Prognostic Value of[ 18F]Fluorodeoxyglucose Positron Emission Tomographic Scanning in Patients with Thyroid Cancer*

Abstract

Poorly differentiated thyroid cancer lesions often lose the ability to concentrate radioactive [131I]iodine (RAI) and exhibit increased metabolic activity, as evidenced by enhanced glucose uptake. We incorporated [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET) scanning into the routine follow-up of a cohort of thyroid cancer patients undergoing annual evaluations. One hundred and twenty-five patients who had previous thyroidectomies were included. They had diagnostic RAI whole body scans, serum thyroglobulin measurements, and additional imaging studies as clinically indicated. During 41 months of follow-up, 14 patients died. Univariate analysis demonstrated that survival was reduced in those with age over 45 yr, distant metastases, PET positivity, high rates of FDG uptake, and high volume of the FDG-avid disease (>125 mL). Survival did not correlate with gender, RAI uptake, initial histology, or grade. Multivariate analysis demonstrated that the single strongest predictor of survival was the volume of FDG-avid disease. The 3-yr survival probability of patients with FDG volumes of 125 mL or less was 0.96 (95% confidence interval, 0.91, 1.0) compared with 0.18 (95% confidence interval, 0.04, 0.85) in patients with FDG volume greater than 125 mL. Only 1 death (of leukemia) occurred in the PET-negative group (n = 66). Of the 10 patients with distant metastases and negative PET scans, all were alive and well. Patients over 45 yr with distant metastases that concentrate FDG are at the highest risk. Once distant metastases are discovered in patients with differentiated thyroid carcinoma, FDG-PET can identify high and low risk subsets. Subjects with a FDG volume greater than 125 mL have significantly reduced short term survival.

Management of papillary and follicular (differentiated) thyroid cancer: new paradigms using recombinant human thyrotropin.

“…Multivariate analysis demonstrated that the single strongest predictor of survival with DTC was the volume of FDG-avid disease (Wang et al 2000). Three-year survival of patients with FDG volumes of ͨ125 ml and > 125 ml was respectively 96% and 18%.…”

Rak pęcherzykowy tarczycy z przerzutami do wątroby — diagnostyka, leczenie i prognoza

“…PET constitutes an expensive but effectual instrument in restaging DTC patients with metastatic disease to groups of low (18F-fluoro-2-deoxyglucose (FDG negative) and high risk (FDG positive) of thyroid cancer mortality [42]. Age over 45 years during PET examination, SUV max, distant metastatic processes, and volume of FDG-avid disease emerged as strong survival predictors [43]. In a study by Robbins et al, only initial PET scan was considered, but probably a series of FDG scans could provide a better follow-up of the disease.…”

“…gromadzenie radiojodu w zmianach przerzutowych korelowało ze skróceniem specyficznego dla nowotworu przeżycia [75]. Jak wspomniano wcześniej, wykazano, że brak aktywności 18F-FDG w przerzutach odległych raka zróżnicowanego tarczycy jest korzystny dla dalszej prognozy [43,75,76]. W pooperacyjnej ocenie nowotworów zróżnicowanych tarczycy, PET z użyciem 18F-FDG stanowi czułe narzędzie w diagnozowaniu przerzutów odległych, jednakże negatywny wynik badania PET nie wyklucza istnienia niefunkcjonalnych, przerzutowych zmian.…”

New Treatments and Shifting Paradigms in Differentiated Thyroid Cancer Management

“…[3][4][5] Options for disease control are limited for these patients. Additional therapeutic options are necessary, and molecular targets have been identifi ed with some success in stabilizing this aggressive form of thyroid cancer.…”

“…2 However, 10% of low-risk thyroid cancers and 25% of high-risk thyroid cancers recur, with mortality rates in excess of 50% for aggressive forms of thyroid cancer. [3][4][5] Traditionally, recurrence or persistence of dis- ease after thyroidectomy and RAI has led to additional treatment with I 131 with successive decrease in effi cacy, an increase in side effects of therapy, and the development of secondary radiation-infl uenced cancers. 6,7 Risk stratifi cation strategies and outcomes data have begun to shift the traditional paradigms of treatment, and the advent of new therapeutic strategies targeting key pathways in growth and survival of cancer cells has opened the opportunity for alternate therapies in treating thyroid cancer.…”