Diagnostic accuracy and prognostic value of 18F-FDG PET in Hürthle cell thyroid cancer patients Journal Article


Authors: Pryma, D. A.; Schoder, H.; Gonen, M.; Robbins, R. J.; Larson, S. M.; Yeung, H. W. D.
Article Title: Diagnostic accuracy and prognostic value of 18F-FDG PET in Hürthle cell thyroid cancer patients
Abstract: Hürthle cell carcinoma is an uncommon and occasionally aggressive differentiated thyroid cancer associated with increased mortality compared with other differentiated thyroid malignancies. Because it generally has lower iodine avidity, 18F-FDG PET has been suggested as a more accurate imaging modality. However, there is limited information with regard to the true diagnostic accuracy and prognostic value of 18F-FDG PET in this disease. Methods: All patients with Hürthle cell thyroid cancer who underwent their first 18F-FDG PET scan between May 1996 and February 2003 were identified retrospectively. 18F-FDG PET scans were reviewed and compared with all available imaging studies, including CT, ultrasound, and radioiodine scintigraphy (RIS). Abnormal 18F-FDG uptake was assessed visually and by measuring the maximum standardized uptake value (SUVmax) of the most intense lesion. Clinical follow-up for at least 1 y or until death was required for inclusion. Results: Forty-four patients met inclusion criteria. The median follow-up was 2.9 y. There were 24 positive and 20 negative 18F-FDG PET scans with 1 false-positive and 1 false-negative study, resulting in a diagnostic sensitivity of 95.8% and a specificity of 95%. In 5 of 11 patients who had both positive CT and 18F-FDG PET findings, 18F-FDG PET revealed additional sites of disease. Furthermore, 18F-FDG PET correctly classified as negative 3 patients with false-positive CT findings. In 3 of 6 patients with positive RIS, 18F-FDG PET revealed additional sites of metastatic disease. Ten patients with positive 18F-FDG PET had negative RIS. Only 1 patient with negative 18F-FDG PET had positive RIS. The SUVmax also provided prognostic information: In a stepwise fashion, each increase in intensity by SUVmax unit was associated with a 6% increase in mortality (P < 0.001). The 5-y overall survival in patients with SUVmax < 10 was 92%; it declined to 64% in those with SUVmax > 10 (P < 0.01). Conclusion: 18F-FDG PET has excellent diagnostic accuracy in Hürthle cell thyroid cancer patients, improving on CT and RIS. Intense 18F-FDG uptake in lesions is an indicator of a poor prognosis. Our data suggest that all patients with Hürthle cell thyroid cancer should undergo 18F-FDG PET as part of their initial postoperative staging and periodically to screen for occult recurrence, particularly in patients with elevated serum thyroglobulin. Copyright © 2006 by the Society of Nuclear Medicine, Inc.
Keywords: adult; cancer survival; clinical article; controlled study; aged; aged, 80 and over; middle aged; survival rate; clinical trial; patient selection; positron emission tomography; follow up; methodology; diagnostic accuracy; metastasis; computer assisted tomography; tomography, x-ray computed; pathology; retrospective study; oncocytoma; adenoma, oxyphilic; cancer mortality; false negative result; blood; diagnostic agent; radioactive iodine; drug uptake; echography; fluorodeoxyglucose f 18; fluorodeoxyglucose f18; positron-emission tomography; prediction and forecasting; predictive value of tests; scintiscanning; thyroid cancer; thyroid neoplasms; thyroglobulin; false positive result; thyroid tumor; ct; thyroid scintiscanning; 18f-fdg pet; hürthle cell thyroid cancer; radioactive iodine scintigraphy
Journal Title: Journal of Nuclear Medicine
Volume: 47
Issue: 8
ISSN: 0161-5505
Publisher: Society of Nuclear Medicine  
Date Published: 2006-08-01
Start Page: 1260
End Page: 1266
Language: English
PUBMED: 16883003
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 34" - "Export Date: 4 June 2012" - "CODEN: JNMEA" - "Source: Scopus"
Citation Impact
MSK Authors
  1. Daniel Alexander Pryma
    8 Pryma
  2. Henry W D Yeung
    126 Yeung
  3. Mithat Gonen
    1030 Gonen
  4. Richard J Robbins
    54 Robbins
  5. Heiko Schoder
    546 Schoder
  6. Steven M Larson
    959 Larson