therapy

Prognostic role of FDG PET/CT in patients with differentiated thyroid cancer treated with 131-iodine empiric therapy

Can 18F-fluorodeoxyglucose positron emission tomography predict the response to radioactive iodine therapy in metastatic differentiated thyroid carcinoma?

Prognostic role of FDG‐PET/CT in differentiated thyroid carcinoma: Where are we now?

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