Impact of 18F-FDG PET/CT on treatment of patients with differentiated thyroid carcinoma, negative 131I whole body scan and elevated serum thyroglobulin

Document Type : Original Article

Authors

1 Department of Molecular Imaging and Therapy, Austin Health, Melbourne, VIC Australia

2 Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia

3 School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia

4 Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia

Abstract

Objective(s): 18F-FDG PET/CT is increasingly performed in patients with differen-tiated thyroid cancer. The aim of this study was to assess the clinical impact of 18F-FDG PET/CT on the management of patients with differentiated thyroid carcinoma who had elevated serum thyroglobulin (Tg) and negative 131I whole body scan (WBS).
Methods: 67 patients with differentiated thyroid carcinoma were included in this study. The findings of 18F-FDG PET/CT imaging were compared with histo-pathology, follow up imaging, or clinical follow-up results. The diagnostic accuracy of 18F-FDG PET/CT was evaluated for the entire patient group and for those patients with stimulated serum thyroglobulin levels of less than 5, 5–10, and more than 10 pmol/L as well as for local recurrences and metastases sites. The impact of 18F-FDG PET/CT on therapeutic management was also evaluated.
Results: 30/67 patients had positive findings on 18F-FDG PET/CT; 28 were true-positive and 2 were false-positive. 18F-FDG PET/CT results were true-negative in 36 patients and false-negative in 1 patient. The overall sensitivity, specificity, accuracy, PPV and NPV of 18F-FDG PET/CT were, 96.5%, 94.5%, 95.5%, 93.3%, and 97.2% respectively. Positive 18F-FDG PET/CT findings were directly correlated with stimulated serum thyroglobulin levels, 7.1% had Tg between 5–10, and 92.9% had Tg greater than 10 pmol/L. 18F-FDG PET/CT had a high or moderate impact on treatment management in 28 (41.8%) of patients.
Conclusion: 18F-FDG PET/CT is able to improve diagnostic accuracy and have management impact in a therapeutically relevant way in patients with differentiated thyroid carcinoma who present with rising thyroglobulin level, negative 131I WBS, and clinical suspicion of recurrent disease.

Keywords

References

  1. Ronga G, Fiorentino A, Paserio E, Signore A, Todino V, Tummarello M, et al. Can iodine-131 whole-body scan be replaced by Tg measurement in the post-surgical follow-up of differentiated thyroid carcinoma? J Nucl Med. 1990; 31:1766–1771.
  2. Roelants V, Nayer PD, Bouckaert A, Beckers C. The predictive value of serum Tg in the follow-up of differentiated thyroid cancer. Eur J Nucl Med. 1997; 24:722–727.
  3. Filesi M, Signore A, Ventroni G, Melacrinis FF, Ronga G. Role of initial iodine- 131 whole-body scan and serum Tg in differentiated thyroid carcinoma J Nucl Med. 1998; 39:1542–1546.
  4. Lamartina L, Deandreis D, Durante C, Filetti S. Imaging in the follow-up of differentiated thyroid cancer: current evidence and future perspectives for a risk-adapted approach. Eur J Endocrinol. 2016; 175(5):R185-R202.
  5. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26(1):1-133.
  6. Helal BO, Merlet P, Toubert ME, Franc B, Schvartz C, Gauthier-Koelesnikov H, et al. Clinical impact of 18F-FDG PET in thyroid carcinoma patients with elevated Tg levels and negative 131I scanning results after therapy. J Nucl Med. 2001; 42:1464–1469.
  7. Schlumberger M, Arcanglioli O, Piekarski JD, Tubiana M, Parmentier C. Detection and treatment of lung metastases of differentiated thyroid carcinoma in patients with normal chest x-rays. J Nucl Med. 1988; 29:1790 –1794.
  8. Maxon H, Smith H. Radioiodine-131I in the diagnosis and treatment of metastatic well differentiated thyroid cancer. Endocrinol Metab Clin North Am. l990; 19:685-7l8.
  9. Pineda JD, Lee T, Ain K, Reynolds JC, Robbins J. Iodine-131 therapy for thyroid cancer patients with elevated Tg and negative diagnostic scan. J Clin Endocrinol Metab. 1995; 80:1488–1492.
  10. Alnafisi NS, Driedger AA, Coates G, Moote DJ, Raphael SJ. FDG PET of recurrent or metastatic 131I-negative papillary thyroid J Nucl Med.2000; 41:1010–1015.
  11. Schluter B, Bohuslavizki KH, Beyer W, Plotkin M, Buchert R, Clausen M.Impact of FDG PET on patients with differentiated thyroid cancer who present with elevated Tg and negative 131I scan. J Nucl Med. 2001; 42:71–76.
  12. Carril J, Quirce R, Serrano J, Banzo I, Jimenez-Bonilla JF, Tabuenca O, et al. Total-body scintigraphy with thallium-201 and iodine-131 in the follow up of differentiated thyroid cancer. J NucI Med. 1997; 38:686-692.
  13. Unal S. Menda Y, Adalet I, Boztepe H, Ozbey N, Alagol F, et al. Thallium-201, technetium-99m-tetrofosmin and iodine-l31 in detecting differentiated thyroid carcinoma metastases. J Nucl Med. 1998; 39:1897-1902.
  14. Fridrich L, Messa C, Landoni C, Lucignani G, Moncayo R, Kendler D, et al. Whole body scintigraphy with 99mTc-MIBI, 18F-FDG and 131I in patients with metastatic thyroid carcinoma. Nucl Med Commun.1997; 18:3-9.
  15. Baudin E, Schlumberger M, Lumbroso J, Travagli JP, Caillou B, Parmenter C.Octreotide scintigraphy in patients with differentiated thyroid carcinoma: contribution for patients with negative radioiodine scan. J Clin Endocnnol Metab. l996; 8l: 2541- 2544.
  16. Grunwald F, Kalicke T, Feine U, Lietzenmayer R, Scheidhauser K, Dietlein M, et al. Fluorine-18 fluorodeoxyglucose positron emission tomography in thyroid cancer: results of a multicentre study. Eur J Nucl Med. 1999; 26:1547–1552.
  17. Shammas A, Degirmenci1 B, Mountz JM, McCook BM, Branstetter B, Badreddine B, et al. 18F-FDG PET/CT in Patients with Suspected Recurrent or Metastatic Well-Differentiated Thyroid Cancer. J Nucl Med 2007; 48:221–226.
  18. Dietlein M, Scheidhauer K, Voth E, Theissen P, Schicha H. Fluorine-18 fluorodeoxy-glucose positron emission tomography and iodine-131 whole-body scintigraphy in the follow-up of differentiated thyroid cancer. Eur J Nucl Med.1997; 24:1342–1348.
  19. Feine U, Lietzenmayer R, Hanke JP, Held J, Wohrle H, Muller-Schauenburg W. Fluorine-18-FDG and iodine-131-iodide uptake in thyroid cancer. J Nucl Med. 1996; 37: 1468–1472.
  20. Joensuu H, Ahonen A. Imaging of metastases of thyroid carcinoma with fluorine-18 fluorodeoxyglucose. J Nucl Med. 1987; 28:910–914.
  21. Scott AM, Gunawardana DH, Kelley B, Stuckey JG, Byrne AJ, Ramshaw JE, et al. PET Changes Management and Improves Prognostic Stratification in Patients with Recurrent Colorectal Cancer: Results of a Multicenter Prospective Study. J Nucl Med. 2008; 49:1451-1457.
  22. Schlumberger M, Arcangioli O, Piekarski JD, Tubiana M, Parmentier C. Detection and treatment of lung metastases of differen-tiated thyroid carcinoma in patients with normal chest x-rays. J Nucl Med. 1988; 29: 1790–1794.
  23. Meng-Jie Dong, Zhen-Feng Liu, Kui Zhao, Ling-Xiang Ruan, Guo-Lin Wang, Shu-Ye Yang, 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; 30:639-650.
  24. 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 manage ment. J Nucl Med 2006; 47: 616–624.
  25. Gross ND, Weissman JL, Talbot JM, Andersen PE, Wax MK, Cohen JI. MRI detection of cervical metastasis from differentiated thyroid carcinoma. Laryngoscope. 2001; 111:1905–1909.
  26. Torlontano M, Attard M, Crocetti U, Tumino S, Bruno R, Costante G, et al. Follow-up of low risk patients with papillary thyroid cancer: role of neck ultrasonography in detecting lymph node metastases. J Clin Endocrinol Metab. 2004; 89:3402–3407.
  27. Wang W, Macapinlac H, Larson SM, Yeh SDJ, Akhurst T, Finn RD, et al. [18F]-2-fluoro-2-deoxy-D-glucosepositron emission tomo-graphy localizes residual thyroid cancer in patients with negative diagnostic 131I whole-body scans and elevated serum Tg levels. J Clin Endocrinol Metab. 1999; 84: 2291–2302.
  28. Lee JW, Lee SL, Lee DH, Kim YJ. Clinical utility of F-18 FDG PET/CT concurrent with 131I therapy in intermediate – to – high risk patients with differentiated thyroid cancer: Dual centre experience with 286 patients. J Nucl Med 2013; 54: 1230-1236.
  29. Qichang W, Bai L, Zhao G, Gege Z, Youjia Z, Qingjie M, et al. Diagnostic performance of 18F-FDG-PET/CT in DTC patients with Tg elevation and negative iodine scintigraphy: a meta-analysis. Eur J Endocrinol. 2019; 181: 93-102.
  30. Kukulska A, Krajewska J, Kołosza Z, Paliczka-Cies Lik E, Puch Z, Gubala E, et al. The role of FDG-PET in localization of recurrent lesions of differentiated thyroid cancer (DTC) in patients with asymptomatic hyperTgemia in a real clinical practice. Eur J Endocrinol. 2016; 175(5):379-85.
  31. Kang SY, Bang J-I, Kang KW, Lee H-Y, Chung J-K. FDG PET/CT for the early prediction of RAI therapy response in patients with metastatic differentiated thyroid carcinoma. PLoS One. 2019; 14(6):e0218416.
  32. Nagarajah J, Janssen M, Hetkamp P, Jentzen W. Iodine symporter targeting with 124I/131I theranostics. J Nucl Med. 2017; 58 (suppl): 34S–38S.
  33. Kreissl MC, Janssen MJR, Nagarajah J. Current Treatment Strategies in Metastasized Differentiated Thyroid Cancer. J Nuc Med. 2019; 60:9-15.
  34. Jeong SY, Lee S-W, Kim HW, Song B-Il, Ahn B-C, Lee J. Clinical applications of SPECT/CT after first I-131 ablation in patients with differentiated thyroid cancer. Clin Endo crinol. 2014; 81(3):445-451.
Asia Oceania Journal of Nuclear Medicine and Biology
Volume 10, Issue 1
January 2022
Pages 20-27

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