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18F-FDG uptake as a prognostic variable in primary differentiated thyroid cancer incidentally detected by PET/CT: a multicentre study

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Our aim was to investigate the association between 18F-fluorodeoxyglucose (FDG) uptake and event-free survival in patients in whom a differentiated thyroid cancer (DTC) was detected by 18F-FDG positron emission tomography (PET)/CT.

Methods

Among 884 focal 18F-FDG PET thyroid incidentalomas referred to our 4 Nuclear Medicine Departments, we investigated 54 patients in whom a DTC was confirmed and a clinical follow-up was available. The ratio between maximum standardized uptake value (SUVmax) of DTC and SUVmean of the liver (SUV ratio) was recorded for each scan. All patients underwent total thyroidectomy and 131I remnant ablation. After a median follow-up of 39 months we assessed the outcome. The association between disease persistence/progression, 18F-FDG uptake and other risk factors (T, N, M and histological subtype) was evaluated through univariate and multivariate analyses.

Results

Of the 54 patients, 39 achieved complete remission. The remaining 15 showed persistence/progression of disease. High 18F-FDG uptake, i.e. SUV ratio ≥3, showed a low positive predictive value (48 %). Low 18F-FDG uptake (SUV ratio < 3) displayed a high negative predictive value (93 %). The median of SUV ratios in T1–T2 (2.2), in M0 (2.7) and in non-virulent subtypes (2.7) were significantly lower (p < 0.03) than in T3–T4 (5.0), M1 (7.3) and virulent subtypes (6.0). Kaplan-Maier analysis showed a significant association between high 18F-FDG uptake and disease persistence/progression (p = 0.001). When we adjusted risk estimates by using a multivariate Cox model, only T (p = 0.05) remained independently associated with disease persistence/progression.

Conclusion

An intense 18F-FDG uptake of the primary DTC is associated with persistence/progression of disease. However, when all other prognostic factors have been taken into account, 18F-FDG uptake does not add further prognostic information.

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Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, Galliera Hospital, Genoa, Italy

    Arnoldo Piccardo, Mehrdad Naseri & Manlio Cabria

  2. Clinical Trial Unit, Office of the Scientific Director, Galliera Hospital, Genoa, Italy

    Matteo Puntoni

  3. Department of Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy

    Francesco Bertagna & Raffaele Giubbini

  4. Department of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland

    Giorgio Treglia, Luca Ceriani & Luca Giovanella

  5. Internal Medicine, Galliera Hospital, Genoa, Italy

    Luca Foppiani

  6. Department of Oncology, University of Turin, Presidio Sanitario Gradenigo, Turin, Italy

    Federico Arecco, Francesca Bardesono & Fabio Orlandi

  7. PET Centre, IRMET, Turin, Italy

    Angelina Cistaro

  8. Department of Nuclear Medicine, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy

    Arnoldo Piccardo

Authors
  1. Arnoldo Piccardo
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  2. Matteo Puntoni
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  3. Francesco Bertagna
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Correspondence to Arnoldo Piccardo.

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Fabio Orlandi and Luca Giovanella share senior co-authorship

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Piccardo, A., Puntoni, M., Bertagna, F. et al. 18F-FDG uptake as a prognostic variable in primary differentiated thyroid cancer incidentally detected by PET/CT: a multicentre study. Eur J Nucl Med Mol Imaging 41, 1482–1491 (2014). https://doi.org/10.1007/s00259-014-2774-y

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  • DOI: https://doi.org/10.1007/s00259-014-2774-y

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