Utility of fluorine-18-fluorodeoxyglucose positron emission tomography in differentiated thyroid carcinoma with negative radioiodine scans and elevated serum thyroglobulin levels

Muros, M.A.; Elvira, J.M. Llamas; Ramírez-Navarro, A.; Gómez, M.J. Acosta; Rodrı́guez-Fernández, Antonio; Muros, Teresa; Torre, Martín López de la; Becerra, A.; Carreras, José

doi:10.1016/s0002-9610(00)00381-0

Cited by 71 publications

(20 citation statements)

References 15 publications

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“…Patients who at the 6-to 12-month follow-up have detectable rhTSH-stimulated Tg levels and abnormalities on other evaluation methods or rhTSH-stimulated Tg above the institutional cut-off also should receive such management. If the posttherapy WBS does not show any uptake, other imaging modalities may be employed: spiral computed tomography of the neck and chest, bone scintigraphy and [ 18 F]fluorodeoxyglucose positron emission tomography (FDG-PET) (33). FDG-PET may be more sensitive when performed following rhTSH stimulation (43).…”

Section: Subsequent Follow-up and Managementmentioning

confidence: 99%

Follow-up of low-risk patients with differentiated thyroid carcinoma: a European perspective

et al. 2004

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Objective: Because differentiated (follicular and papillary) thyroid cancer (DTC) may recur years after initial treatment, the follow-up of patients with DTC is long term. However, this population has changed, with more individuals being discovered at an earlier stage of the disease, so that previous follow-up protocols based mostly on data from high-risk patients no longer apply. We sought to develop an improved protocol for the follow-up of low-risk patients with DTC based on the findings of recent studies. Methods: We analysed recent literature on the follow-up of DTC. Results: Recent large studies have produced three important findings: (i) in patients with low-risk DTC with no evidence of disease up to the 6-to 12-month follow-up, diagnostic whole-body scan adds no information when serum thyroglobulin (Tg) is undetectable and interference from anti-Tg antibodies is absent; (ii) use of recombinant human thyroid-stimulating hormone to aid Tg measurement is effective and provides greater safety, quality-of-life and work productivity than does levothyroxine withdrawal with its attendant hypothyroidism; and (iii) ultrasonography performed by an experienced operator is the most sensitive means of detecting neck recurrences of DTC. Conclusions: We present a revised follow-up protocol for low-risk patients taking into account the above findings. This protocol should help clinicians enter a new era of monitoring characterized by greater safety, simplicity, convenience and cost savings.

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Section: Subsequent Follow-up and Managementmentioning

confidence: 99%

Follow-up of low-risk patients with differentiated thyroid carcinoma: a European perspective

et al. 2004

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“…Early detection of DTC relapse in these patients significantly increases the possibility of an effective treatment, especially in a case of local recurrence or single metastases amendable for surgery. In a patient with elevated serum Tg level, negative WBS and normal results of imaging studies fluorodeoxyglucose-positron emission tomography (FDG-PET) may be considered (6,7,8). It is in fact an examination dedicated for the diagnostics of other types of cancer that, in contrary to DTC, show a high dynamics and rapid cell divisions.…”

Section: Introductionmentioning

confidence: 99%

The role of FDG-PET in localization of recurrent lesions of differentiated thyroid cancer (DTC) in patients with asymptomatic hyperthyroglobulinemia in a real clinical practice

Kukulska

Krajewska

Kołosza

et al. 2016

European Journal of Endocrinology

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Introduction: Available methods, including serum thyroglobulin (Tg) measurement and whole-body scan (WBS) performed after radioiodine administration, allow for a precise diagnostics in differentiated thyroid cancer (DTC). However, some asymptomatic patients demonstrate negative WBS despite a high Tg serum concentration. In these subjects, fluorodeoxyglucose-positron emission tomography (FDG-PET) should be considered. The primary aim of our study was to evaluate a diagnostic value of FDG-PET in asymptomatic hyperthyroglobulinemia. The secondary one was to determine a prognostic value of a negative FDG-PET result in DTC patients with elevated Tg level. Material: One hundred and ten FDG-PET/CT scans were retrospectively analyzed, 85 scans were done under TSH stimulation and 25 on LT 4 suppressive therapy. Follow-up ranged between 4 and 9 years. Results: The first FDG-PET/CT detected cancer foci in 49 subjects with a global sensitivity of 45%. When the sensitivity was evaluated with reference to TSH stimulation and suppression, its values were 50 and 28% respectively. In 42 patients, FDG-PET failed to diagnose the reason for elevated Tg level. During further follow-up, in 17 of them, DTC recurrence was detected by other methods (CT, MRI, US). Fourteen subjects with asymptomatic hyperthyroglobulinemia were free of DTC progression for at least 4 years. Conclusions: FDG-PET in DTC patients with asymptomatic hyperthyroglobulinemia constitutes a valuable diagnostic tool. Negative FDG-PET demonstrated a limited prognostic significance, as only every third patient did not show DTC progression. Moreover, negative FDG-PET does not justify less strict DTC monitoring, because it is related to 40% risk of relapse during the 5-year follow-up.

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“…The 10-y survival rate of DTC is .80% because of treatments such as total thyroidectomy and ablation of remnants with radioiodine (13). However, metastases of thyroid carcinoma develop in 7%-23% of patients; the distant metastases occur commonly in the lungs, bones, and brain, and bones are the second common site of metastases from thyroid carcinoma (14).Several earlier reports showed that 18 F-FDG PET is highly sensitive in detecting DTC and is particularly useful for the evaluation of patients with negative radioactive iodine scintigraphy and elevated thyroglobulin levels (15)(16)(17)(18)(19)(20). For the detection of bone metastases of thyroid…”

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confidence: 99%

“…Several earlier reports showed that 18 F-FDG PET is highly sensitive in detecting DTC and is particularly useful for the evaluation of patients with negative radioactive iodine scintigraphy and elevated thyroglobulin levels (15)(16)(17)(18)(19)(20). For the detection of bone metastases of thyroid…”

mentioning

confidence: 99%

Comparison of 18F-FDG PET and Bone Scintigraphy in Detection of Bone Metastases of Thyroid Cancer

Ito¹,

Katô²,

Ikeda³

et al. 2007

Journal of Nuclear Medicine

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We compared the efficacies of 18 F-FDG PET and 99m Tc-bone scintigraphy for the detection of bone metastases in patients with differentiated thyroid carcinoma (DTC). Methods: We examined 47 patients (32 women, 15 men; mean age 6 SD, 57.0 6 10.7 y) with DTC who had undergone total thyroidectomy and were hospitalized to be given 131 I therapy. All patients underwent both whole-body 18 F-FDG PET and 99m Tc-bone scintigraphy. The skeletal system was classified into 11 anatomic segments and assessed for the presence of bone metastases. Bone metastases were verified either when positive findings were obtained on .2 imaging modalities-201 Tl scintigraphy, 131 I scintigraphy, and CT-or when MRI findings were positive if vertebral MRI was performed. Results: Bone metastases were confirmed in 59 of 517 (11%) segments in 18 (38%) of the 47 study patients. The sensitivities (visualization rate) for bone metastases on a segment basis using 18 F-FDG PET and 99m Tcbone scintigraphy were 50 of 59 (84.7%) and 46 of 59 (78.0%), respectively; the difference between these values was not statistically significant. There were only 2 (0.4%) false-positive cases in a total of 451 bone segments without bone metastases when examined by 18 F-FDG PET, whereas 39 (8.6%) were falsepositive when examined by 99m Tc-bone scintigraphy. Therefore, the specificities of 18 F-FDG PET and 99m Tc-bone scintigraphy were 449 of 451 (99.6%) and 412 of 451 (91.4%), respectively; the difference between these values was statistically significant (P , 0.001). The overall accuracies of 18 F-FDG PET and 99m Tcbone scintigraphy were 499 of 510 (97.8%) and 458 of 510 (89.8%), respectively; the difference between these was also statistically significant (P , 0.001). Conclusion: The specificity and the overall accuracy of 18 F-FDG PET for the diagnosis of bone metastases in patients with DTC are higher than those of 99m Tc-bone scintigraphy, whereas the difference in the sensitivities of both modalities is not statistically significant. In comparison with 99m Tc-bone scintigraphy, 18 F-FDG PET is superior because of its lower incidence of false-positive results in the detection of bone metastases of DTC. Skel etal imaging by 18 F-FDG PET has been shown to be useful in the detection of bone metastases of breast (1-6), lung (1,4,7,8), thyroid (4), esophageal (4,9), gastric (4), colorectal (4), endemic nasopharyngeal (10), renal cell (11), prostate (1), ovarian (4), and testicular (4) carcinomas. In most of these studies, 18 F-FDG PET was proven to be superior to conventional scintigraphic imaging using 99m Tclabeled phosphate compounds ( 99m Tc-methylene diphosphonate [ 99m Tc-MDP] or 99m Tc-hydroxymethylene diphosphonate [ 99m Tc-HMDP]). For the detection and evaluation of bone metastases of various kinds of carcinomas, 99m Tc-bone scintigraphy has been used widely because of its overall high sensitivity and the easy evaluation of the entire skeleton (12). However, 99m Tc-bone scintigraphy leads often to falsepositive lesions and, consequently, its specificity is r...

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Utility of fluorine-18-fluorodeoxyglucose positron emission tomography in differentiated thyroid carcinoma with negative radioiodine scans and elevated serum thyroglobulin levels

Cited by 71 publications

References 15 publications

Follow-up of low-risk patients with differentiated thyroid carcinoma: a European perspective

Follow-up of low-risk patients with differentiated thyroid carcinoma: a European perspective

The role of FDG-PET in localization of recurrent lesions of differentiated thyroid cancer (DTC) in patients with asymptomatic hyperthyroglobulinemia in a real clinical practice

Comparison of 18F-FDG PET and Bone Scintigraphy in Detection of Bone Metastases of Thyroid Cancer

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