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18F-DOPA PET/CT in the diagnosis and localization of persistent medullary thyroid carcinoma

  • Aurélien Archier
  • Céline Heimburger
  • Carole Guerin
  • Isabelle Morange
  • Fausto F Palazzo
  • Jean-François Henry
  • Olivier Schneegans
  • Olivier Mundler
  • Ahmad Esmaeel Abdullah
  • Frédéric Sebag
  • Alessio Imperiale
  • David Taïeb
Original Article

Abstract

Purpose

To evaluate the performance of 18F-l-dihydroxyphenylalanine (18F-DOPA) PET/CT in the detection of locoregional and distant medullary thyroid carcinoma (MTC) metastases and to compare imaging findings with histological data.

Methods

We retrospectively evaluated 86 MTC patients with persistently high serum calcitonin levels after initial surgery who had undergone 18F-DOPA PET/CT between January 2007 and December 2014 in two referral centres. They were followed up for at least 6 months after the PET/CT assessment. The results were compared with histological data or with the findings obtained during follow-up using a complementary imaging modality.

Results

18F-DOPA PET/CT was positive in 65 of the 86 patients, corresponding to a patient-based sensitivity of 75.6 %. Distant metastatic disease (M1) was seen in 29 patients including 11 with previously unknown metastases revealed only by PET/CT. Among the 36 patients without distant metastatic spread, 25 had nodal involvement limited to the neck, and 10 of these 25 patients underwent reoperation. The lymph node compartment-based sensitivity of 18F-DOPA PET/CT was 100 % in the two institutions but lesion-based sensitivity was only 24 %. Preoperative and postoperative median calcitonin levels were 405 pg/mL (range 128 – 1,960 pg/mL) and 259 pg/mL (range 33 – 1,516 pg/mL), respectively. None of the patients achieved normalization of serum calcitonin after reoperation.

Conclusion

18F-DOPA PET/CT enables early diagnosis of a significant number of patients with distant metastasis. It has a limited sensitivity in the detection of residual disease but provides high performance for regional analysis. A surgical compartment-oriented approach could be the approach of choice whatever the number of nodes revealed by 18F-DOPA PET/CT.

Keywords

Medullary thyroid carcinoma Positron emission tomography 18F-DOPA Neuroendocrine tumours 

Notes

Compliance with ethical standards

Conflicts of interest

None.

Informed consent

18F-DOPA was used in the setting of marketing authorization. In keeping with local institutional guidelines, all patients gave informed consent for the use of anonymous personal data extracted from their medical records for scientific or epidemiological purposes.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Aurélien Archier
    • 1
    • 2
  • Céline Heimburger
    • 3
  • Carole Guerin
    • 4
  • Isabelle Morange
    • 5
  • Fausto F Palazzo
    • 4
  • Jean-François Henry
    • 4
  • Olivier Schneegans
    • 6
  • Olivier Mundler
    • 1
    • 2
  • Ahmad Esmaeel Abdullah
    • 1
  • Frédéric Sebag
    • 4
  • Alessio Imperiale
    • 3
    • 7
  • David Taïeb
    • 1
    • 2
    • 8
  1. 1.Department of Nuclear Medicine, La Timone University HospitalAix-Marseille UniversityMarseilleFrance
  2. 2.European Center for Research in Medical ImagingAix-Marseille UniversityMarseilleFrance
  3. 3.Department of Biophysics and Nuclear MedicineUniversity Hospitals of StrasbourgStrasbourgFrance
  4. 4.Department of Endocrine Surgery, Conception HospitalAix-Marseille UniversityMarseilleFrance
  5. 5.Department of Endocrinology, Conception HospitalAix-Marseille UniversityMarseilleFrance
  6. 6.Department of Nuclear MedicinePaul Strauss Cancer CenterStrasbourgFrance
  7. 7.Faculty of MedicineICube, UMR 7357 University of Strasbourg/CNRS and FMTSStrasbourgFrance
  8. 8.Inserm UMR1068 Marseille Cancerology Research CenterInstitut Paoli-CalmettesMarseilleFrance

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