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Park HL, Boo SH, Park SY, Moon SW, Yoo IR. Prognostic value of TLR from FDG PET/CT in patients with margin-negative stage IB and IIA non-small cell lung cancer. Eur Radiol 2023; 33:7274-7283. [PMID: 37060445 DOI: 10.1007/s00330-023-09641-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/16/2023] [Accepted: 03/30/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVES To evaluate the prognostic value of TLR from PET/CT in patients with resection margin-negative stage IB and IIA non-small cell lung cancer (NSCLC) and compare high-risk factors necessitating adjuvant treatment (AT). METHODS Consecutive FDG PET/CT scans performed for the initial staging of NSCLC stage IB and IIA were retrospectively reviewed. The maximum standardized uptake value (SUVmax) of the primary tumor and mean SUV of the liver were acquired. The tumor-to-liver SUV ratio (TLR) was also calculated. Charts were reviewed for basic patient characteristics and high-risk factors for considering AT (poor differentiation, visceral pleura invasion, vascular invasion, tumors > 4 cm, and wedge resection). Statistical analysis was performed using Cox regression analysis and the Kaplan-Meier method. RESULTS Of the 112 patients included, 15 (13.4%) died, with a median overall survival (OS) of 43.8 months. Twenty-two patients (19.6%) exhibited recurrence, with median disease-free survival (DFS) of 36.0 months. In univariable analysis, pathology, poor differentiation, and TLR were associated with shorter DFS and OS. In multivariable analysis, TLR (hazard ratio [HR] = 1.263, p = 0.008) and differentiation (HR = 3.087, p = 0.012) were associated with shorter DFS. Also, TLR (HR = 1.422, p < 0.001) was associated with shorter OS. CONCLUSION TLR from FDG PET/CT was an independent prognostic factor for recurrence and survival. PET parameters constitute risk factors for consideration in the decision-making for AT in margin-negative stage IB and IIA NSCLC. CLINICAL RELEVANCE STATEMENT In this study, TLR from FDG PET/CT was an independent prognostic factor in stage IB-IIA non-small cell cancer patients. Although additional validation studies are warranted, TLR has the potential to be used to determine the need for adjuvant therapy. KEY POINTS • High TLR is an independent poor prognostic factor in stage IB-IIA NSCLC. • Adjuvant treatment should be considered in patients with high TLR following complete tumor resection.
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Affiliation(s)
- Hye Lim Park
- Division of Nuclear Medicine, Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun Ha Boo
- Division of Nuclear Medicine, Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Korea
| | - Sonya Youngju Park
- Division of Nuclear Medicine, Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Korea
| | - Seok Whan Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ie Ryung Yoo
- Division of Nuclear Medicine, Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Korea.
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Tang X, Shi L, Zhao Z, Wang J, Yang R, Huang Y, Tang J, Chen Z, Wang F. Clinical role of 18F-FDG PET/CT for detection of radioactive iodine refractory differentiated thyroid cancer. Medicine (Baltimore) 2023; 102:e33878. [PMID: 37327310 PMCID: PMC10270557 DOI: 10.1097/md.0000000000033878] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/08/2023] [Indexed: 06/18/2023] Open
Abstract
In clinical settings, an estimated 10% differentiated thyroid cancer (DTC) cases become radioactive iodide refractory (RAIR), which lack a molecular marker and have fewer treatment selections. A higher uptake of 18F-fluorodeoxyglucose (18F-FDG) might indicate poor prognosis for DTC. This study aimed to evaluate the clinical value of 18F-FDG psitron emission tomography/computed tomography (PET/CT) for the early diagnosis of RAIR-DTC and high-risk DTC. A total of 68 DTC patients were enrolled and underwent 18F-FDG PET/CT for the detection of recurrence and/or metastasis. 18F-FDG uptake was evaluated in patients with different postoperative recurrence risks or TNM stages and compared between RAIR and non-RAIR-DTC based on its maximum standardized uptake value and tumor/liver (T/L) ratio. The final diagnosis was judged by histopathology and follow-up data. Of 68 DTC cases, 42 were RAIR and 24 non-RAIR, with 2 not determined. A total of 263 of 293 lesions detected on 18F-FDG PET/CT were confirmed to be locoregional or metastatic after follow-up. The T/L ratio was significantly higher for RAIR than for non-RAIR (median 5.18 vs 1.44; P < .01) and also significantly higher in postoperative patients at high-risk of recurrence than at low to medium risk (median 4.90 vs 2.16; P < .01). 18F-FDG PET/CT exhibited a sensitivity of 83.3% and specificity of 87.5% for identifying RAIR, with a cutoff T/L value of 2.98. 18F-FDG PET/CT has the potential to diagnose RAIR-DTC early and identify the high-risk DTC. The T/L ratio is a useful parameter for the detection of RAIR-DTC patients.
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Affiliation(s)
- Xiaowei Tang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Department of Medical Image, Jiangyin Hospital of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Wuxi, China
| | - Liang Shi
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhenyu Zhao
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jun Wang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Rui Yang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yue Huang
- Department of Pathology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jun Tang
- Department of Nuclear Medicine, Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou, China
| | - Zhengguo Chen
- NHC Key Laboratory of Nuclear Technology Medical Transformation, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, China
| | - Feng Wang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Department of Nuclear Medicine, Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou, China
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de Koster EJ, van Engen-van Grunsven ACH, Bussink J, Frielink C, de Geus-Oei LF, Kusters B, Peters H, Oyen WJG, Vriens D. [ 18F]FDG Uptake and Expression of Immunohistochemical Markers Related to Glycolysis, Hypoxia, and Proliferation in Indeterminate Thyroid Nodules. Mol Imaging Biol 2022; 25:483-494. [PMID: 36253663 PMCID: PMC10172288 DOI: 10.1007/s11307-022-01776-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The current study explored the association between 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG) uptake and the quantitative expression of immunohistochemical markers related to glucose metabolism, hypoxia, and cell proliferation in benign and malignant thyroid nodules of indeterminate cytology. PROCEDURES Using a case-control design, 24 patients were selected from participants of a randomized controlled multicenter trial (NCT02208544) in which [18F]FDG-PET/CT and thyroid surgery were performed for Bethesda III and IV nodules. Three equally sized groups of [18F]FDG-positive malignant, [18F]FDG-positive benign, and [18F]FDG-negative benign nodules were included. Immunohistochemical staining was performed for glucose transporters (GLUT) 1, 3, and 4; hexokinases (HK) 1 and 2; hypoxia-inducible factor-1 alpha (HIF1α; monocarboxylate transporter 4 (MCT4); carbonic anhydrase IX (CA-IX); vascular endothelial growth factor (VEGF); sodium-iodide symporter (NIS); and Ki-67. Marker expression was scored using an immunoreactive score. Unsupervised cluster analysis was performed. The immunoreactive score was correlated to the maximum and peak standardized uptake values (SUVmax, SUVpeak) and SUVmax ratio (SUVmax of nodule/background SUVmax of contralateral, normal thyroid) of the [18F]FDG-PET/CT using the Spearman's rank correlation coefficient and compared between the three groups using Kruskal-Wallis tests. RESULTS The expression of GLUT1, GLUT3, HK2, and MCT4 was strongly positively correlated with the SUVmax, SUVpeak, and SUVmax ratio. The expression of GLUT1 (p = 0.009), HK2 (p = 0.02), MCT4 (p = 0.01), and VEGF (p = 0.007) was statistically significantly different between [18F]FDG-positive benign nodules, [18F]FDG-positive thyroid carcinomas, and [18F]FDG-negative benign nodules. In both [18F]FDG-positive benign nodules and [18F]FDG-positive thyroid carcinomas, the expression of GLUT1, HK2, and MCT4 was increased as compared to [18F]FDG-negative benign nodules. VEGF expression was higher in [18F]FDG-positive thyroid carcinomas as compared to [18F]FDG-negative and [18F]FDG-positive benign nodules. CONCLUSIONS Our results suggest that [18F]FDG-positive benign thyroid nodules undergo changes in protein expression similar to those in thyroid carcinomas. To expand the understanding of the metabolic changes in benign and malignant thyroid nodules, further research is required, including correlation with underlying genetic alterations.
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Affiliation(s)
- Elizabeth J de Koster
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands.
| | | | - Johan Bussink
- Department of Radiation Oncology, Radiotherapy & OncoImmunology Laboratory, Radboud University Medical Center, Nijmegen, Netherlands
| | - Cathelijne Frielink
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands.,Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands.,Biomedical Photonic Imaging Group, University of Twente, Enschede, the Netherlands
| | - Benno Kusters
- Department of Pathology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Hans Peters
- Department of Radiation Oncology, Radiotherapy & OncoImmunology Laboratory, Radboud University Medical Center, Nijmegen, Netherlands
| | - Wim J G Oyen
- Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands.,Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, the Netherlands.,Department of Biomedical Sciences and Humanitas Clinical and Research Centre, Department of Nuclear Medicine, Humanitas University, Milan, Italy
| | - Dennis Vriens
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
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Positron Emission Tomography Radiopharmaceuticals in Differentiated Thyroid Cancer. Molecules 2022; 27:molecules27154936. [PMID: 35956886 PMCID: PMC9370596 DOI: 10.3390/molecules27154936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/01/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022] Open
Abstract
Differentiated thyroid cancer (DTC), arising from thyroid follicular epithelial cells, is the most common type of thyroid cancer. Despite the well-known utilization of radioiodine treatment in DTC, i.e., iodine-131, radioiodine imaging in DTC is typically performed with iodine-123 and iodine-131, with the current hybrid scanner performing single photon emission tomography/computed tomography (SPECT/CT). Positron emission tomography/computed tomography (PET/CT) provides superior visualization and quantification of functions at the molecular level; thus, lesion assessment can be improved compared to that of SPECT/CT. Various types of cancer, including radioiodine-refractory DTC, can be detected by 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG), the most well-known and widely used PET radiopharmaceutical. Several other PET radiopharmaceuticals have been developed, although some are limited in availability despite their potential clinical utilizations. This article aims to summarize PET radiopharmaceuticals in DTC, focusing on molecular pathways and applications.
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Scappaticcio L, Piccardo A, Treglia G, Poller DN, Trimboli P. The dilemma of 18F-FDG PET/CT thyroid incidentaloma: what we should expect from FNA. A systematic review and meta-analysis. Endocrine 2021; 73:540-549. [PMID: 33761104 PMCID: PMC8325664 DOI: 10.1007/s12020-021-02683-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/05/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE 18F-FDG thyroid incidentaloma (TI) occurs in ~2% of PET/CT examinations with a cancer prevalence of up to 35-40%. Guidelines recommend fine-needle aspiration cytology (FNA) if a focal 18F-FDG TI corresponds to a sonographic nodule >1 cm. The aim of this systematic review and meta-analysis was to provide evidence-based data on the diagnostic distribution of 18F-FDG TIs in the six Bethesda systems for reporting thyroid cytopathology (BETHESDA) subcategories. METHODS Original studies reporting 18F-FDG TIs and cytologically classified according to BETHESDA were included. Six separate meta-analyses were performed to obtain the pooled prevalence (95% confidence interval, 95% CI) of 18F-FDG TIs in the six BETHESDA subcategories. RESULTS Fifteen studies were finally included. Nine studies were from Asian/Eastern and six from Western countries. FNA data according to BETHESDA was available in 2304 cases. The pooled prevalence of 18F-FDG TIs according to BETHESDA was BETHESDA I 10% (6-14), BETHESDA II 45% (37-53), BETHESDA III 8% (3-13), BETHESDA IV 8% (5-12), BETHESDA V 6% (4-9), BETHESDA VI 19% (13-25). A significantly different prevalence was found in the BETHESDA IV between Asian/Eastern (2%) and Western (19%) studies. CONCLUSION Two-thirds of focal 18F-FDG TIs undergoing FNA have either malignant (BETHESDA VI) or benign (BETHESDA II) cytology while a minority will have indeterminate (BETHESDA III or IV) FNA results. Significant differences between Asian/Eastern and Western studies are also present in the prevalence of indeterminate FNA results.
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Affiliation(s)
- Lorenzo Scappaticcio
- Unit of Endocrinology and Metabolic Diseases, University of Campania 'L. Vanvitelli'', Naples, Italy.
| | | | - Giorgio Treglia
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Clinic of Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Health Technology Assessment Unit, Academic Education, Research and Innovation Area, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - David N Poller
- Departments of Cytology & Pathology, Queen Alexandra Hospital, Portsmouth, UK
- UCL Cancer Institute, 72 Huntley St., Bloomsbury, London, WC1E 6DD, UK
| | - Pierpaolo Trimboli
- Clinic for Endocrinology and Diabetology, Lugano Regional Hospital, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
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Piccardo A, Puntoni M, Dezzana M, Bottoni G, Foppiani L, Marugo A, Catrambone U, Ugolini M, Sola S, Gatto M, Treglia G, Giovanella L, Trimboli P. Indeterminate thyroid nodules. The role of 18F-FDG PET/CT in the "era" of ultrasonography risk stratification systems and new thyroid cytology classifications. Endocrine 2020; 69:553-561. [PMID: 32124261 DOI: 10.1007/s12020-020-02239-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 02/18/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the reliability of 18F-FDG PET/CT in distinguishing differentiated thyroid cancers (DTCs) and follicular neoplasms (FNs) from nodular hyperplasias (NH) in thyroid nodules with indeterminate cytology according to the Italian consensus for the classification and reporting of thyroid cytology (ICCRTC). We also tested whether the 18F-FDG PET/CT result was an independent risk factor for DTCs or FNs when sex, age, nodule dimensions, the European Thyroid Imaging and Reporting Data System (EU-TIRADS) and ICCRTC were considered. METHODS We evaluated all patients with thyroid nodules and indeterminate cytology from September 2015 to May 2019; nodules were classified as low risk (TIR3A) and high risk (TIR3B) according to the ICCRTC. Neck ultrasonography features according to EU-TIRADS were re-evaluated and 18F-FDG PET/CT performed. All these patients were surgically treated. RESULTS We included 111 patients; 67 nodules were classified as TIR3A and 44 as TIR3B. Overall, we found 27 DTCs, 57 NHs and 27 FNs. Among 73 FDG-negative nodules, we found four low-risk papillary thyroid cancers. All follicular thyroid cancers were identified by 18F-FDG-PET/CT. All TIR3A with low-risk US and negative 18F-FDG-PET/CT were NH. In TIR3A nodules, the sensitivity, specificity, negative and positive predictive values (NPV, PPV) of 18F-FDG PET/CT and EU-TIRADS for DTCs were 77.8%, 41.4%, 92.3%, 17.1% and 66.7%, 56.9%, 91.7%, 19.4%, respectively. In TIR3B nodules, the sensitivity, specificity, NPV and PPV of 18F-FDG PET/CT and EU-TIRADS for DTCs were 88.9%, 38.5%, 83.3%, 50% and 88.2%, 58.3%, 87.5%, 60%, respectively. On multivariate analysis, 18F-FDG-PET/CT (OR 9.04), ICCRTC (O.R. 7.57) and EU-TIRADS (OR 4.41) were all independent risk factors associated to DTCs and FNs. CONCLUSION 18F-FDG-PET/CT is a reliable rule-out test for DTC even in thyroid nodules with indeterminate high-risk results. In this subgroup, PPV also tends to be considerable. 18F-FDG-PET/CT results, ICCRTC and EU-TIRADS proved independent risk factors associated to DTCs and FNs.
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Affiliation(s)
- Arnoldo Piccardo
- Department of Nuclear Medicine, Galliera Hospital, Mura delle Cappuccine 14, 16128, Genoa, Italy.
| | - Matteo Puntoni
- Clinical Trial Research Unit, Galliera Hospital, Genoa, Italy
| | - Marih Dezzana
- Department of Histopathology, Galliera Hospital, Genoa, Italy
| | - Gianluca Bottoni
- Department of Nuclear Medicine, Galliera Hospital, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Luca Foppiani
- Department of Internal Medicine, Galliera Hospital, Genoa, Italy
| | | | | | - Martina Ugolini
- Department of Nuclear Medicine, Galliera Hospital, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Simona Sola
- Department of Histopathology, Galliera Hospital, Genoa, Italy
| | - Martina Gatto
- Department of Nuclear Medicine, Galliera Hospital, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Giorgio Treglia
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Health Technology Assessment Unit, General Directorate, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Pierpaolo Trimboli
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
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Treglia G, Goichot B, Giovanella L, Hindié E, Jha A, Pacak K, Taïeb D, Walter T, Imperiale A. Prognostic and predictive value of nuclear imaging in endocrine oncology. Endocrine 2020; 67:9-19. [PMID: 31734779 PMCID: PMC7441826 DOI: 10.1007/s12020-019-02131-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 11/02/2019] [Indexed: 12/20/2022]
Abstract
In the last few years, the role and use of medical technologies in (neuro)endocrine oncology has greatly evolved allowing not only important diagnostic information but also prognostic stratification in different clinical situations. The terms "prognostic" and "predictive" are commonly used to describe the relationships between biomarkers and patients' clinical outcomes but have quite different meaning. The present work discusses the prognostic and predictive value of nuclear medicine imaging. It critically reviews the clinical significance and potential impact of molecular examinations on follow-up and therapeutic strategies in patients with neuroendocrine neoplasms, thyroid tumors, and adrenal malignancies.
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Affiliation(s)
- Giorgio Treglia
- Clinic of Nuclear Medicine and PET/CT Center, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
- Health Technology Assessment Unit, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Clinical Trial Unit, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Bernard Goichot
- Endocrinology and Internal Medicine Department, Hautepierre Hospital, University Hospitals of Strasbourg, Strasbourg, France
| | - Luca Giovanella
- Clinic of Nuclear Medicine and PET/CT Center, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
- University Hospital and University of Zürich, Zürich, Switzerland
| | - Elif Hindié
- Nuclear Medicine Department, Haut-Lévêque Hospital, University Hospitals of Bordeaux, University of Bordeaux, Bordeaux, France
- LabEx TRAIL, University of Bordeaux, Bordeaux, France
| | - Abhishek Jha
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Karel Pacak
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - David Taïeb
- Nuclear Medicine, La Timone University Hospital, Aix-Marseille University, Marseille, France
- European Center for Research in Medical Imaging, Aix-Marseille University, Marseille, France
| | - Thomas Walter
- Medical Oncology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- University of Lyon, Université Lyon 1, Lyon, France
| | - Alessio Imperiale
- Biophysics and Nuclear Medicine, Hautepierre Hospital, University Hospitals of Strasbourg, Strasbourg University/FMTS, Strasbourg, France.
- Molecular Imaging-DRHIM, IPHC, UMR 7178, CNRS/Unistra, Strasbourg, France.
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Giovanella L, Avram AM, Iakovou I, Kwak J, Lawson SA, Lulaj E, Luster M, Piccardo A, Schmidt M, Tulchinsky M, Verburg FA, Wolin E. EANM practice guideline/SNMMI procedure standard for RAIU and thyroid scintigraphy. Eur J Nucl Med Mol Imaging 2019; 46:2514-2525. [DOI: 10.1007/s00259-019-04472-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 07/29/2019] [Indexed: 12/15/2022]
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Evaluation of Malignancy Risk in 18F-FDG PET/CT Thyroid Incidentalomas. Diagnostics (Basel) 2019; 9:diagnostics9030092. [PMID: 31394887 PMCID: PMC6787921 DOI: 10.3390/diagnostics9030092] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/04/2019] [Accepted: 08/05/2019] [Indexed: 02/03/2023] Open
Abstract
Thyroid incidentalomas detected by 18 fluoro-2-deoxy-d-glucose (FDG)-positron emission tomography/computed tomography (PET/CT) are a real challenge for nuclear medicine physicians and clinicians. This study aimed to evaluate the risk of malignancy for patients with focal thyroid incidentalomas (TIs) diagnosed through FDG PET/CT. Data from 6900 patients, with a known primary tumor, who had an FDG PET/CT investigation performed were analyzed for the presence of incidental thyroid uptake. The focal TIs were reported, and the patients were referred for further investigation to the endocrinology department. There were 126 patients (1.82%) who presented with focal thyroid uptake, and for 87 of them, investigations were completed with ultrasonography (US), and for 29 with a fine needle aspiration biopsy (FNAB) procedure. Malignancy was detected in 7.93% (10/126) of cases. An arbitrary cutoff value of four was established for the standard uptake value lean body mass (SUVlbm Max) to differentiate the malignant nodules from the benign ones, and this value was significantly associated with malignancy (p = 0.0168). TIs are not so frequent, but they have a potential malignancy risk, and a proper evaluation is required. Even though SUVlbm Max is a predictive factor for malignancy, the FNAB remains the main diagnostic method for the therapeutic management of these patients.
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Maturo A, Tromba L, De Anna L, Carbotta G, Livadoti G, Donello C, Falbo F, Galiffa G, Esposito A, Biancucci A, Carbotta S. Incidental thyroid carcinomas. A retrospective study. G Chir 2019; 38:94-101. [PMID: 28691675 DOI: 10.11138/gchir/2017.38.2.094] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIM The aim of the present study is to report our series of incidental thyroid carcinomas in the last 15 years and their follow-up, discussing therapeutics indications and surgical choices. PATIENTS AND METHODS We have considered 1793 patients operated on Surgical Sciences Department of "Sapienza" University of Rome from January 1, 2001 to December 31, 2015. The study was conducted on 83 totally thyroidectomized patients with a real incidental thyroid carcinoma, by clinical, laboratory and instrumental controls. Whole-body scan was the most important test in postoperative evaluation. RESULTS In our series, the incidence of incidental carcinomas was 4.62%. Compared to the total number of cancer patients, the percentage is 21,9%. In 15.66% of cases there was multifocality and in 7.23% also bilaterality. Regarding the histological type, in all cases they were papillary carcinoma. The size of the neoplastic lesions ranged from a minimum of 3 to a maximum of 10 mm. Whole-body scan revealed lymph node metastasis in 57.69% of patients. DISCUSSION Comparing these data with our previous studies we have seen a significant increase in incidence of incidental thyroid carcinomas over the years. Our therapeutical choice is total thyroidectomy and complection thyroidectomy after lobectomy, because of a relevant percentage of multifocality and/or bilaterality of these tumors. Many Authors on the contrary prefer a more conservative approach invoking the good prognosis of these tumors. The 57.69% of lymph node metastasis at postoperative whole-body scan comfort us in our setting. CONCLUSION Incidental thyroid carcinomas are not uncommon. We consider only tumors until 1 cm in diameter. Multifocality and bilaterality are often present such as occult lymph node metastasis. Our therapeutical choice is total thyroidectomy in order to conduct a proper follow-up.
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Lim CH, Moon SH, Cho YS, Choi JY, Lee KH, Hyun SH. Prognostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with combined hepatocellular-cholangiocarcinoma. Eur J Nucl Med Mol Imaging 2019; 46:1705-1712. [DOI: 10.1007/s00259-019-04327-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/01/2019] [Indexed: 12/17/2022]
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Lee CH, Lee SW, Son SH, Hong CM, Jeong JH, Jeong SY, Ahn BC, Lee J. PROGNOSTIC VALUE OF LYMPH NODE UPTAKE ON PRETREATMENT F-18 FDG PET/CT IN PATIENTS WITH N1B PAPILLARY THYROID CARCINOMA. Endocr Pract 2019; 25:787-793. [PMID: 31013158 DOI: 10.4158/ep-2018-0607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The aim of this study was to investigate the prognostic value of metabolic characteristics of metastatic lymph node (LN) using pretreatment F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for patients with papillary thyroid carcinoma (PTC) and metastatic lateral LN (N1b). Methods: Ninety-six PTC patients (female:male = 72:24; median age, 44.5 years) with pathologic N1b who underwent pretreatment FDG PET/CT, total thyroidectomy, and radioactive iodine ablation were retrospectively reviewed. To predict responses to initial therapy and recurrence, clinicopathologic factors and metabolic parameters were reviewed, such as sex, age, tumor size, extranodal extension, number and ratio of metastatic LNs, serum thyroglobulin, and maximum standardized uptake value (SUVmax). Results: Among the 96 PTC patients, 81 (84.4%) were classified into the acceptable response (58 excellent; 23 indeterminate) and 15 (15.6%) into the incomplete response (8 biochemical incomplete; 7 structural incomplete) by the 2015 American Thyroid Association management guideline for differentiated thyroid carcinoma. The multivariate analysis showed that SUVmax of N1b (P = .018), pre-ablation stimulated thyroglobulin level (P = .006), and the ratio of metastatic LNs (P = .018) were related to incomplete response. The cutoff value of each variable was determined by receiver operating characteristic analysis. Nine (9.4%) patients experienced recurrences (median follow-up: 50 months). The Kaplan-Meier analysis revealed that SUVmax of N1b (cutoff value: 2.3; P = .025) and ratio of metastatic LNs (cutoff value: 0.218; P = .037) were significant prognostic factors for recurrence. Conclusion: High SUVmax of N1b cervical LN on pretreatment FDG PET/CT could predict incomplete responses to initial therapy and recurrence in patients with N1b PTC. Abbreviations: ATA = American Thyroid Association; DTC = well-differentiated thyroid carcinoma; FDG = F-18 fluorodeoxyglucose; IQR = interquartile range; LN = lymph node; N1b = metastatic lateral cervical lymph node; PET/CT = positron emission tomography/computed tomography; PTC = papillary thyroid carcinoma; RAI = radioactive iodine; ROC = receiver operating characteristic; SUVmax = maximum standardized uptake value; Tg = thyroglobulin; USG = ultrasonography.
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13
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Piccardo A, Trimboli P, Foppiani L, Treglia G, Ferrarazzo G, Massollo M, Bottoni G, Giovanella L. PET/CT in thyroid nodule and differentiated thyroid cancer patients. The evidence-based state of the art. Rev Endocr Metab Disord 2019; 20:47-64. [PMID: 30900067 DOI: 10.1007/s11154-019-09491-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A more conservative approach to the clinical management of thyroid nodules and differentiated thyroid cancer has recently been proposed by the 2015 ATA guidelines. In this context, fine-needle aspiration biopsy has been reserved for nodules with particular ultrasound features or dimensions that exclude low-risk thyroid lesions. Accordingly, a less aggressive surgical approach (i.e. lobectomy) has been recommended as the first-choice treatment in nodules with indeterminate cytology or in small cytologically confirmed malignant nodules. At the same time, radioactive remnant ablation has been considered only for DTC patients with concrete risks of disease persistence/relapse after thyroidectomy. In addition, further radioactive iodine therapies (RAI) have been proposed only for patients presenting unresectable and iodine-avid structural relapse. In this complex scenario, which requires attention to each clinical aspect of the patient, the introduction of accurate diagnostic tools is highly warranted. PET/CT is a very sensitive and specific diagnostic procedure that can better characterize the risk of thyroid nodules, identify DTC relapse early and predict the response to RAI. Thus, it seems essential to customize a more conservative approach to thyroid nodules and DTC patients. The aim of this review is to report the principal clinical context in which PET/CT has been used and to evaluate the evidence-based support for each diagnostic indication.
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Affiliation(s)
- Arnoldo Piccardo
- Department of Nuclear Medicine, Galliera Hospital, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy.
| | - Pierpaolo Trimboli
- Clinic of Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Lugano, Bellinzona, Switzerland
| | - Luca Foppiani
- Department of Internal Medicine, Galliera Hospital, Genoa, Italy
| | - Giorgio Treglia
- Clinic of Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Lugano, Bellinzona, Switzerland
- Health Technology Assessment Unit, General Directorate, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
| | - Giulia Ferrarazzo
- Department of Nuclear Medicine, Galliera Hospital, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Michela Massollo
- Department of Nuclear Medicine, Galliera Hospital, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Gianluca Bottoni
- Department of Nuclear Medicine, Galliera Hospital, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Luca Giovanella
- Clinic of Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Lugano, Bellinzona, Switzerland
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Pattison DA, Bozin M, Gorelik A, Hofman MS, Hicks RJ, Skandarajah A. 18F-FDG–Avid Thyroid Incidentalomas: The Importance of Contextual Interpretation. J Nucl Med 2017; 59:749-755. [DOI: 10.2967/jnumed.117.198085] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 09/11/2017] [Indexed: 11/16/2022] Open
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15
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Morbelli S, Ferrarazzo G, Pomposelli E, Pupo F, Pesce G, Calamia I, Fiz F, Clapasson A, Bauckneht M, Minuto M, Sambuceti G, Giusti M, Bagnasco M. Relationship between circulating anti-thyroglobulin antibodies (TgAb) and tumor metabolism in patients with differentiated thyroid cancer (DTC): prognostic implications. J Endocrinol Invest 2017; 40:417-424. [PMID: 27844413 DOI: 10.1007/s40618-016-0578-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 11/02/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE TgAb have been proposed as tumor markers in DTC. Recent evidence links TgAb levels with DTC aggressiveness. We aimed to evaluate the relationship between TgAb and tumor glucose metabolism in DTC patients. METHODS Seventy-one DTC patients who underwent 18F-FDG PET/CT were included. According to TgAb value and trends, patients were divided into TgAb positive (TgAb+) or negative (TgAb-) as well as in patients with increasing (Inc-TgAb) or decreasing (Dec-TgAb) trend. On the basis of the results of FDG-PET, post-therapy 131I and Tg levels, patients were divided into two groups according to the evidence (ED) or absence (NED) of disease. ED patients were further divided into three subgroups: 1. radioiodine avid with positive 18F-FDG PET/CT (PET+/131I+), 2. radioiodine refractory with positive 18F-FDG PET/CT (PET+/131I-) and 3. radioiodine avid with negative 18F-FDG PET/CT (PET-/131I+). MeanSUV of FDG-avid lesions was assessed and averaged for each patient (SUVmean-pt). T test was performed to assess the difference between SUVmean in TgAb-, TgAb+ and in Inc-TgAb and Dec-TgAb subgroups. Difference in TgAb between ED and NED patients as well as between ED patients and PET+/131I+, PET+/131I- and PET-/131I+ subgroups was compared. RESULTS SUVmean was significantly higher in Inc-TgAb with respect to Dec-TgAb subgroup (5.2 ± 1.5 vs. 2.9 ± 1.1, p < 0.05). TgAb were higher only in the ED PET+/131I+ subgroup with respect to NED patients (p < 0.01). CONCLUSIONS The relationship between higher tumor metabolism and trend of TgAb supports a prognostic relevance of TgAb in DTC patients. Significantly higher TgAb in radioiodine avid tumors with positive 18F-FDG PET/CT further testify the role of TgAb as surrogate tumor marker in DTC.
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Affiliation(s)
- S Morbelli
- Nuclear Medicine UnitIRCCS AOU San Martino - IST, University of Genoa, Largo R. Benzi 10, 16132, Genoa, Italy.
- Thyroid Cancer Board, IRCCS AOU San Martino - IST, University of Genoa, Genoa, Italy.
| | - G Ferrarazzo
- Nuclear Medicine UnitIRCCS AOU San Martino - IST, University of Genoa, Largo R. Benzi 10, 16132, Genoa, Italy
| | - E Pomposelli
- Nuclear Medicine UnitIRCCS AOU San Martino - IST, University of Genoa, Largo R. Benzi 10, 16132, Genoa, Italy
- Thyroid Cancer Board, IRCCS AOU San Martino - IST, University of Genoa, Genoa, Italy
| | - F Pupo
- Autoimmunity UnitIRCCS AOU San Martino - IST, University of Genoa, Genoa, Italy
| | - G Pesce
- Autoimmunity UnitIRCCS AOU San Martino - IST, University of Genoa, Genoa, Italy
| | - I Calamia
- Nuclear Medicine UnitIRCCS AOU San Martino - IST, University of Genoa, Largo R. Benzi 10, 16132, Genoa, Italy
| | - F Fiz
- Nuclear Medicine UnitIRCCS AOU San Martino - IST, University of Genoa, Largo R. Benzi 10, 16132, Genoa, Italy
| | - A Clapasson
- Autoimmunity UnitIRCCS AOU San Martino - IST, University of Genoa, Genoa, Italy
| | - M Bauckneht
- Nuclear Medicine UnitIRCCS AOU San Martino - IST, University of Genoa, Largo R. Benzi 10, 16132, Genoa, Italy
| | - M Minuto
- U.O. Chirurgia 1, Department of Surgery, IRCCS AOU San Martino - IST, Genoa, Italy
- Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
- Thyroid Cancer Board, IRCCS AOU San Martino - IST, University of Genoa, Genoa, Italy
| | - G Sambuceti
- Nuclear Medicine UnitIRCCS AOU San Martino - IST, University of Genoa, Largo R. Benzi 10, 16132, Genoa, Italy
| | - M Giusti
- Endocrinology UnitIRCCS AOU San Martino - IST, University of Genoa, Genoa, Italy
- Thyroid Cancer Board, IRCCS AOU San Martino - IST, University of Genoa, Genoa, Italy
| | - M Bagnasco
- Autoimmunity UnitIRCCS AOU San Martino - IST, University of Genoa, Genoa, Italy
- Thyroid Cancer Board, IRCCS AOU San Martino - IST, University of Genoa, Genoa, Italy
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Piccardo A, Puntoni M, Bottoni G, Treglia G, Foppiani L, Bertoli M, Catrambone U, Arlandini A, Dib B, Altrinetti V, Massollo M, Bossert I, Cabria M, Bertagna F, Giovanella L. Differentiated Thyroid Cancer lymph-node relapse. Role of adjuvant radioactive iodine therapy after lymphadenectomy. Eur J Nucl Med Mol Imaging 2016; 44:926-934. [DOI: 10.1007/s00259-016-3593-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 12/06/2016] [Indexed: 01/26/2023]
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Abstract
Neuroblastoma is an embryonic tumor of the peripheral sympathetic nervous system, and is metastatic or otherwise high risk for relapse in nearly 50% of cases, with a long-term survival of <40%. Therefore, exact staging with radiological and nuclear medicine imaging methods is crucial for finding the adequate therapeutic choice. The tumor cells express the norepinephrine transporter, which makes metaiodobenzylguanidine (MIBG), an analogue of norepinephrine, an ideal tumor-specific agent for imaging. On the contrary, MIBG imaging has several disadvantages such as limited spatial resolution, limited sensitivity in small lesions, need for two or even more acquisition sessions, and a delay between the start of the examination and result. Most of these limitations can be overcome with positron emission tomography (PET) using different radiotracers. Furthermore, for operative or biopsy planning, a combination with morphological imaging methods is indispensable. This article would discuss the therapeutic strategy for primary and follow-up diagnosis in neuroblastoma using MIBG scintigraphy and different new PET tracers as well as multimodality imaging.
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Affiliation(s)
- Thomas Pfluger
- Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany.
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18
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Kim SK, So Y, Chung HW, Yoo YB, Park KS, Hwang TS, Kim B, Lee WW. Analysis of predictability of F-18 fluorodeoxyglucose-PET/CT in the recurrence of papillary thyroid carcinoma. Cancer Med 2016; 5:2756-2762. [PMID: 27539659 PMCID: PMC5083728 DOI: 10.1002/cam4.867] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/22/2016] [Accepted: 07/25/2016] [Indexed: 11/19/2022] Open
Abstract
Whether preoperative F-18 fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) can predict recurrence of papillary thyroid carcinoma (PTC) remains unclear. Herein, we evaluated the potential of primary tumor FDG avidity for the prediction of tumor recurrence in PTC patients. A total of 412 PTC patients (72 males, 340 females; age: 47.2 ± 12.2 years; range: 17-84 years) who underwent FDG-PET/CT prior to total thyroidectomy (n = 350), subtotal thyroidectomy (n = 2), or lobectomy (n = 60) from 2007 to 2011 were analyzed. The predictive ability for recurrence was investigated among various clinicopathological factors, BRAFV600E mutation, and preoperative FDG avidity of the primary tumor using Kaplan-Meier (univariate) and Cox proportional hazards regression (multivariate) analyses. Of the 412 patients, 19 (4.6%) experienced recurrence, which was confirmed either by pathology (n = 17) or high serum thyroglobulin level (n = 2), during a mean follow-up period of 43.9 ± 16.6 months. Of the 412 patients, 237 (57.5%) had FDG-avid tumors (maximum standardized uptake value, 7.1 ± 7.0; range: 1.6-50.5). Kaplan-Meier analysis revealed that tumor size (P = 0.0054), FDG avidity of the tumor (P = 0.0049), extrathyroidal extension (P = 0.0212), and lymph node (LN) stage (P < 0.0001) were significant predictors for recurrence. However, only LN stage remained a significant predictor in the multivariate analysis (P < 0.0001). Patients with FDG-avid tumors had higher LN stage (P < 0.0001), larger tumor size (P < 0.0001), and more frequent extrathyroidal extension (P < 0.0001). In conclusion, FDG avidity of the primary tumor in preoperative FDG-PET/CT could not predict the recurrence of PTC. LN stage was the only identified predictor of PTC recurrence.
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Affiliation(s)
- Suk Kyeong Kim
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Young So
- Department of Nuclear Medicine, Konkuk University School of Medicine, Seoul, Korea.
- Bioimaging Translational Open Innovation Center, Konkuk University School of Medicine, Seoul, Korea.
| | - Hyun Woo Chung
- Department of Nuclear Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Young Bum Yoo
- Department of Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Kyung Sik Park
- Department of Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Tae Sook Hwang
- Department of Pathology, Konkuk University School of Medicine, Seoul, Korea
| | - Bokyung Kim
- Bioimaging Translational Open Innovation Center, Konkuk University School of Medicine, Seoul, Korea
- Department of Physiology, Konkuk University School of Medicine, Seoul, Korea
| | - Won Woo Lee
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea
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19
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Treglia G, Giovanella L. Prognostic role of FDG-PET/CT in differentiated thyroid carcinoma: Where are we now? J Med Imaging Radiat Oncol 2016; 59:278-80. [PMID: 26053477 DOI: 10.1111/1754-9485.12317] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 04/11/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Giorgio Treglia
- Department of Nuclear Medicine, Thyroid and PET/CT Center, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Luca Giovanella
- Department of Nuclear Medicine, Thyroid and PET/CT Center, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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20
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Piccardo A, Puntoni M, Treglia G, Foppiani L, Bertagna F, Paparo F, Massollo M, Dib B, Paone G, Arlandini A, Catrambone U, Casazza S, Pastorino A, Cabria M, Giovanella L. Thyroid nodules with indeterminate cytology: prospective comparison between 18F-FDG-PET/CT, multiparametric neck ultrasonography, 99mTc-MIBI scintigraphy and histology. Eur J Endocrinol 2016; 174:693-703. [PMID: 26966173 DOI: 10.1530/eje-15-1199] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/19/2016] [Indexed: 01/03/2023]
Abstract
PURPOSE To evaluate the role of (18)F-flurodeoxiglucose positron emission tomography/computed tomography ((18)F-FDG-PET/CT) in predicting malignancy of thyroid nodules with indeterminate cytology. PATIENTS AND METHODS We analysed 87 patients who have been scheduled to undergo surgery for thyroid nodule with indeterminate cytology. All patients underwent (18)F-FDG-PET/CT, multiparametric neck ultrasonography (MPUS), and (99m)Tc-methoxyisobutylisonitrile scintigraphy ((99m)Tc-MIBI-scan). Histopathology was the standard of reference. We compared the sensitivity (SE), specificity (SP), accuracy (AC), positive (PPV) and negative predictive (NPV) values of (18)F-FDG-PET/CT with those of (99m)Tc-MIBI-scan and MPUS in detecting cancer. Univariate and multivariate analyses evaluated the association between each diagnostic tool and histopathology. RESULTS On histopathology, 69 out of 87 nodules were found to be benign and 18 to be malignant. The SE, SP, AC, PPV and NPV of (18)F-FDG-PET/CT were 94, 58, 66, 37 and 98% respectively. The SE, AC and NPV of (18)F-FDG-PET/CT were significantly higher than those of MPUS and (99m)Tc-MIBI-scan. The association of both positive (18)F-FDG-PET/CT and MPUS (FDG+/MPUS+) showed significantly lower SE (61% vs 94%) and NPV (88% vs 98%) than (18)F-FDG-PET/CT alone, but significantly higher SP (77% vs 58%). On univariate analysis, (18)F-FDG-PET/CT and the combination of FDG+/MPUS+ and of FDG+/MIBI- were all significantly associated with histopathology. On multivariate analysis, only FDG+/MIBI- was significantly associated with histopathology. CONCLUSION The AC of (18)F-FDG-PET /CT in detecting thyroid malignancy is higher than that of (99m)Tc-MIBI-scan and MPUS. A negative (18)F-FDG-PET/CT correctly predicts benign findings on histopathology. The association of FDG+/MPS+ is significantly more specific than (18)F-FDG-PET/CT alone in identifying differentiated thyroid cancer. A positive (18)F-FDG-PET/CT is significantly associated with malignancy when qualitative (99m)Tc-MIBI-scan is rated as negative.
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Affiliation(s)
- A Piccardo
- Nuclear Medicine UnitOffice of the Scientific Director, Galliera Hospital, Genoa, Italy
| | - M Puntoni
- Clinical Trial UnitOffice of the Scientific Director, Galliera Hospital, Genoa, Italy
| | - G Treglia
- Department of Nuclear Medicine and PET/CT CentreOncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - L Foppiani
- Internal MedicineGalliera Hospital, Genoa, Italy
| | - F Bertagna
- Department of Nuclear MedicineUniversity of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - F Paparo
- Department of RadiologyGalliera Hospital, Genoa, Italy
| | - M Massollo
- Nuclear Medicine UnitOffice of the Scientific Director, Galliera Hospital, Genoa, Italy
| | - B Dib
- Nuclear Medicine UnitOffice of the Scientific Director, Galliera Hospital, Genoa, Italy
| | - G Paone
- Department of Nuclear Medicine and PET/CT CentreOncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - A Arlandini
- Department of SurgeryThyroid Centre, Galliera Hospital, Genoa, Italy
| | - U Catrambone
- Department of SurgeryThyroid Centre, Galliera Hospital, Genoa, Italy
| | - S Casazza
- Department of PathologyGalliera Hospital, Genoa, Italy
| | - A Pastorino
- Department of PathologyGalliera Hospital, Genoa, Italy
| | - M Cabria
- Nuclear Medicine UnitOffice of the Scientific Director, Galliera Hospital, Genoa, Italy
| | - L Giovanella
- Department of Nuclear Medicine and PET/CT CentreOncology Institute of Southern Switzerland, Bellinzona, Switzerland
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21
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FDG PET performed at thyroid remnant ablation has a higher predictive value for long-term survival of high-risk patients with well-differentiated thyroid cancer than radioiodine uptake. Clin Nucl Med 2015; 40:378-83. [PMID: 25608175 DOI: 10.1097/rlu.0000000000000699] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The predictive value of FDG PET at thyroid remnant ablation was evaluated in comparison to radioiodine uptake in high-risk patients with differentiated thyroid cancer. PATIENTS AND METHODS One hundred forty-one patients who underwent radioiodine therapy (RIT) after total thyroidectomy and received at least 1 further RIT due to suspected metastases were retrospectively analyzed. Patients had not received RIT previously. FDG PET was performed before thyroid remnant ablation. Thyroid-stimulating hormone-stimulated serum thyroglobulin (Tg) was measured for biochemical response assessment (change of Tg between the first and second RIT, ΔTg). RESULTS Biochemical response could be evaluated in 80 patients; survival data could be obtained for 88 patients (maximum, 124 months). Biochemical response was significantly better in patients with radioiodine-positive metastases compared with patients with radioiodine-negative metastases (median ΔTg I+, 55.8% vs I-, 112.6%; P < 0.01). Regarding survival, deaths occurred later in patients with radioiodine-positive metastases compared with radioiodine-negative patients; however, there was no significant difference regarding overall survival (I+, 61.3% vs I-, 58.2%; P > 0.05). Patients with FDG-positive metastases at thyroid remnant ablation showed a poorer biochemical response compared with patients with FDG-negative metastases (median ΔTg FDG+, 77.5% vs FDG-, 53.2%; P < 0.05), and these groups also differed significantly regarding survival (overall survival FDG+, 48.5% vs FDG-, 100%, P < 0.05). CONCLUSIONS At thyroid remnant ablation, FDG PET is more predictive for long-term survival, whereas radioiodine uptake is more important for short-term response. FDG PET performed at thyroid remnant ablation might represent a useful tool for management of high-risk patients with differentiated thyroid cancer.
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Kim H, Na KJ, Choi JH, Ahn BC, Ahn D, Sohn JH. Feasibility of FDG-PET/CT for the initial diagnosis of papillary thyroid cancer. Eur Arch Otorhinolaryngol 2015; 273:1569-76. [PMID: 25971994 DOI: 10.1007/s00405-015-3640-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 04/26/2015] [Indexed: 12/26/2022]
Abstract
To assess the role of [18F]-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) as a preoperative diagnostic tool in papillary thyroid carcinoma (PTC). From 2011 to 2014, 197 patients with PTC (246 tumor foci in all) underwent FDG-PET. Among these patients, 46 underwent neck dissection for lateral neck metastasis. According to the FDG avidity of the tumor foci or lateral neck metastasis, factors associated with the prognostic value were evaluated by univariate and multivariate logistic regression analyses. Among the 197 patients, 7 (3.6 %) were incidentally found to have non-thyroid origin malignancy. Additionally, 63.0 % (155/246) of PTC foci showed FDG uptake on PET/CT. Univariate analysis showed that the tumor size, the presence of extrathyroidal extension, BRAF mutation, and Hashimoto thyroiditis were associated with FDG avidity. However, except for pathological extrathyroidal extension, the other factors showed statistically significant correlations with FDG avidity (p < 0.001, p = 0.008, and p = 0.009, respectively). FDG uptake in lateral neck node metastasis showed high specificity and negative predictive value (NPV). In four cases of nonspecific findings on ultrasonography (USG)/CT, FDG avidity was helpful to diagnose the presence of lateral neck metastasis. The maximum standardized uptake value (SUVmax) of PET/CT was correlated with the maximum diameter of the involved lateral node. FDG avidity did not show any significance in the recurrence-free survival of both the thyroid tumor and lateral neck metastasis. The FDG avidity of PTC did not show prognostic predictive meaning. However, in the case of lateral neck metastasis, FDG avidity showed high sensitivity and NPV, and could provide better information in cases of nonspecific findings on USG and CT.
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Affiliation(s)
- Heejin Kim
- Department of Otorhinolaryngology, Kyungpook National University College of Medicine, 200 Dongdukro, Junggu, Daegu, Republic of Korea
| | - Kyung Jin Na
- Department of Otorhinolaryngology, Kyungpook National University College of Medicine, 200 Dongdukro, Junggu, Daegu, Republic of Korea
| | - Jae Hyuk Choi
- Department of Otorhinolaryngology, Kyungpook National University College of Medicine, 200 Dongdukro, Junggu, Daegu, Republic of Korea
| | - Byeong-Cheol Ahn
- Department of Nuclear Medicine, Kyungpook National University College of Medicine, 200 Dongdukro, Junggu, Daegu, Republic of Korea
| | - Dongbin Ahn
- Department of Otorhinolaryngology, Kyungpook National University College of Medicine, 200 Dongdukro, Junggu, Daegu, Republic of Korea
| | - Jin Ho Sohn
- Department of Otorhinolaryngology, Kyungpook National University College of Medicine, 200 Dongdukro, Junggu, Daegu, Republic of Korea.
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Differentiated thyroid cancer incidentally detected by ¹⁸F-FDG PET/CT: patient's future in a hot-spot? Eur J Nucl Med Mol Imaging 2015; 41:1479-81. [PMID: 24824461 DOI: 10.1007/s00259-014-2794-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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24
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Employing Bayesian approach to the intermediate risk categories of the Bethesda thyroid cytopathology reporting system: can FDG PET/CT find a strong enough evidence-base to be practised clinically as an adjunct? Eur J Nucl Med Mol Imaging 2014; 41:2354-5. [PMID: 25201009 DOI: 10.1007/s00259-014-2908-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 08/25/2014] [Indexed: 10/24/2022]
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