Abstract
Objective
The aim of the study was to disclose the place of 18F-FDG PET/CT to predict recurrent disease in patients with differentiated thyroid cancer (DTC), negative radioiodine whole-body scan (WBS) and high serum thyroglobulin (Tg).
Methods
Seventy-one patients who underwent total thyroidectomy followed by radioactive iodine ablation and had negative radioiodine WBS but elevated Tg levels underwent PET/CT. They were followed up for 6–50 months (median 23) for the occurence of recurrent disease as detected by either clinical findings, other imaging modalities or histopathological examination. The place of PET/CT findings at baseline to predict the presence of recurrent disease was evaluated. Correlation between PET/CT findings and Tg levels was examined and a threshold for Tg level above which the predictive value of PET/CT was highest was determined.
Results
PET/CT was positive for recurrent disease in 38 (53.5 %) patients. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of PET/CT to predict the occurence of recurrent disease at follow-up were 68.8, 78.3, 86.8, 54.5 and 71.9 %, respectively. The sensitivity, accuracy and PPV of PET/CT increased with increasing Tg levels. The highest diagnostic accuracy of PET/CT, with a sensitivity of 76.2 % and a specificity of 100 % to detect recurrent disease appeared to be at a Tg level greater than 29 ng/mL.
Conclusion
Our findings suggest that 18F-FDG-PET/CT is a valuable tool to predict the occurence of recurrent disease in patients with DTC, negative WBS and elevated Tg levels. PET/CT positivity has been shown to be strongly and positively correlated with Tg levels in this patient subset.
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References
Pacini F, Schlumberger M, Dralle H, Elisei R, Smit JW, Wiersinga W, European Thyroid Cancer Taskforce. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol. 2006;154(6):787–803.
Mazzaferri EL, Robbins RJ, Spencer CA, Braverman LE, Pacini F, Wartofsky L, et al. A consensus report of the role of serum thyroglobulin as a monitoring method for low-risk patients with papillary thyroid carcinoma. J Clin Endocrinol Metab. 2003;88:1433–41.
Ashcraft MW, Van Herle AJ. The comparative value of serum thyroglobulin measurements and iodine 131 total body scans in the follow-up study of patients with treated differentiated thyroid cancer. Am J Med. 1981;71:806–14.
Dong M-J, Liu Z-F, Zhao K, Ruan L-X, Wang G-L, Yang S-Y, et al. Value of 18F-FDG-PET/PET–CT in differentiated thyroid carcinoma with radioiodine-negative whole-body scan: a meta-analysis. Nucl Med Commun. 2009;30:639–50.
Pineda JD, Lee T, Ain K, Reynolds JC, Robbins J. Iodine-131 therapy for thyroid cancer patients with elevated thyroglobulin and negative diagnostic scan. J Clin Endocrinol Metab. 1995;80:1488–92.
Silberstein EB. The problem of the patient with thyroglobulin elevation but negative iodine scintigraphy: the TENIS syndrome. Semin Nucl Med. 2011;41:113–20.
Palaniswamy SS, Subramanyam P. Diagnostic utility of PET/CT in thyroid malignancies: an update. Ann Nucl Med. doi:10.1007/s12149-013-0740-6.
American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19(11):1167–214.
Vural GU, Akkas BE, Ercakmak N, Basu S, Alavi A. Prognostic significance of FDG PET/CT on the follow-up of patients of differentiated thyroid carcinoma with negative 131I whole-body scan and elevated thyroglobulin levels: correlation with clinical and histopathologic characteristics and long-term follow-up data. Clin Nucl Med. 2012;37(10):953–9.
Treglia G, Muoio B, Giovanella L, Salvatori M. The role of positron emission tomography and positron emission tomography/computed tomography in thyroid tumours: an overview. Eur Arch Otorhinolaryngol. 2013;270:1783–7.
Giovanella L, Trimboli P, Verburg FA, Treglia G, Piccardo A, Foppiani L, et al. Thyroglobulin levels and thyroglobulin doubling time independently predict a positive 18F-FDG PET/CT scan in patients with biochemical recurrence of differentiated thyroid carcinoma. Eur J Nucl Med Mol Imaging. 2013;40:874–80.
Bertagna F, Biasiotto G, Orlando E, Bosio G, Giubbini R. Role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in patients affected by differentiated thyroid carcinoma, high thyroglobulin level, and negative 131I scan: review of the literature. Jpn J Radiol. 2010;28(9):629–36.
Finkelstein SE, Grigsby PW, Siegel BA, Dehdashti F, Moley JF, Hall BL. Combined [18F]Fluorodeoxyglucose positron emission tomography and computed tomography (FDG-PET/CT) for detection of recurrent, 131I-negative thyroid cancer. Ann Surg Oncol. 2008;15(1):286–92.
Bannas P, Derlin T, Groth M, Apostolova I, Adam G, Mester J, et al. Can (18)F-FDG-PET/CT be generally recommended in patients with differentiated thyroid carcinoma and elevated thyroglobulin levels but negative I-131 whole body scan? Ann Nucl Med. 2012;26(1):77–85.
Na SJ, Yoo leR, O JH, Lin C, Lin Q, Kim SH, et al. Diagnostic accuracy of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography in differentiated thyroid cancer patients with elevated thyroglobulin and negative (131)I whole body scan: evaluation by thyroglobulin level. Ann Nucl Med. 2012;26(1):26–34.
Ozkan E, Aras G, Kucuk NO. Correlation of 18F-FDG PET/CT findings with histopathological results in differentiated thyroid cancer patients who have increased thyroglobulin or antithyroglobulin antibody levels and negative 131I whole-body scan results. Clin Nucl Med. 2013;38(5):326–31.
Shammas A, Degirmenci B, Mountz JM, McCook BM, Branstetter B, Bencherif B, et al. 18F-FDG PET/CT in patients with suspected recurrent or metastatic well-differentiated thyroid cancer. J Nucl Med. 2007;48(2):221–6.
Mirallié E, Guillan T, Bridji B, Resche I, Rousseau C, Ansquer C, et al. Therapeutic impact of 18FDG-PET/CT in the management of iodine-negative recurrence of differentiated thyroid carcinoma. Surgery. 2007;142(6):952–8.
Palmedo H, Bucerius J, Joe A, Strunk H, Hortling N, Meyka S, et al. Integrated PET/CT in differentiated thyroid cancer: diagnostic accuracy and impact on patient management. J Nucl Med. 2006;47(4):616–24.
Zuijdwijk MD, Vogel WV, Corstens FH, Oyen WJ. Utility of fluorodeoxyglucose-PET in patients with differentiated thyroid carcinoma. Nucl Med Commun. 2008;29(7):636–41.
Dong MJ, Liu ZF, Zhao K, Ruan LX, Wang GL, Yang SY, et al. Value of 18F-FDG-PET/PET–CT in differentiated thyroid carcinoma with radioiodine-negative whole-body scan: a meta-analysis. Nucl Med Commun. 2009;30(8):639–50.
Bertagna F, Bosio G, Biasiotto G, Rodella C, Puta E, Gabanelli S, et al. F-18 FDG-PET/CT evaluation of patients with differentiated thyroid cancer with negative I-131 total body scan and high thyroglobulin level. Clin Nucl Med. 2009;34:756–61.
Giovanella L, Ceriani L, De Palma D, Suriano S, Castellani M, Verburg FA. Relationship between serum thyroglobulin and 18FDG-PET/CT in 131I-negative differentiated thyroid carcinomas. Head Neck. 2012;34(5):626–31.
Moog F, Linke R, Manthey N, Tiling R, Knesewitsch P, Tatsch K, et al. Influence of thyroid-stimulating hormone levels on uptake of FDG in recurrent and metastatic differentiated thyroid carcinoma. J Nucl Med. 2000;41:1989–95.
Van Tol KM, Jager PL, Piers DA, Pruim J, de Vries EG, Dullaart RP, et al. Better yield of 18 fluorodeoxyglucose-positron emission tomography in patients with metastatic differentiated thyroid carcinoma during thyrotropin stimulation. Thyroid. 2002;12:381–7.
Filetti S, Damante G, Foti D. Thyrotropin stimulates glucose transport in cultured rat thyroid cells. Endocrinology. 1987;120:2576–81.
Petrich T, Borner AR, Otto D, Hofmann M, Knapp WH. Influence of rhTSH on 18F-fluorodeoxyglucose uptake by differentiated thyroid carcinoma. Eur J Nucl Med Mol Imaging. 2002;29:641–7.
Deichen JT, Schmidt C, Prante O, Maschauer S, Papadopulos T, Kuwert T. Influence of TSH on uptake of 18Ffluorodeoxyglucose in human thyroid cells in vitro. Eur J Nucl Med Mol Imaging. 2004;31:507–12.
Wang W, Macapinlac H, Larson SM, Yeh SD, Akhurst T, Finn RD, et al. [18F] 2-fluoro-2 deoxy-d-glucose positron emission tomography localizes residual thyroid cancer in patients with negative diagnostic (131)I whole-body scans and elevated serum thyroglobulin levels. J Clin Endocrinol Metab. 1999;84:2291–302.
Feine U, Lietzenmayer R, Hanke JP, Held J, Wöhrle H, Müller-Schauenburg W. Fluorine-18-FDG and iodine-131-iodide uptake in thyroid cancer. J Nucl Med. 1996;37(9):1468–72.
Moog F, Linke R, Manthey N, Tiling R, Knesewitsch P, Tatsch K, et al. Influence of thyroid-stimulating hormone levels on uptake of FDG in recurrent and metastatic differentiated thyroid carcinoma. J Nucl Med. 2000;41:1989–95.
Schreinemakers JM, Vriens MR, Munoz-Perez N, Guerrero MA, Suh I, Rinkes IH, et al. Fluorodeoxyglucose-positron emission tomography scan-positive recurrent papillary thyroid cancer and the prognosis and implications for surgical management. World J Surg Oncol. 2012;10:192.
Akkas BE, Demirel BB, Vural GU. Prognostic factors affecting disease-specific survival in patients with recurrent and/or metastatic differentiated thyroid carcinoma detected by positron emission tomography/computed tomography. Thyroid. 2013;. doi:10.1089/thy.2012.0195.
van Dijk D, Plukker JT, Phan HT, Muller Kobold AC, van der Horst-Schrivers AN, Jansen L, et al. 18-Fluorodeoxyglucose positron emission tomography in the early diagnostic workup of differentiated thyroid cancer patients with a negative post-therapeutic iodine scan and detectable thyroglobulin. Thyroid. 2013;23:1003–9.
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Özdemir, E., Yildirim Poyraz, N., Polat, S.B. et al. Diagnostic value of 18F-FDG PET/CT in patients with TENIS syndrome: correlation with thyroglobulin levels. Ann Nucl Med 28, 241–247 (2014). https://doi.org/10.1007/s12149-013-0801-x
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DOI: https://doi.org/10.1007/s12149-013-0801-x