The role of FDG-PET/CT in differentiated thyroid cancer patients with negative iodine-131 whole-body scan and elevated anti-Tg level

Asa, Sertaç; Aksoy, Şemsi Mustafa; Vatankulu, Betül; Aliyev, Anar; Uslu, Lebriz; Ozhan, Meftune; Sağer, Sait; Halaç, Metin; Sönmezoğlu, Kerim

doi:10.1007/s12149-014-0897-7

Cited by 21 publications

(26 citation statements)

References 33 publications

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“…In differentiated thyroid carcinoma (DTC) patients with negative 131 I whole-body scan ( 131 I WBS) and detectable thyroglobulin (Tg) levels during follow-up, a fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan plays an important role in localizing disease [11,12]. In patients with high-risk thyroid cancer, the role of the 18 F-FDG PET/CT scan has expanded to initial staging, prognostic evaluation, and assessment of treatment response [8].…”

Section: Introductionmentioning

confidence: 99%

The role of early 18F-FDG PET/CT in therapeutic management and ongoing risk stratification of high/intermediate-risk thyroid carcinoma

et al. 2015

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Little is known about the role in ongoing risk stratification of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) performed early after radioactive iodine (RAI) ablation in differentiated thyroid carcinoma (DTC). The aim of the study is to investigate whether 18F-FDG PET/CT performed early after RAI ablation is useful to detect disease and to influence therapy and ongoing risk stratification. Patients with high/intermediate risk of recurrent DTC were included. 18F-FDG PET/CT scan was performed within 6 months after RAI ablation. We confirmed results with other imaging techniques, pathology reports, or follow-up. We classified the patient response as excellent, acceptable, or incomplete. Modified Hicks criteria were used to evaluate clinical impact. We included 81 patients with high/intermediate risk of recurrent DTC. Forty-one (50.6%) had positive uptake in 18F-FDG PET/CT, with negative (131)I whole-body scan ((131)I WBS). Sensitivity, specificity, and diagnostic accuracy of 18F-FDG PET/CT were 92.5, 90.2, and 91.4%, respectively. 18F-FDG PET/CT results had an impact on therapy in 38.3% of patients. One year after initial therapy, 45.7% showed excellent response, 8.6% acceptable response, and 45.7% incomplete response. A statistically significant relationship was found between negative 18F-FDG PET/CT and excellent response (80 vs. 12.2%, p < 0.001; OR 52.8). 18F-FDG PET/CT scan performed early in surveillance of patients with high/intermediate-risk thyroid carcinoma provides important additional information not available with conventional follow-up methods and had a high impact on therapy. A negative 18F-FDG PET/CT predicts an excellent response to therapy in the new ongoing risk stratification.

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Section: Introductionmentioning

confidence: 99%

The role of early 18F-FDG PET/CT in therapeutic management and ongoing risk stratification of high/intermediate-risk thyroid carcinoma

et al. 2015

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“…also demonstrated the same results. Asa et al 16. reported that 18 F-FDG PET/CT could be an effective alternative in the detection of recurrence or metastasis, and to resolve the TgAb controversy for such patients.…”

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confidence: 99%

Serum midkine as a surrogate biomarker for metastatic prediction in differentiated thyroid cancer patients with positive thyroglobulin antibody

Jia

Meng

et al. 2017

Sci Rep

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Serum thyroglobulin (Tg) is the main post-operative tumor biomarker for patients with differentiated thyroid cancer (DTC). However, the presence of thyroglobulin antibodies (TgAb) can interfere with Tg level and invalidate the test. In this study, we aimed to investigate the predicative value of midkine (MK) as a cancer biomarker for DTC patients with positive TgAb before the first 131I therapy. MK levels were measured by enzyme-linked immunosorbent assay in 151 recruited DTC patients after exercising strict inclusion and exclusion criteria. There were 28 TgAb positive DTC patients with metastases and 123 DTC patients without metastases. The value of pre-131I-ablative MK to predict metastasis was assessed by receiver operating characteristic (ROC) curves in these two groups of patients. MK levels in the TgAb positive DTC patients were significantly higher than the DTC patients without metastases. ROC showed good predictability of MK, with an area under the curve of 0.856 (P < 0.001), and a diagnostic accuracy of 83% at the optimal cut-off value of 550 pg/ml. In conclusion, we show that MK can potentially be used as a surrogate biomarker for predicting DTC metastases when Tg is not suitable due to TgAb positivity.

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“…This is contrary to the findings of Schluter et al [14], who reported a positive scan in 11% of patients with Tg levels of 10 ng/ml or less, increasing to 50% when Tg levels were between 10 and 20 ng/ml, and rising to 93% at Tg levels above 100 ng/ml. In a study of 40 patients with negative 131 I scans and elevated TgAb levels, Asa et al [15] reported a positive 18 F-FDG PET/CT in 50% and concluded that 18 F-FDG PET/CT can be used effectively in the detection of recurrence/metastasis during follow-up.…”

Section: Discussionmentioning

confidence: 99%

Can the American Thyroid Association Risk of Recurrence Predict Radioiodine Refractory Disease in Differentiated Thyroid Cancer?

Hassan¹,

Riaz²,

Bashir³

et al. 2016

Eur Thyroid J

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Objective: The aim of this study was to compare the TNM staging system and the American Thyroid Association (ATA) recurrence risk classification in predicting radioiodine refractory disease (RRD) in differentiated thyroid cancer (DTC) and to analyze the correlation of stimulated thyroglobulin (Tg) levels and rate of Tg elevation with the standardized uptake value on ¹⁸F-fludeoxyglucose (FDG) PET/CT scan. Methods: RRD was indicated through the retrospective analysis of consecutive ¹⁸F-FDG PET/CT scans in DTC with stimulated Tg >10 ng/ml and negative ¹³¹I NaI whole-body scans (WBS). Tg elevation velocity was compared to the likelihood of a positive scan. The ATA recurrence risk and TNM staging system were compared to see which of them better predicted the subsequent development of RRD. Results: Fifty-eight of 636 subjects developed RRD: 52 papillary and 6 follicular thyroid cancer. The median time between diagnosis and a negative WBS was 24 months (range 12-240). RRD developed in 11 low-risk, 32 intermediate-risk and 15 high-risk patients. A better response to therapy was seen in the low-risk versus the intermediate- and high-risk groups. ¹⁸F-FDG PET/CT scans had a diagnostic accuracy of 94.8%, sensitivity of 97.7%, specificity of 85.7%, positive predictive value of 95.6% and negative predictive value of 92%. There was no correlation between the Tg level or rate of rise and a positive scan. Overall, PET-CT upstaged 18 (31%) cases, leading to a change in management in 20 (35%) cases. Conclusion: The TNM and ATA staging systems show no significant difference in predicting the development of RRD. RRD is less likely in stage I, II and low-risk patients. There is no correlation between the level or rate of Tg rise and a positive ¹⁸F-FDG PET/CT scan.

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The role of FDG-PET/CT in differentiated thyroid cancer patients with negative iodine-131 whole-body scan and elevated anti-Tg level

Cited by 21 publications

References 33 publications

The role of early 18F-FDG PET/CT in therapeutic management and ongoing risk stratification of high/intermediate-risk thyroid carcinoma

The role of early 18F-FDG PET/CT in therapeutic management and ongoing risk stratification of high/intermediate-risk thyroid carcinoma

Serum midkine as a surrogate biomarker for metastatic prediction in differentiated thyroid cancer patients with positive thyroglobulin antibody

Can the American Thyroid Association Risk of Recurrence Predict Radioiodine Refractory Disease in Differentiated Thyroid Cancer?

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