Comparison of 18F-fluorodeoxyglucose uptake with the expressions of glucose transporter type 1 and Na+/I- symporter in patients with untreated papillary thyroid carcinoma

KSNM60 in Nuclear Endocrinology: from the Beginning to the Future

Nuclear endocrinology is the main ignitor for founding the Korean Society of Nuclear Medicine (KSNM) in the early 1960s by outstanding pioneering medical doctors. Management of thyroid diseases required nuclear medicine technology in the early days of the KSNM and was rapidly developed by advancements in nuclear medicine technology. Nuclear thyroidology remains one of the main clinical applications in nuclear medicine worldwide. Nuclear medicine technology provides essential information for diagnosing and assessing diseases of the parathyroid glands, pituitary gland, and neuroendocrine tumors (NETs). In addition, therapeutic nuclear medicine is essential for managing nonresectable NETs. Nuclear endocrinology remains a major section in clinical nuclear medicine, and members of the KSNM have contributed to progressing better management of benign and malignant endocrine diseases. This review summarizes the historical activities and milestone contributions to nuclear endocrinology made by the members of the KSNM over the past 60 years to congratulate the KSNM on its 60-year anniversary.

The Utility of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Differentiated Thyroid Cancer Patients with Biochemical Recurrence and Negative Whole-Body Radioiodine Scintigraphy and Evaluation of the Possible Role of a Limited Regional Scan

Purpose of the Study

¹⁸F-Fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) is used in the management of recurrent differentiated thyroid cancer (DTC) patients presented with rising thyroglobulin (Tg) or anti-Tg antibody (Atg) levels and negative whole-body I-131 scan (WBS). We aimed to evaluate the utility of regional or limited PET/CT in a large population preset with variable Tg/(ATg) levels.

Materials and Methods

In a retrospective study, we analyzed 137 PET/CT done on DTC patients presented with raised Tg/Atg and negative WBS. Retrospective evaluation of other available clinical information was done.

Results

One hundred and thirty-seven patients aged 8-72 years (41 ± 17.7 years) were included in the study. Eighty-nine (64.9%) patients had positive findings on ¹⁸F-FDG PET-CT. It included thyroid bed recurrence, cervical, mediastinal lymphadenopathy, lung, and bone lesions. In addition, 36 patients had metabolically inactive lung nodules detected on CT. Serum Tg and female sex were the only predictors for a positive PET scan. In most (97.1%) of the patients, the disease was limited to the neck and thoracic region.

Conclusions

PET/CT is an excellent imaging modality for evaluating DTC patients presented with biochemical recurrence. It not only finds the disease in more than 80% of the patients but also detects distant metastatic disease, which precludes regional therapies. Lesions were noted mostly in the neck and thoracic region with very few distant skeletal metastases (4/137 patients). In most of the patients, routine vertex to mid-thigh imaging could be avoided.

FDG PET/CT for the early prediction of RAI therapy response in patients with metastatic differentiated thyroid carcinoma

Background

In some patients with metastatic differentiated thyroid cancer, even if they had substantial of radioactive iodine (RAI) uptake, the RAI therapy response was poor. We investigated the usefulness of FDG PET/CT for the early prediction of RAI therapy response in the patients with metastatic differentiated thyroid cancer (DTC).

Methods

The 54 metastatic DTC patients who underwent both RAI therapy scan and FDG PET/CT at the same period were enrolled in the study. Clinical information and several parameters from RAI therapy scan and FDG PET/CT were investigated. Therapeutic response of RAI was assessed as two categories: response rate (RR) and disease control rate (DCR).

Results

Twenty-two patients (41%) had therapeutic response to RAI therapy, whereas 32 (59%) patients did not. There were no significant differences in age, sex, stage, histology, metastasis site, stimulated Tg or Tg-Ab, therapeutic doses, and even RAI uptake pattern among two groups. However, there was a significant negative correlation between FDG avidity of metastatic lesions and RR (OR = 0.233; p = 0.016). Although the patient group with only RAI uptake showed a significant correlation with RR (OR = 5.833; p = 0.01), the patient group with both RAI and FDG uptake did not show any significant correlation with RR. In the subgroup analysis, uptake grades of RAI or FDG was well correlated with DCR.

Conclusions

The patient group with FDG uptake in metastatic DTC showed poor response to RAI therapy regardless of the degree of RAI uptake. Therefore, FDG PET/CT may help us identify the patients with radioiodine refractory DTC and establish an appropriate treatment strategy in the early period.

mRNA Expression of SLC5A5 and SLC2A Family Genes in Papillary Thyroid Cancer: An Analysis of The Cancer Genome Atlas

PURPOSE

The present study investigated the dynamics and prognostic role of messenger RNA (mRNA) expression responsible for ¹⁸F-fluorodeoxyglucose (FDG) uptake in FDG positron emission tomography (PET) and radioactive iodine (¹³¹I) uptake in whole-body radioactive iodine scans (WBS) in papillary thyroid cancer (PTC) patients.

MATERIALS AND METHODS

The primary and processed data were downloaded from the Genomic Data Commons Data Portal. Expression data for sodium/iodide symporter (solute carrier family 5 member 5, SLC5A5), hexokinase (HK1-3), glucose-6-phosphate dehydrogenase (G6PD), and glucose transporter (solute carrier family 2, SLC2A1-4) mRNA were collected.

RESULTS

Expression of SLC5A5 mRNA were negatively correlated with SLC2A1 mRNA and positively correlated with SLC2A4 mRNA. In PTC with BRAF mutations, expressions of SLC2A1, SLC2A3, HK2, and HK3 mRNA were higher than those in PTC without BRAF mutations. Expression of SLC5A5, SLC2A4, HK1, and G6PD mRNA was lower in PTC without BRAF mutation. PTCs with higher expression of SLC5A5 mRNA had more favorable disease-free survival, but no association with overall survival.

CONCLUSION

Expression of SLC5A5 mRNA was negatively correlated with SLC2A1 mRNA. This finding provides a molecular basis for the management of PTC with negative WBS using ¹⁸F-FDG PET scans. In addition, higher expression of SLC5A5 mRNA was associated with less PTC recurrence, but not with deaths.

The Role of the NIS (SLC5A5) Gene in Papillary Thyroid Cancer: A Systematic Review

Papillary thyroid cancer (PTC) is the most common thyroid malignancy. Genetic and epigenetic alterations play a decisive role in the onset of several human neoplasms. Mutations and polymorphisms are two frequent genetic alterations. Located on chromosome 19 (19p13.11), the NIS SLC5A5 (solute carrier family 5 member 5) gene encodes a highly specialized and efficient 80-90 kDa transmembrane glycoprotein that mediates active transport of iodide from the bloodstream into the follicular cells. Given the highly significant role of NIS in the physiology and the cancer pathogenesis process, this paper's objective is to provide a comprehensive assessment of the associations between NIS gene and protein with papillary thyroid cancer.

F18-FDG-PET for recurrent differentiated thyroid cancer: a systematic meta-analysis

Background

Positron emission tomography (PET) with fluor-18-deoxy-glucose (FDG) is widely used for diagnosing recurrent or metastatic disease in patients with differentiated thyroid cancer (DTC).

Purpose

To assess the diagnostic accuracy of FDG-PET for DTC in patients after ablative therapy.

Material and Methods

A systematic search was conducted in Medline/PubMed, EMBASE, Cochrane Library, Web of Science, and Open Grey looking for all English-language original articles on the performance of FDG-PET in series of at least 20 patients with DTC having undergone ablative therapy including total thyroidectomy. Diagnostic performance measures were pooled using Reitsma’s bivariate model.

Results

Thirty-four publications between 1996 and 2014 met the inclusion criteria. Pooled sensitivity and specificity were 79.4% (95% confidence interval [CI], 73.9–84.1) and 79.4% (95% CI, 71.2–85.4), respectively, with an area under the curve of 0.858.

Conclusion

F18-FDG-PET is a useful method for detecting recurrent DTC in patients having undergone ablative therapy.

Management of Invasive Differentiated Thyroid Cancer

BACKGROUND

Invasive disease is a poor prognostic factor for patients with differentiated thyroid cancer (DTC). Uncontrolled central neck disease is a common cause of distressing death for patients presenting in this manner. Advances in assessment and management of such cases have led to significant improvements in outcome for this patient group. This article reviews the patterns of invasion and a contemporary approach to investigation and treatment of patients with invasive DTC.

SUMMARY

Aerodigestive tract invasion is reported in around 10% of case series of DTC. Assessment should include not only clinical history and physical examination with endoscopy as indicated, but ultrasound and contrast-enhanced cross-sectional imaging. Further studies including positron emission tomography should be considered, particularly in recurrent cases that are radioactive iodine (RAI) resistant. Both the patient and the extent of disease should be carefully assessed prior to embarking on surgery. The aim of surgery is to resect all gross disease. When minimal visceral invasion is encountered early, "shave" procedures are recommended. In the setting of transmural invasion of the airway or esophagus, however, full thickness excision is required. For intermediate cases in which invasion of the viscera has penetrated the superficial layers but is not evident in the submucosa, opinion is divided. Early reports recommended an aggressive approach. More recently authors have tended to recommend less aggressive resections with postoperative adjuvant therapies. The role of external beam radiotherapy continues to evolve in DTC with support for its use in patients considered to have RAI-resistant tumors.

CONCLUSIONS

Patients with invasive DTC require a multidisciplinary approach to investigation and treatment. With detailed assessment, appropriate surgery, and adjuvant therapy when indicated, this patient group can expect durable control of central neck disease, despite the aggressive nature of their primary tumors.

Relationships between transporter expression and the status of BRAF V600E mutation and F-18 FDG uptake in papillary thyroid carcinomas

PURPOSE

The purpose of this study was to evaluate the expression of the glucose transporters GLUT1 and GLUT3 in papillary thyroid carcinomas (PTCs) and to elucidate their relationship with the BRAF V600E mutation and F-18 FDG uptake.

MATERIALS AND METHODS

We retrospectively analyzed data of 52 PTC patients (41 women and 11 men; mean age, 52.4 ± 14.5 years). F-18 FDG PET/CT was performed preoperatively, and the maximum standardized uptake value (SUVmax) was calculated. GLUT1/GLUT3 expression was determined immunohistochemically, and the BRAF V600E mutation was detected using DNA sequencing.

RESULTS

GLUT1 and GLUT3 were expressed in 82.7% (43/52) and 59.6% (31/52) PTCs, respectively. The BRAF V600E mutation was detected in 65.4% (34/52) PTCs. The odds ratio between GLUT1 expression and the BRAF V600E mutation was 5.2 (95% CI, 1.11-24.05; p < 0.05), and that between GLUT3 expression and the BRAF V600E mutation was 3.8 (95% CI, 1.14-12.53; p < 0.05). The SUVmax of PTCs was significantly higher if they carried the BRAF V600E mutation (11.3 ± 2.0, compared with 5.7 ± 1.4 for wild type BRAF tumors, Mann-Whitney test, p = 0.016). Neither GLUT1 nor GLUT3 expression was significantly associated with the SUVmax of F-18 FDG PET/CT in PTCs.

CONCLUSIONS

Our findings confirmed that both GLUT1 and GLUT3 are strongly expressed by PTCs, although their expression was not significantly associated with the SUVmax of F-18 FDG PET/CT. However, GLUT1 and GLUT3 expressions were significantly associated with the presence of the BRAF V600E mutation, and the SUVmax of tumors was significantly higher in the presence of the mutated BRAF gene.

Assessment of the Role of Different Imaging Modalities with Emphasis on Fdg Pet/Ct in the Management of Well Differentiated Thyroid Cancer (WDTC)

BACKGROUND

Positron emission tomography/computed tomography is suggested to have a role in detection of iodine negative recurrence in well differentiated thyroid cancer. The aim of this study is to identify role of different imaging modalities in the management of well differentiated thyroid cancer.

METHODS

We reviewed 900 well differentiated thyroid cancer patients after post-thyroidectomy who underwent recombinant human thyroid stimulating hormone stimulated Sodium Iodide I 131 imaging. Out of 900 patients, 74 had positron emission tomography/computed tomography. Multivariate analysis was performed by controlling positron emission tomography/computed tomography, Sodium Iodide I 131 scan, neck ultrasonography, age, sex, primary tumor size, stage, histology, thyroglobulin. Patients were grouped according to results of Sodium Iodide I 131 scan and positron emission tomography/computed tomography.

RESULTS

Positron emission tomography/computed tomography was positive in 23 of 74 patients. The sensitivity for positron emission tomography was 11/11(100%), the specificity was 51/63 (81.0%), the positive predictive value was 11/23 (47.8%), and the negative predictive value was 51/51 (100%). The sensitivity for the neck ultrasonography was 4/8 (50%), the specificity was 53/60 (88.3%), positive predictive value was 4/11 (36.4%), and negative predictive value was 53/57 (93.0%). 50% of patients who had Sodium Iodide I 131 negative scan and positive positron emission tomography/computed tomography had a change in management. Thirty-six percent with positive neck ultrasonography had a change in management. Out of 11 recurrences, 6 had distant metastatic disease, and 5/11 had regional nodal disease. Neck ultrasonography showed nodal metastasis in 4/5 (80%).

CONCLUSION

Positron emission tomography/computed tomography altered management in the presence of a high thyroglobulin level and a negative Sodium Iodide I 131 scan. Neck ultrasonography should be the first line of imaging with rising thyroglobulin levels. Positron emission tomography/computed tomography should be considered for cases with high thyroglobulin levels and normal neck ultrasonography to look for distant metastatic disease.

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

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.

Post-PET ultrasound improves specificity of 18F-FDG-PET for recurrent differentiated thyroid cancer while maintaining sensitivity

Background

Positron emission tomography (PET) using fluor-18-deoxyglucose (18F-FDG) with or without computed tomography (CT) is generally accepted as the most sensitive imaging modality for diagnosing recurrent differentiated thyroid cancer (DTC) in patients with negative whole body scintigraphy with iodine-131 (I-131).

Purpose

To assess the potential incremental value of ultrasound (US) over 18F-FDG-PET-CT.

Material and Methods

Fifty-one consecutive patients with suspected recurrent DTC were prospectively evaluated using the following multimodal imaging protocol: (i) US before PET (pre-US) with or without fine needle biopsy (FNB) of suspicious lesions; (ii) single photon emission computed tomography (≥3 GBq I-131) with co-registered CT (SPECT-CT); (iii) 18F-FDG-PET with co-registered contrast-enhanced CT of the neck; (iv) US in correlation with the other imaging modalities (post-US). Postoperative histology, FNB, and long-term follow-up (median, 2.8 years) were taken as composite gold standard.

Results

Fifty-eight malignant lesions were identified in 34 patients. Forty lesions were located in the neck or upper mediastinum. On receiver operating characteristics (ROC) analysis, 18F-FDG-PET had a limited lesion-based specificity of 59% at a set sensitivity of 90%. Pre-US had poor sensitivity and specificity of 52% and 53%, respectively, increasing to 85% and 94% on post-US, with knowledge of the PET/CT findings (P < 0.05 vs. PET and pre-US). Multimodal imaging changed therapy in 15 out of 51 patients (30%).

Conclusion

In patients with suspected recurrent DTC, supplemental targeted US in addition to 18F-FDG-PET-CT increases specificity while maintainin sensitivity, as non-malignant FDG uptake in cervical lesions can be confirmed.