Skip to main content

Advertisement

SpringerLink
Log in

Diagnostic value of [18F]Fluorocholine PET/CT in detection of primary medullary thyroid cancer

  • Original Article
  • Published:
Annals of Nuclear Medicine Aims and scope Submit manuscript

Abstract

Objective

Medullary thyroid cancer (MTC) is a challenging neuroendocrine malignancy where the role of nuclear medicine imaging is currently limited. This paper investigates the potential diagnostic value of [18F]Fluorocholine PET/CT in primary MTC.

Methods

We prospectively enrolled 25 patients (10 male, 15 female) with suspicion for primary MTC based on fine-needle aspiration biopsy (FNAB). All patients had a baseline three phase [18F]Fluorocholine PET/CT (2.5 MBq/kg): two regional head and neck and upper mediastinum studies at 5 min (first phase) and 120 min (third phase) and a whole-body PET/CT (from the skull vertex to mid-thighs) at 60 min (second phase). Any non-physiological radiotracer uptake was regarded as MTC positive. All patients referred to surgery had a preoperative neck-US. True lesion status was assessed using either histopathology, FNAB results or follow-up imaging and laboratory (calcitonin, CEA) results. Results with p < 0.05 were considered statistically significant.

Results

Nineteen of 25 patients (76%) were surgically treated and histopathology reports were obtained. Patient-based sensitivity and positive predictive value for detection of any MTC lesion using [18F]Fluorocholine PET/CT were both 100%. Neck-US was more specific (100% vs 70%; p = 0.002) and had a higher positive predictive value than [18F]Fluorocholine PET/CT (100% vs 55%; p = 0.018) for N1a and N1b staging. [18F]Fluorocholine PET/CT had a higher sensitivity (100% vs 50%; p = 0.025) and higher negative predictive value (100% vs 81%; p = 0.026) than neck-US for N1b staging. The optimal SUVmax cut-off to differentiate malignant from benign neck lesions at 60 and 120 min was 2.56. Patients with M1 stage on PET/CT had higher calcitonin (median of 5,372 vs 496.6 pg/ml; p = 0.005) and CEA concentrations (median of 95.8 vs 18.65 µg/l; p = 0.034) compared to patients with M0 disease.

Conclusion

[18F]Fluorocholine PET/CT appears to be a promising radiotracer for primary staging of MTC by increasing diagnostic accuracy for N staging and detecting possible distant metastatic sites at initial presentation of disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Wells SA, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF, et al. Revised American thyroid association guidelines for the management of medullary thyroid carcinoma. Thyroid. 2015;25:567–610. http://online.liebertpub.com/doi/10.1089/thy.2014.0335.

  2. Lim H, Devesa SS, Sosa JA, Check D, Kitahara CM. Trends in thyroid cancer incidence and mortality in the United States, 1974–2013. JAMA. 2017;317:1338. http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2017.2719.

  3. Wells SA, Pacini F, Robinson BG, Santoro M, Santoro M. Multiple endocrine neoplasia type 2 and familial medullary thyroid carcinoma: an update. J Clin Endocrinol Metab. 2013;98:3149–64. http://www.ncbi.nlm.nih.gov/pubmed/23744408.

  4. Azar FK, Lee SL, Rosen JE. Medullary thyroid cancer: an update for surgeons. Am Surg. 2015;81:1–8. http://www.ncbi.nlm.nih.gov/pubmed/25569037.

  5. Schlumberger M, Bastholt L, Dralle H, Jarzab B, Pacini F, Smit JWA. 2012 European thyroid association guidelines for metastatic medullary thyroid cancer. Eur Thyroid J. 2012;1:5–14. http://www.karger.com/doi/10.1159/000336977.

  6. Shi L, Song H, Zhu H, Li D, Zhang N. Pattern, predictors, and recurrence of cervical lymph node metastases in papillary thyroid cancer. Contemp Oncol (Pozn). 2013;17:504–9.

    Google Scholar 

  7. Roman S, Lin R, Sosa JA. Prognosis of medullary thyroid carcinoma. Cancer. 2006;107:2134–42. http://www.ncbi.nlm.nih.gov/pubmed/17019736.

  8. Lee CR, Lee S, Son H, Ban E, Kang S-W, Lee J, et al. Medullary thyroid carcinoma: a 30-year experience at one institution in Korea. Ann Surg Treat Res. 2016;91:278–87. http://www.ncbi.nlm.nih.gov/pubmed/27904849.

  9. Modigliani E, Cohen R, Campos JM, Conte-Devolx B, Maes B, Boneu A, et al. Prognostic factors for survival and for biochemical cure in medullary thyroid carcinoma: results in 899 patients. The GETC Study Group. Groupe d’étude des tumeurs à calcitonine. Clin Endocrinol (Oxf). 1998;48:265–73. http://www.ncbi.nlm.nih.gov/pubmed/9578814.

  10. Roy M, Chen H, Sippel RS. Current understanding and management of medullary thyroid cancer. Oncologist. 2013;18:1093–100. http://www.ncbi.nlm.nih.gov/pubmed/24037980.

  11. Yeh MW, Bauer AJ, Bernet VA, Ferris RL, Loevner LA, Mandel SJ, et al. American thyroid association statement on preoperative imaging for thyroid cancer surgery. Thyroid. 2015;25:3–14. http://www.ncbi.nlm.nih.gov/pubmed/25188202.

  12. DeGrado TR, Coleman RE, Wang S, Baldwin SW, Orr MD, Robertson CN, et al. Synthesis and evaluation of 18F-labeled choline as an oncologic tracer for positron emission tomography: initial findings in prostate cancer. Cancer Res. 2001;61:110–7. http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=11196147&retmode=ref&cmd=prlinks.

  13. Mapelli P, Incerti E, Ceci F, Castellucci P, Fanti S, Picchio M. 11C- or 18F-Choline PET/CT for imaging evaluation of biochemical recurrence of prostate cancer. J Nucl Med. 2016;57:43S-48S. http://www.ncbi.nlm.nih.gov/pubmed/27694171.

  14. Glunde K, Bhujwalla ZM, Ronen SM. Choline metabolism in malignant transformation. Nat Rev Cancer. 2011;11:835–48. http://www.nature.com/articles/nrc3162.

  15. Team RC. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2018. https://www.r-project.org/.

  16. Ciappuccini R, Edet-Sanson A, Saguet-Rysanek V, Gauthé M, Bardet S. Thyroid incidentaloma on 18F-fluorocholine PET/CT and 68Ga-PSMA PET/CT revealing a medullary thyroid carcinoma. Clin Nucl Med. 2019;1. http://Insights.ovid.com/crossref?an=00003072-900000000-97175.

  17. Joseph T, Wooden R, Bryant A, Zhong M, Lu Z, Foster DA. Transformation of cells overexpressing a tyrosine kinase by phospholipase D1 and D2. Biochem Biophys Res Commun. 2001;289:1019–24. https://www.sciencedirect.com/science/article/pii/S0006291X01961182.

  18. Rasul S, Hartenbach S, Rebhan K, Göllner A, Karanikas G, Mayerhoefer M, et al. [18F]DOPA PET/ceCT in diagnosis and staging of primary medullary thyroid carcinoma prior to surgery. Eur J Nucl Med Mol Imaging. 2018;45:2159–69. http://link.springer.com/10.1007/s00259-018-4045-9.

  19. Albano D, Durmo R, Bertagna F, Giubbini R. 18F-choline PET/CT incidental thyroid uptake in patients studied for prostate cancer. Endocrine. 2018. https://doi.org/10.1007/s12020-018-01832-6.

    Article  PubMed  Google Scholar 

  20. Choi JS, Kim J, Kwak JY, Kim MJ, Chang HS, Kim E-K. Preoperative staging of papillary thyroid carcinoma: comparison of ultrasound imaging and CT. AJR Am J Roentgenol. 2009;193:871–8. http://www.ncbi.nlm.nih.gov/pubmed/19696304.

  21. Hwang HS, Orloff LA. Efficacy of preoperative neck ultrasound in the detection of cervical lymph node metastasis from thyroid cancer. Laryngoscope. 2011;121:487–91. http://www.ncbi.nlm.nih.gov/pubmed/21344423.

  22. Sippel RS, Kunnimalaiyaan M, Chen H. Current management of medullary thyroid cancer. Oncologist. 2008;13:539–47. http://www.ncbi.nlm.nih.gov/pubmed/18515739

  23. Franc S, Niccoli-Sire P, Cohen R, Bardet S, Maes B, Murat A, et al. Complete surgical lymph node resection does not prevent authentic recurrences of medullary thyroid carcinoma. Clin Endocrinol (Oxf) 2001;55:403–9. http://doi.wiley.com/10.1046/j.1365-2265.2001.01339.x

Download references

Acknowledgements

We thank all doctors, radiopharmacists, technologist, nurses and other supporting staff working at our respective departments, as well as our families and friends, for their help in making our research projects possible.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, University Medical Centre Ljubljana, Zaloska cesta 7, 1000, Ljubljana, Slovenia

    Jan Jamsek, Katja Zaletel, Sebastijan Rep & Luka Lezaic

  2. Department of Surgical Oncology, Institute of Oncology, Zaloska cesta 2, 1000, Ljubljana, Slovenia

    Marko Hocevar & Damijan Bergant

  3. Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia

    Jan Jamsek, Marko Hocevar, Katja Zaletel & Luka Lezaic

  4. Faculty of Health Sciences, University of Ljubljana, Zdravstvena pot 5, 1000, Ljubljana, Slovenia

    Sebastijan Rep

Authors
  1. Jan Jamsek
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marko Hocevar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Damijan Bergant
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Katja Zaletel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sebastijan Rep
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Luka Lezaic
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

The manuscript design, data analysis and main drafting was performed by the first author JJ under direct supervision of the corresponding author LL. MH, DB, KZ and SR contributed substantially to interpretation of the data. All authors provided detailed revisions during the manuscript preparation, approved the final version and are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Luka Lezaic.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the National Medical Ethics Committee of Slovenia in 2014 (No. 92/08/14) and is registered at ClinicalTrials.gov (NCT03643055).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jamsek, J., Hocevar, M., Bergant, D. et al. Diagnostic value of [18F]Fluorocholine PET/CT in detection of primary medullary thyroid cancer. Ann Nucl Med 35, 429–437 (2021). https://doi.org/10.1007/s12149-021-01579-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12149-021-01579-7

Keywords

Search

Navigation