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Nuklearmedizin 2013; 52(01): 1-6
DOI: 10.3413/nukmed-0489-12-03
Original article
Schattauer GmbH

Diagnostic value and therapeutic impact of 18F-FDG-PET/CT in differentiated thyroid cancer

Results of a German multicentre studyDiagnostischer Wertigkeit und therapeutische Konsequenzen der 18F-FDG-PET/CT beim differenzierten SchilddrüsenkarzinomErgebnisse einer multizentrischen deutschen Studie
B. Riemann   *
1   Department of Nuclear Medicine, University Hospital of Münster, Germany
,
K. Uhrhan   *
2   Department of Nuclear Medicine, University Hospital of Cologne, Germany
,
M. Dietlein
2   Department of Nuclear Medicine, University Hospital of Cologne, Germany
,
D. Schmidt
3   Department of Nuclear Medicine, University Hospital of Erlangen, Germany
,
T. Kuwert
3   Department of Nuclear Medicine, University Hospital of Erlangen, Germany
,
R. Dorn
4   Nuclear Medicine Clinic, Klinikum Augsburg, Germany
,
J. Sciuk
4   Nuclear Medicine Clinic, Klinikum Augsburg, Germany
,
T. Kodalle
1   Department of Nuclear Medicine, University Hospital of Münster, Germany
,
O. Schober
1   Department of Nuclear Medicine, University Hospital of Münster, Germany
› Institutsangaben
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Publikationsverlauf

received: 27. März 2012

accepted in revised form: 21. September 2012

Publikationsdatum:
04. Januar 2018 (online)

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Summary

The clinical significance of 18F-FDG-PET/CT in the follow-up of patients with differentiated thyroid carcinoma was evaluated and the results were compared with those of 18F-FDGPET, 131I-whole-body scintigraphy including SPECT/CT (WBS) and ultrasound. In addition, it was the aim to investigate the impact of 18F-FDG-PET/CT on the therapeutic management. Patients, methods: 327 patients (209 women, 118 men; mean age 53 ± 18 years) with differentiated thyroid cancer (242 papillary, 75 follicular, 6 mixed, 1 Hürthle cell and 3 poorly differentiated tumours) were analyzed retrospectively at four tertiary referral centres. 289 18F-FDG-PET/CT and 118 18F-FDG-PET studies were performed in these patients between 2007 and 2010. In addition, an overall clinical evaluation was performed, including cytology, histology, thyroglobulin level, ultrasound, WBS, and subsequent clinical course in order to compare the molecular imaging results. Finally, the change in therapeutic management due to findings of 18F-FDG-PET/CT was investigated. Results: The sensitivity of 18F-FDG-PET/CT was 92%, the specificity was 95%. Sensitivity and specificity of 18F-FDG-PET alone were 67% and 93%, respectively. WBS showed a sensitivity of 65% and a specificity of 94%. The corresponding values of ultrasound were 37% and 94%, respectively. The sensitivity of 18F-FDG-PET/CT in the group of patients with a negative WBS (n=194) amounted to 96%. When 18F-FDG-PET/CT and WBS were considered in combination, tumour tissue was missed in only 2 out of 133 patients; when 18F-FDG-PET and WBS were combined, tumour tissue was missed in 1 out of 24 patients. 18F-FDG-PET/CT resulted in management change in 43% (n=57/133) with a decision on surgical approach in 20% (n=27/133). Conclusions: 18F-FDG-PET/CT is superior to 18F-FDG-PET alone in patients with differentiated thyroid cancer and has a direct impact on the therapeutic management of patients with suspected local recurrence or metastases, particularly in those with negative WBS.

Zusammenfassung

Die klinische Bedeutung der 18F-FDG-PET/CT in der Nachsorge des differenzierten Schilddrüsenkarzinoms wurde untersucht und die Ergebnisse wurden mit denen der 18F-FDGPET, 131I-Ganzkörper-Szintigraphie inklusive SPECT/CT (GKS) und Sonographie verglichen. Darüber hinaus wurde der Einfluss der 18F-FDG-PET/CT auf das therapeutische Management evaluiert. Patienten, Methode: An vier Zentren der Maximalversorgung wurden 327 Patienten (209 Frauen, 118 Männer; mittleres Alter 53 ± 18 Jahre) mit differenzierten Schilddrüsenkarzinomen (242 papilläre, 75 follikuläre, 6 gemischte, 1 Hürthle-Zell und 3 gering differenzierte Tumore) analysiert. Die 289 18F-FDG-PET/CT und 118 18F-FDG-PET Studien fanden zwischen 2007 und 2010 statt. Darüber hinaus wurde eine allgemeine klinische Untersuchung inklusive Zytologie, Histologie, Thyreoglobulin-Spiegel, Sonographie, GKS und/oder dem weiteren klinischen Verlauf durchgeführt, um sie mit den Ergebnissen der molekularen Bildgebung zu vergleichen. Schließlich wurde untersucht, inwieweit die Befunde der 18F-FDG-PET/CT zur Änderung des therapeutischen Managements führten. Ergebnisse: Die Sensitivität der 18F-FDG-PET/CT betrug 92%, die Spezifität 95%. Die Sensitivität und Spezifität der 18F-FDG-PET alleine lagen bei 67% bzw. 93%. Die GKS zeigte eine Sensitivität von 65% und eine Spezifität von 94%. Die entsprechenden Werte der Sonographie waren 37% bzw. 94%. In der Gruppe der Patienten mit einer negativen GKS (n = 194) betrug die Sensitivität der 18F-FDG-PET/CT 96%. Wurden 18F-FDG-PET/CT und GKS zusammen berücksichtigt wurden, wurde Tumorgewebe bei nureinem von 24 Patienten übersehen. Die 18F-FDG-PET/CT führte zu einer Änderung des Managements in 43% (n = 57/133), wobei in 20% (n = 27/133) der Fälle die Entscheidung für ein operatives Vorgehen getroffen wurde. Schlussfolgerung: Bei Patienten mit differenzierten Schilddrüsenkarzinomen ist 18F-FDG-PET/CT der 18F-FDGPET überlegen. Weiterhin hat sie einen direkten Einfluss auf das therapeutische Management von Patienten mit dem Verdacht auf Lokalrezidiv oder Metastasen, besonders bei denen mit negativer GKS.

Keywords

FDG-PET/CT - FDG-PET - thyroid cancer - multicentre study

Schlüsselwörter

FDG-PET/CT - FDG-PET - Schilddrüsenkrebs - multi zentrische Studie

* Both authors contributed equally to this work.


 

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