FDG PET/CT in differentiated thyroid cancer patients with low thyroglobulin levels

in European Journal of Endocrinology
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  • 1 Department of Pediatric Endocrinology, Wilhelmina Children’s Hospital (WKZ), University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
  • | 2 Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
  • | 3 Department of Surgery, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
  • | 4 Department of Nuclear Medicine and Radiology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
  • | 5 Department of Endocrine Oncology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands

Correspondence should be addressed to B de Keizer; Email: B.deKeizer@umcutrecht.nl
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Objective

To evaluate the usefulness of [18F]fluorodeoxyglucose (FDG) positron emissive tomography (PET)/CT in patients with low detectable thyroglobulin levels suspicious for persistent or recurrent differentiated thyroid cancer (DTC).

Methods

A retrospective case series study evaluating FDG PET/CT in patients with detectable thyroglobulin (Tg) levels (≥0.20 and <10.00 ng/mL) after initial treatment with total thyroidectomy and I-131 thyroid remnant ablation for pT1-3aN0-1bM0 DTC. Sensitivity, specificity, positive (PPV) and negative predictive value (NPV) of FDG PET/CT were calculated.

Results

Twenty-seven patients underwent FDG PET/CT. Median Tg level at FDG PET/CT was 2.00 ng/mL (range 0.30–9.00). FDG PET/CT was positive in 14 patients (51.9%): lesions suspicious for lymph node metastases were depicted in 12 patients, and lung metastases in 2. DTC was confirmed in 13/14 FDG PET/CT-positive patients. In 9/13 patients with a negative FDG PET/CT, DTC was confirmed ≤3 months after FDG PET/CT. The sensitivity, PPV, specificity and NPV were 59.1, 92.9, 80.0 and 30.8%, respectively.

Conclusions

This case series shows that FDG PET/CT might be useful to detect persistent or recurrent DTC in patients with low detectable Tg. However, when FDG PET/CT is negative, this does not rule out DTC and further investigations are necessary.

 

     European Society of Endocrinology

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  • 1

    Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM & Schlumberger M et al.2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 2016 26 1133. (https://doi.org/10.1089/thy.2015.0020)

    • Search Google Scholar
    • Export Citation
  • 2

    Pacini F, Lari R, Mazzeo S, Grasso L, Taddei D, Pinchera A. Diagnostic value of a single serum thyroglobulin determination on and off thyroid suppressive therapy in the follow-up of patients with differentiated thyroid cancer. Clinical Endocrinology 1985 23 405411. (https://doi.org/10.1111/j.1365-2265.1985.tb01098.x)

    • Search Google Scholar
    • Export Citation
  • 3

    van Tol KM, Jager PL, de Vries EGE, Piers DA, Boezen HM, Sluiter WJ, Dullaart RPF, Links TP. Outcome in patients with differentiated thyroid cancer with negative diagnostic whole-body scanning and detectable stimulated thyroglobulin. European Journal of Endocrinology 2003 148 589596. (https://doi.org/10.1530/eje.0.1480589)

    • Search Google Scholar
    • Export Citation
  • 4

    Smallridge RC, Diehl N, Bernet V. Practice trends in patients with persistent detectable thyroglobulin and negative diagnostic radioiodine whole body scans: a survey of American Thyroid Association members. Thyroid 2014 24 15011507. (https://doi.org/10.1089/thy.2014.0043)

    • Search Google Scholar
    • Export Citation
  • 5

    Kist JW, De Keizer B, Van Der Vlies M, Brouwers AH, Huysmans DA, Van Der Zant FM, Hermsen R, Stokkel MPM, Hoekstra OS & Vogel WV et al.124I PET/CT to predict the outcome of blind 131I treatment in patients with biochemical recurrence of differentiated thyroid cancer: results of a multicenter diagnostic cohort study (THYROPET). Journal of Nuclear Medicine 2016 57 701707. (https://doi.org/10.2967/jnumed.115.168138)

    • Search Google Scholar
    • Export Citation
  • 6

    Ma C, Xie J, Kuang A. Is empiric 131I therapy justified for patients with positive thyroglobulin and negative 131I whole-body scanning results? Journal of Nuclear Medicine 2005 46 11641170.

    • Search Google Scholar
    • Export Citation
  • 7

    Pettinato C, Spezi E, Nanni C, Grassetto G, Monari F, Allegri V, Civollani S, Cima S, Zagni P & Mazzarotto R et al.Pretherapeutic dosimetry in patients affected by metastatic thyroid cancer using 124I PET/CT sequential scans for 131I treatment planning. Clinical Nuclear Medicine 2014 39 e367e374. (https://doi.org/10.1097/RLU.0000000000000490)

    • Search Google Scholar
    • Export Citation
  • 8

    Qichang W, Lin B, Gege Z, Youjia Z, Qingjie M, Renjie W, Bin J. Diagnostic performance of 18F-FDG-PET/CT in DTC patients with thyroglobulin elevation and negative iodine scintigraphy: a meta-analysis. European Journal of Endocrinology 2019 181 93102. (https://doi.org/10.1530/EJE-19-0261)

    • Search Google Scholar
    • Export Citation
  • 9

    James WPT Research on obesity. Nutrition Bulletin 1977 4 187190. (https://doi.org/10.1111/j.1467-3010.1977.tb00966.x)

  • 10

    Boellaard R, O’Doherty MJ, Weber WA, Mottaghy FM, Lonsdale MN, Stroobants SG, Oyen WJG, Kotzerke J, Hoekstra OS & Pruim J et al.FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0. European Journal of Nuclear Medicine and Molecular Imaging 2010 37 181200. (https://doi.org/10.1007/s00259-009-1297-4)

    • Search Google Scholar
    • Export Citation
  • 11

    Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK, Gershenwald JE, Compton CC, Hess KR & Sullivan DC et al.AJCC Cancer Staging Manual. Springer International Publishing: American Joint Commission on Cancer, 2017. (https://doi.org/10.1007/978-3-319-40618-3)

    • Search Google Scholar
    • Export Citation
  • 12

    Bertagna F, Bosio G, Biasiotto G, Rodella C, Puta E, Gabanelli S, Lucchini S, Merli G, Savelli G & Giubbini R et al.F-18 FDG-PET/CT evaluation of patients with differentiated thyroid cancer with negative I-131 total body scan and high thyroglobulin level. Clinical Nuclear Medicine 2009 34 756761. (https://doi.org/10.1097/RLU.0b013e3181b7d95c)

    • Search Google Scholar
    • Export Citation
  • 13

    Albano D, Tulchinsky M, Dondi F, Mazzoletti A, Lombardi D, Bertagna F, Giubbini R. Thyroglobulin doubling time offers a better threshold than thyroglobulin level for selecting optimal candidates to undergo localizing [18F]FDG PET/CT in non-iodine avid differentiated thyroid carcinoma. European Journal of Nuclear Medicine and Molecular Imaging 2021 48 461468. (https://doi.org/10.1007/s00259-020-04992-8)

    • Search Google Scholar
    • Export Citation
  • 14

    Filippi L, Frantellizzi V, Monari F, Rizzini EL, Tabacchi E, Pirisino R, Marongiu A, Nuvoli S, Bagni O & De Vincentis G et al.Usefulness of pet/ct with18f-fdg in patients with differentiated thyroid carcinoma after radioiodine therapy: an Italian multicenter study. Diagnostics 2021 11 1264. (https://doi.org/10.3390/diagnostics11071264)

    • Search Google Scholar
    • Export Citation
  • 15

    Haslerud T, Brauckhoff K, Reisæter L, Küfner Lein R, Heinecke A, Varhaug JE, Biermann M. F18-FDG-PET for recurrent differentiated thyroid cancer: a systematic meta-analysis. Acta Radiologica 2016 57 11931200. (https://doi.org/10.1177/0284185115594645)

    • Search Google Scholar
    • Export Citation
  • 16

    Rosenbaum SJ, Lind T, Antoch G, Bockisch A. False-positive FDG PET uptake – the role of PET/CT. European Radiology 2006 16 10541065. (https://doi.org/10.1007/s00330-005-0088-y)

    • Search Google Scholar
    • Export Citation
  • 17

    Allweiss P, Braunstein GD, Katz A, Waxman A. Sialadenitis following I-131 therapy for thyroid carcinoma: concise communication. Journal of Nuclear Medicine 1984 25 755758

    • Search Google Scholar
    • Export Citation
  • 18

    Van Nostrand D The benefits and risks of I-131 therapy in patients with well-differentiated thyroid cancer. Thyroid 2009 19 13811391. (https://doi.org/10.1089/thy.2009.1611)

    • Search Google Scholar
    • Export Citation
  • 19

    Klain M, Nappi C, Nicolai E, Romeo V, Piscopo L, Giordano A, Gaudieri V, Zampella E, Pace L & Carlo C et al.Comparison of simultaneous 18F-2-[18F] FDG PET/MR and PET/CT in the follow-up of patients with differentiated thyroid cancer. European Journal of Nuclear Medicine and Molecular Imaging 2020 47 30663073. (https://doi.org/10.1007/s00259-020-04938-0)

    • Search Google Scholar
    • Export Citation
  • 20

    Bertagna F, Biasiotto G, Orlando E, Bosio G, Giubbini R. Role of 1F-fluorodeoxyglucose positron emission tomography/computed tomography in patients affected by differentiated thyroid carcinoma, high thyroglobulin level, and negative 131I scan: review of the literature. Japanese Journal of Radiology 2010 28 629636. (https://doi.org/10.1007/s11604-010-0488-z)

    • Search Google Scholar
    • Export Citation
  • 21

    Choi SJ, Jung KP, Lee SS, Park YS, Lee SM, Bae SK. Clinical usefulness of F-18 FDG PET/CT in papillary thyroid cancer with negative radioiodine scan and elevated thyroglobulin level or positive anti-thyroglobulin antibody. Nuclear Medicine and Molecular Imaging 2016 50 130136. (https://doi.org/10.1007/s13139-015-0378-5)

    • Search Google Scholar
    • Export Citation
  • 22

    Agate L, Bianchi F, Giorgetti A, Sbragia P, Bottici V, Brozzi F, Santini P, Molinaro E, Vitti P & Elisei R et al.Detection of metastases from differentiated thyroid cancer by different imaging techniques (neck ultrasound, computed tomography and [18F]-FDG positron emission tomography) in patients with negative post-therapeutic 131I whole-body scan and detectable serum thyroglobulin levels. Journal of Endocrinological Investigation 2014 37 967972. (https://doi.org/10.1007/s40618-014-0134-1)

    • Search Google Scholar
    • Export Citation
  • 23

    Leboulleux S, Schroeder PR, Busaidy NL, Auperin A, Corone C, Jacene HA, Ewertz ME, Bournaud C, Wahl RL & Sherman SI et al.Assessment of the incremental value of recombinant thyrotropin stimulation before 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography imaging to localize residual differentiated thyroid cancer. Journal of Clinical Endocrinology and Metabolism 2009 94 13101316. (https://doi.org/10.1210/jc.2008-1747)

    • Search Google Scholar
    • Export Citation
  • 24

    Ma C, Xie J, Lou Y, Gao Y, Zuo S, Wang X. The role of TSH for 18F-FDG-PET in the diagnosis of recurrence and metastases of differentiated thyroid carcinoma with elevated thyroglobulin and negative scan: a meta-analysis. European Journal of Endocrinology 2010 163 177183. (https://doi.org/10.1530/EJE-10-0256)

    • Search Google Scholar
    • Export Citation