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Prospective study on the clinical relevance of 18F-DOPA positron emission tomography/computed tomography in patients with medullary thyroid carcinoma

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A Correction to this article was published on 06 June 2022

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Abstract

Purpose

18F-DOPA Positron Emission Tomography/Computed Tomography (18F-DOPA PET/CT) is a sensitive functional imaging method (65–75%) for detecting disease localization in medullary thyroid cancer (MTC). We aimed: (i) to assess the clinical usefulness of 18F-DOPA PET/CT in patients with MTC and elevated calcitonin (Ctn) and CEA levels and, (ii) to evaluate changes in disease management secondary to the findings encountered with this methodology.

Methods

Thirty-six patients with MTC and Ctn levels ≥150 pg/ml were prospectively included. Neck ultrasound, chest contrast-enhanced CT, liver magnetic resonance imaging/abdominal three-phase contrast-enhanced CT and bone scintigraphy were carried out up to 6 months before the 18F DOPA PET/CT.

Results

Seventy eight percent of patients were female and 27% had hereditary MTC. Median Ctn level was 1450 pg/ml [150–56620], median CEA level 413 ng/ml [2.9–7436]. Median Ctn DT was 37.5 months [5.7–240]; median CEA DT was 31.8 [4.9–180]. 18F-DOPA PET/CT was positive in 33 patients (91.6%); in 18 (56%) uptake was observed in lymph nodes in the neck or mediastinum, in seven cases (22%) distant metastases were diagnosed, and in eight additional patients (24%) both locoregional and distant sites of disease were found. Ctn and CEA levels were higher in patients with ≥3 foci of distant metastases. In 14 patients (38.8%), findings on 18F-DOPA PET/CT led to changes in management; surgery for locoregional lymph nodes was the most frequent procedure in 8 patients (22%).

Conclusion

18F-DOPA PET/CT was useful for the detection of recurrent disease in MTC, providing incremental value over conventional imaging procedures that led to modification in treatment strategies in nearly 40% of patients.

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References

  1. S. Wells, Revised American Thyroid Association Guidelines for the management of medullary thyroid carcinoma. Thyroid 25(6), 567–590 (2015). https://doi.org/10.1089/thy.2014.0335

    Article  PubMed  PubMed Central  Google Scholar 

  2. M.R. Pelizzo, Natural history, diagnosis, treatment and outcome of medullary thyroid cancer: 37 years experience on 157 patients. Eur. J. Surg. Oncol. 33(4), 493–497 (2007). https://doi.org/10.1016/j.ejso.2006.10.021

    Article  CAS  PubMed  Google Scholar 

  3. L. Louhibi, Demographic, clinical, and genetic characteristics of patients with medullary thyroid cancer in the past 16 years in Castilla-La Mancha. Endocrinol. Nutr. 61(8), 398–403 (2014). https://doi.org/10.1016/j.endonu.2014.02.006

    Article  PubMed  Google Scholar 

  4. K.S. Slavikova, What is currently the best radiopharmaceutical for the hybrid PET/CT detection of recurrent medullary thyroid carcinoma? Curr. Radiopharm. 6(2), 96–105 (2013). https://doi.org/10.2174/1874471011306020006.

    Article  CAS  PubMed  Google Scholar 

  5. S. Filetti, Thyroid Cancer: ESMO Clinical Practice Guidelines for Diagnosis, Treatment and Follow-up. Ann. Oncol. 30(12), 1856–1883 (2019). https://doi.org/10.1093/annonc/mdz400

    Article  CAS  PubMed  Google Scholar 

  6. A. Giraudet, Imaging medullary thyroid carcinoma with persistently elevated calcitonin levels. J. Clin. Endocrinol. Metab. 92(11), 4185–4190 (2007). https://doi.org/10.1210/jc.2007-1211

    Article  CAS  PubMed  Google Scholar 

  7. G. Treglia, Detection rate of recurrent medullary thyroid carcinoma using fluorine-18 fluorodeoxyglucose positron emission tomography: a meta-analysis. Endocrine 42, 535–545 (2012). https://doi.org/10.1007/s12020-012-9671-6

    Article  CAS  PubMed  Google Scholar 

  8. J. Yang, The combined use of calcitonin doubling time and 18F-FDG PET/CT improves prognostic values in medullary thyroid carcinoma: the clinical utility of 18F-FDG PET/CT. Endocr. Pr. 23(8), 942–948 (2017). https://doi.org/10.4158/EP171806.OR

    Article  Google Scholar 

  9. Y. Ito, Calcitonin doubling time in medullary thyroid carcinoma after the detection of distant metastases keenly predicts patients’ carcinoma death. Endocr. J. 63(7), 663–667 (2016). https://doi.org/10.1507/endocrj.EJ16-0140

    Article  CAS  PubMed  Google Scholar 

  10. L. Giovanella, EAMN practice guideline for PET TC imaging in medullary thyroid carcinoma. Eur. J. Nucl. Med. Mol. 47(1), 61–77 (2020). https://doi.org/10.1007/s00259-019-04458-6.

    Article  Google Scholar 

  11. W. Melega, L-6-e8F]Fluoro-DOPA Metabolism in monkeys and humans: biochemical parameters for the formulation of tracer kinetic models with positron emission tomography. J. Cereb. Blood Flow. Metab. 11, 890–897 (1991). https://doi.org/10.1038/jcbfm.1991.154

    Article  CAS  PubMed  Google Scholar 

  12. M. Bergström, In vivo demostration of enzyme actity in endocrime pancreatric tumors: decarboxylation of carbon 11 DOPA to carbon 11 dopamine. J. Nucl. Med. 37, 32–37 (1996)

    PubMed  Google Scholar 

  13. S. Hoegerle, 18F-DOPA positron emission tomography for tumour detection in patients with medullary thyroid carcinoma and elevated calcitonin levels. Eur. J. Nucl. Med. 28(1), 64–71 (2001). https://doi.org/10.1007/s002590000404

    Article  CAS  PubMed  Google Scholar 

  14. R. Haddad, NCCN Guidelines version 2.2021. Thyroid carcinoma. https://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf. Accessed 10/15/2021

  15. A. Archier, (18)F-DOPA PET/CT in the diagnosis and localization of persistent medullary thyroid carcinoma. Eur. J. Nucl. Med. Mol. Imaging 43(6), 1027–1033 (2016). https://doi.org/10.1007/s00259-015-3227-y

    Article  CAS  PubMed  Google Scholar 

  16. F. Caobelli, Predictive and prognostic value of 18F-DOPA PET/CT in patients affected by recurrent medullary carcinoma of the thyroid. Ann. Nucl. Med. 1(32), 7–15 (2018). https://doi.org/10.1007/s12149-017-1213-0

    Article  Google Scholar 

  17. W. Noordzij, Adrenal tracer uptake by 18F-FDOPA PET/CT in patients with pheochromocytoma and controls. Eur. J. Nucl. Med. Mol. Imaging 46, 1560–1566 (2019). https://doi.org/10.1007/s00259-019-04332-5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. L. Brammen, Medullary thyroid carcinoma: do ultrasonography and F-DOPA-PET-CT influence the initial surgical strategy? Ann Surg. Oncol. 3919–3927 (2018). https://doi.org/10.1245/s10434-018-6829-3

  19. S. Rasul, 18 F DOPA PET /TC in diagnosis and stating of primary thyroid carcinoma prior to surgery. Eur. J. Nucl. Mol. Imaging 45(12), 2159–2149 (2018). https://doi.org/10.1007/s00259-018-4045-9

    Article  CAS  Google Scholar 

  20. M. Terroir, F-18-Dopa PET/CT is more sensitive than whole body MRI for the localization of persistent/recurrent disease of medullary thyroid. Thyroid 29 (10), 1457–1464, https://doi.org/10.1089/thy.2018.0351

  21. S. Lee, Comparison of 5 different PET radiopharmaceuticals for the detection of recurrent medullary thyroid carcinoma: a network meta-analysis. Clin. Nucl. Med. 45, 341–348 (2020). https://doi.org/10.1097/RLU.0000000000002940

    Article  PubMed  Google Scholar 

  22. G. Treglia, Comparison of 18-F DOPA, 18-F FDG and 68Ga-Somatostatin analogue PET/CT in patients with recurrent medullary thyroid carcinoma. Eur. J. Nucl. Med. Mol. Imaging 39, 569–580 (2012). https://doi.org/10.1007/s00259-011-2031-6. 569-580

    Article  CAS  PubMed  Google Scholar 

  23. F. Castinetti, PET imaging in medullary thyroid carcinoma:time for reappraisal? Thyroid 31(2), 151–155 (2021). https://doi.org/10.1089/thy.2020.0674

    Article  PubMed  Google Scholar 

  24. F. Calabria, 18 F- DOPA . In: Radiopharmaceuticals. A guide to PET/CT and PET/MRI, ed. F. Calabria, O. Schillaci (Springer Nature Switzerland AG) (2020, second edition), p. 37–57.

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Acknowledgements

We thank Drs. Eduardo Faure and Soledad Berlingieri for the referral of patients.

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Authors and Affiliations

  1. Department of Endocrinology, Instituto de Oncología AH Roffo, Ciudad Autónoma de Buenos Aires, Argentina

    Inés Califano

  2. Division of Endocrinology, Hospital de Clínicas, University of Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina

    Fabián Pitoia

  3. Molecular Imaging and Metabolic Therapy Section. Imaging Department, University Hospital CEMIC, Galván 4102. CP 1414, Ciudad Autónoma de Buenos Aires, Argentina

    Roxana Chirico, Alejandra De Salazar & María José Bastianello

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  1. Inés Califano
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  2. Fabián Pitoia
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  5. María José Bastianello
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Correspondence to Inés Califano.

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All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments.

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Written informed consent was obtained from every participant patient.

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Califano, I., Pitoia, F., Chirico, R. et al. Prospective study on the clinical relevance of 18F-DOPA positron emission tomography/computed tomography in patients with medullary thyroid carcinoma. Endocrine 77, 143–150 (2022). https://doi.org/10.1007/s12020-022-03062-3

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