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

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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