[(18)F]-2-fluoro-2-deoxy-D-glucose positron emission tomography localizes residual thyroid cancer in patients with negative diagnostic (131)I whole body scans and elevated serum thyroglobulin levels Journal Article

  

Authors:	Wang, W.; Macapinlac, H.; Larson, S. M.; Yeh, S. D. J.; Akhurst, T.; Finn, R. D.; Rosai, J.; Robbins, R. J.
Article Title:	[(18)F]-2-fluoro-2-deoxy-D-glucose positron emission tomography localizes residual thyroid cancer in patients with negative diagnostic (131)I whole body scans and elevated serum thyroglobulin levels
Abstract:	Progressive dedifferentiation of thyroid cancer cells leads to a loss of iodine-concentrating ability, with resultant false negative, whole body radioactive iodine scans in approximately 20% of all differentiated metastatic thyroid cancer lesions. We tested the hypothesis that all metastatic thyroid cancer lesions that did not concentrate iodine, but did produce thyroglobulin (Tg), could be localized by [18F] 2-fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET). We performed FDG-PET on 37 patients with differentiated thyroid cancer after surgery and radioiodine ablation who had negative diagnostic 131I whole body scans during routine follow-up. Serum Tg, Tg autoantibodies, neck ultrasounds, and other clinically indicated imaging procedures were performed to detect residual disease. In those with elevated Tg levels, FDG-PET localized occult disease in 71%, was false positive in one, and was false negative in five patients. The majority of false negative FDG-PET occurred in patients with minimal cervical adenopathy. Surgical resections, biopsies, 131I therapy, and differentiation therapy were performed based on the PET results. The FDG-PET result changed the clinical management in 19 of the 37 patients. In patients with elevated Tg levels, FDG-PET had a positive predictive value of 92%. In patients with low Tg levels, FDG-PET had a negative predictive value of 93%. No FDG-PET scans were positive in stage I patients; however, they were always positive in stage IV patients with elevated Tg levels. An elevated TSH level (i.e. hypothyroidism) did not increase the ability to detect lesions. FDG-PET is able to localize residual thyroid cancer lesions in patients who have negative diagnostic 131I whole body scans and elevated Tg levels, although it was not sensitive enough to detect minimal residual disease in cervical nodes.
Keywords:	adolescent; adult; clinical article; human tissue; aged; middle aged; human cell; cancer localization; comparative study; positron emission tomography; diagnostic accuracy; laboratory diagnosis; adenocarcinoma; carcinoma, papillary; cell differentiation; pathology; biopsy; blood; iodine 131; diagnostic agent; radioactive iodine; iodine radioisotopes; minimal residual disease; fluorodeoxyglucose f 18; computer assisted emission tomography; fluorodeoxyglucose f18; scintiscanning; thyroidectomy; thyroid cancer; thyroid neoplasms; papillary carcinoma; thyroglobulin; cervical lymph node; thyroglobulin blood level; false negative reactions; thyroid tumor; adenocarcinoma, follicular; fluorodeoxyglucose; tomography, emission-computed; whole body scintiscanning; fluorine radioisotopes; fluorine; humans; human; male; female; priority journal; article
Journal Title:	Journal of Clinical Endocrinology and Metabolism
Volume:	84
Issue:	7
ISSN:	0021-972X
Publisher:	Oxford University Press
Date Published:	1999-07-01
Start Page:	2291
End Page:	2302
Language:	English
PUBMED:	10404792
PROVIDER:	scopus
DOI:	10.1210/jcem.84.7.5827
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-0033237663&partnerID=40&md5=d97ba03182546f63e12711748f1636f2
Notes:	Article -- Export Date: 16 August 2016 -- Source: Scopus

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