Intense 18-fluorodeoxyglucose uptake by the thymus on PET scan does not necessarily herald recurrence of thyroid carcinoma

Godart, V.; Weynand, Birgit; Coche, Edgard; Nayer, Philippe De; Daumerie, Chantal

doi:10.1007/bf03345343

Cited by 9 publications

(4 citation statements)

References 28 publications

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“…Later, Michigishi et al described 131 I-WBS, and demonstrated strong thymic uptake on histologically confirmed hyperplastic thymic tissue after RIAT for thyroid cancer (11). After additional reports regarding thymic uptake of 131 I (19,20), Godart et al reported intense uptake of FDG in thymic hyperplasia after thyroid surgery (21). However, these are all case reports, and there has been no large population study of RTHP related to RIAT.…”

Section: Discussionmentioning

confidence: 85%

Rebound Thymic Hyperplasia Detected by¹⁸F-FDG PET/CT After Radioactive Iodine Ablation Therapy for Thyroid Cancer

Jeon

Lee

et al. 2014

Thyroid

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Background: Rebound thymic hyperplasia (RTHP) is not an uncommon finding after radiation or chemotherapy in patients with various malignancies. However, there are limited case reports of this phenomenon after radioactive iodine ablation therapy (RIAT) in differentiated thyroid cancer (DTC). The goal of this study was to evaluate the incidence, patterns, and factors affecting RTHP after RIAT using 18 F-FDG PET/CT. Methods: The study design was a retrospective review of 2550 patients (568 men, 1982 women; age 13-79 years) who underwent FDG PET/CT imaging after total thyroidectomy and RIAT from June 2009 through June 2012. Patients were divided into four age-related subgroups. Overall incidence, age-related incidences, and sex distribution were evaluated in patients with thymic FDG uptake on PET/CT (RTHP + ). The correlation between incidence of RTHP and age was assessed using the Cochran-Armitage trend test. The Wilcoxon rank-sum test and multiple regression were applied to investigate the effect of applied dose of radioactive iodine (RAI) and age on the incidence of RTHP. Correlations of standardized uptake value (SUV) and thymic volume with age and morphologic type were also evaluated. Results: Overall incidence of RTHP after RIAT was 1.49%, and all of the RTHP + patients except one were female. The Cochran-Armitage trend test revealed significantly decreased incidence from the second to fifth decade (8.84%, 1.74%, 0.98%, and 0.39% respectively; p < 0.001). In each age-related subgroup, the RAI dose was significantly higher in the RTHP + than RTHP -group ( p < 0.001), while there was no difference in RAI dose in RTHP + patients among age-related subgroups ( p = 0.838). SUV mean and SUV max of RTHP revealed no meaningful correlation with RAI dose or age. There were no differences among morphologic patterns of RTHP in age distribution and ablation dose. Conclusions: RTHP after RIAT showed a strong female predominance, despite the higher administration dose of RAI in male patients. Although the decreased incidence of RTHP after RIAT with age is similar to the pattern of RTHP induced by other causes, the fact that older patients, even sixth decade patients, can present with RTHP after RIAT is noteworthy in the management of DTC.

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Section: Discussionmentioning

confidence: 85%

Rebound Thymic Hyperplasia Detected by¹⁸F-FDG PET/CT After Radioactive Iodine Ablation Therapy for Thyroid Cancer

Jeon

Lee

et al. 2014

Thyroid

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“…67 Because recent surgery induces inflammation and FDG uptake, PET scanning should be performed, if possible, at least 3 months after surgical procedures.…”

Section: -100 >100mentioning

confidence: 99%

The role of PET in follow-up of patients treated for differentiated epithelial thyroid cancers

et al. 2007

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This article provides an update on the use of 2-[(18)F]-fluoro-2-deoxyglucose PET in the follow-up of patients treated for differentiated thyroid carcinoma (DTC). Although DTC recurrence is principally identified by a detectable basal or TSH-stimulated thyroglobulin level, PET helps to localize recurrent disease in patients with normal (131)I total-body scans and other normal anatomic imaging studies. The sensitivity of PET for localization of recurrence ranges from 45% to 100% according to tumor burden and differentiation. Whether PET should be performed after TSH stimulation is unclear, but several studies have reported an increase in the number of lesions detected by uptake of 2-[(18)F]-fluoro-2-deoxyglucose in this setting. Dependent on a center's approach, PET can alter therapeutic management in 9-51% of cases. Furthermore, PET might have a prognostic impact on survival in patients with metastatic disease and aid clinicians in selecting patients who need closer follow-up or aggressive treatment. PET can, therefore, be used advantageously in the follow-up of patients with DTC and can localize disease in patients with elevated thyroglobulin levels, normal total-body scans, and normal findings on conventional imaging modalities. In patients in whom local treatment is planned, especially those with aggressive pathologic variants of thyroid cancer, PET can exclude distant metastases. In patients with metastatic disease, PET can help to identify patients needing closer follow-up.

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“…The understanding of the 99m Tc-3PRGD2 imaging appearance of thymic hyperplasia and its association with increased serum Tg level is important for preventing misdiagnosis of metastatic disease and avoiding unnecessary treatment, such as surgery or radioiodine therapy [ 38 , 39 ]. Further longitudinal studies are needed to confirm that the hyperplastic thymic with activated angiogenesis does not necessarily herald recurrence and metastasis of DTC [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

Hyperplastic thymus with increased angiogenesis is correlated with elevated serum thyroglobulin level in differentiated thyroid cancer patients with TENIS syndrome

et al. 2017

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AimsTo investigate the association between angiogenetic activity of hyperplastic thymus and serum thyroglobulin (Tg) level in differentiated thyroid carcinoma patients with thyroglobulin (Tg)-elevated Negative Iodine Scintigraphy (TENIS) Syndrome.MethodsA cohort of 30 consecutive patients who underwent total thyroidectomy followed by radioiodine ablation and had TENIS syndrome received integrin αvβ3 targeted imaging with 99mTc-HYNIC-PEG4-E[PEG4-c(RGDfk)]2 (99mTc-3PRGD2). The correlation of angiogenetic activity of the thymus and the serum Tg levels was evaluated in patients with enlarged thymus.ResultsEnlarged thymus was detected in 9 out of the 30 TENIS patients and all hyperplastic thymus showed an increased accumulation of the tracer (median tumor/background ratio: 2.8). Five of them had only mediastinal uptake and surgical removal of the mediastinal mass in one provided histopathologic evidence of thymic tissue. The other four were not assigned further treatment and were free of disease in the follow-up, though their stimulated Tg levels consistently increased. Four out of the 9 patients showed 99mTc-3PRGD2 uptake outside the mediastinum were assigned surgery followed by radioiodine treatment. Their stimulated Tg levels decreased after iodine ablation, but not drop back to normal. A significant linear correlation was observed between serum Tg levels and the degree of angiogenesis in the hyperplastic thymus.ConclusionsThe angiogenetic activity in hyperplastic thymus was related with the consistently elevated serum Tg levels in TENIS syndrome patients. Based on the existing literature and current data, we propose further intervention for patients with RGD uptake outside thymus, while close follow-up for patients with only mediastinal uptake.

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Intense 18-fluorodeoxyglucose uptake by the thymus on PET scan does not necessarily herald recurrence of thyroid carcinoma

Cited by 9 publications

References 28 publications

Rebound Thymic Hyperplasia Detected by¹⁸F-FDG PET/CT After Radioactive Iodine Ablation Therapy for Thyroid Cancer

Rebound Thymic Hyperplasia Detected by¹⁸F-FDG PET/CT After Radioactive Iodine Ablation Therapy for Thyroid Cancer

The role of PET in follow-up of patients treated for differentiated epithelial thyroid cancers

Hyperplastic thymus with increased angiogenesis is correlated with elevated serum thyroglobulin level in differentiated thyroid cancer patients with TENIS syndrome

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Intense 18-fluorodeoxyglucose uptake by the thymus on PET scan does not necessarily herald recurrence of thyroid carcinoma

Cited by 9 publications

References 28 publications

Rebound Thymic Hyperplasia Detected by18F-FDG PET/CT After Radioactive Iodine Ablation Therapy for Thyroid Cancer

Rebound Thymic Hyperplasia Detected by18F-FDG PET/CT After Radioactive Iodine Ablation Therapy for Thyroid Cancer

The role of PET in follow-up of patients treated for differentiated epithelial thyroid cancers

Hyperplastic thymus with increased angiogenesis is correlated with elevated serum thyroglobulin level in differentiated thyroid cancer patients with TENIS syndrome

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Rebound Thymic Hyperplasia Detected by¹⁸F-FDG PET/CT After Radioactive Iodine Ablation Therapy for Thyroid Cancer

Rebound Thymic Hyperplasia Detected by¹⁸F-FDG PET/CT After Radioactive Iodine Ablation Therapy for Thyroid Cancer