Nuclear Medicine and Molecular Imaging

, Volume 52, Issue 2, pp 135–143 | Cite as

The Predictive Values of Lesion Size, F-18 FDG Avidity and I-131 Avidity for the Clinical Outcome of I-131 Treatment in Patients with Metastatic Differentiated Thyroid Carcinoma Only in the Lung

  • Joon Ho Choi
  • Byung Hyun Byun
  • Ilhan Lim
  • Hansol Moon
  • Jihyun Park
  • Kyoung Jin Chang
  • Byung Il Kim
  • Chang Woon Choi
  • Sang Moo Lim
Original Article
  • 19 Downloads

Abstract

Purpose

We aimed to evaluate the prognostic values of radiography, F-18 FDG PET, and I-131 whole body scans in patients with lung-only metastasis from differentiated thyroid carcinoma (DTC).

Methods

Between 1998 and 2013, we included 31 patients (F: 26, M: 5) with lung-only metastasis from DTC who had been treated with I-131 and underwent PET. Lung metastasis was categorized according to the size (macronodular ≥1.0 cm vs. micronodular <1.0 cm), FDG avidity (avid vs. non-avid), and I-131 avidity (avid vs. non-avid). Progression-free survival (PFS) was evaluated for each patient.

Results

Among 31 patients, seven (23%) had macronodular lung metastasis, 26 (84%) had FDG avid lung metastasis, and 16 (52%) had I-131 avid lung metastasis. During the median follow-up period of 9.4 y, median PFS was 6.1 y. Based on Kaplan-Meier analysis, macronodular lung metastasis (p = 0.017) and I-131 non-avid lung metastasis (p = 0.059) were significantly associated with worse outcomes, but FDG avid lung metastasis was not (p = 0.135). Patients with FDG non-avid lung metastasis did not experience disease progression during follow-up, while 11 of 26 patients (42%) experienced disease progression. Based on univariate analysis, the hazard ratio for a poor prognosis was 3.78 (p = 0.029) for macronodular lung metastasis and 3.29 (p = 0.079) for I-131 non-avid lung metastasis.

Conclusions

Macronodular and I-131 non-avid lung metastasis were associated with a poor prognosis in lung-only metastasis from DTC. Although FDG avid lung metastasis may be associated with a poor prognosis, a larger-scale study is needed.

Keywords

Differentiated thyroid carcinoma Lung metastasis F-18 FDG avidity I-131 avidity Micronodular Macronodular 

Notes

Acknowledgements

This study was supported by a grant from the Korea Institute of Radiological and Medical Sciences (KIRAMS), funded by the Ministry of Science, ICT and Future Planning, Republic of Korea (711045543/50462-2017) and by the Establishment and Operation of Research Infrastructure for Radioisotope Application (50461-2017), funded by the Ministry of Science, ICT and Future Planning, Republic of Korea.

Compliance with Ethical Standards

Conflict of Interest

Joon Ho Choi, Byung Hyun Byun, Ilhan Lim, Hansol Moon, Jihyun Park, Kyoung Jin Chang, Byung Il Kim, Chang Woon Choi, and Sang Moo Lim have no conflicts of interest to declare.

Ethics Statement

This study was approved by the Institutional Review Board at the Korea Cancer Center Hospital (IRB No. K-1511-002-003). The manuscript contains a statement that the study was approved by an institutional review board or equivalent and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All subjects in the study gave written informed consent or the institutional review board waived the need to obtain informed consent.

References

  1. 1.
    Lang BH, Wong KP, Cheung CY, Wan KY, Lo CY. Evaluating the prognostic factors associated with cancer-specific survival of differentiated thyroid carcinoma presenting with distant metastasis. Ann Surg Oncol. 2013;20:1329–35.CrossRefPubMedGoogle Scholar
  2. 2.
    Casara D, Rubello D, Saladini G, Masarotto G, Favero A, Girelli ME, et al. Different features of pulmonary metastases in differentiated thyroid cancer: natural history and multivariate statistical analysis of prognostic variables. J Nucl Med. 1993;34:1626–31.PubMedGoogle Scholar
  3. 3.
    Chopra S, Garg A, Ballal S, Bal CS. Lung metastases from differentiated thyroid carcinoma: prognostic factors related to remission and disease-free survival. Clin Endocrinol. 2015;82:445–52.CrossRefGoogle Scholar
  4. 4.
    Durante C, Haddy N, Baudin E, Leboulleux S, Hartl D, Travagli JP, et al. Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: benefits and limits of radioiodine therapy. J Clin Endocrinol Metab. 2006;91:2892–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Cho SW, Choi HS, Yeom GJ, Lim JA, Moon JH, Park DJ, et al. Long-term prognosis of differentiated thyroid cancer with lung metastasis in Korea and its prognostic factors. Thyroid. 2014;24:277–86.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Song HJ, Qiu ZL, Shen CT, Wei WJ, Luo QY. Pulmonary metastases in differentiated thyroid cancer: efficacy of radioiodine therapy and prognostic factors. Eur J Endocrinol. 2015;173:399–408.CrossRefPubMedGoogle Scholar
  7. 7.
    Casara D, Rubello D, Saladini G, Gallo V, Masarotto G, Busnardo B. Distant metastases in differentiated thyroid cancer: long-term results of radioiodine treatment and statistical analysis of prognostic factors in 214 patients. Tumori. 1991;77:432–6.PubMedGoogle Scholar
  8. 8.
    Sampson E, Brierley JD, Le LW, Rotstein L, Tsang RW. Clinical management and outcome of papillary and follicular (differentiated) thyroid cancer presenting with distant metastasis at diagnosis. Cancer. 2007;110:1451–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Hong CM, Ahn BC, Jeong SY, Lee SW, Lee J. Distant metastatic lesions in patients with differentiated thyroid carcinoma. Clinical implications of radioiodine and FDG uptake. Nuklearmedizin. 2013;52:121–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Pitoia F, Bueno F, Cross G. Long-term survival and low effective cumulative radioiodine doses to achieve remission in patients with 131Iodine-avid lung metastasis from differentiated thyroid cancer. Clin Nucl Med. 2014;39:784–90.CrossRefPubMedGoogle Scholar
  11. 11.
    Kim M, Kim WG, Park S, Kwon H, Jeon MJ, Lee JJ, et al. Initial size of metastatic lesions is best prognostic factor in patients with metastatic differentiated thyroid carcinoma confined to the lung. Thyroid. 2017;27:49–58.CrossRefPubMedGoogle Scholar
  12. 12.
    Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–34.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Pacini F, Cetani F, Miccoli P, Mancusi F, Ceccarelli C, Lippi F, et al. Outcome of 309 patients with metastatic differentiated thyroid carcinoma treated with radioiodine. World J Surg. 1994;18:600–4.CrossRefPubMedGoogle Scholar
  14. 14.
    Filetti S, Bidart JM, Arturi F, Caillou B, Russo D, Schlumberger M. Sodium/iodide symporter: a key transport system in thyroid cancer cell metabolism. Eur J Endocrinol. 1999;141:443–57.CrossRefPubMedGoogle Scholar
  15. 15.
    Kim DH, Jung JH, Son SH, Kim CY, Hong CM, Jeong SY, et al. Difference of clinical and radiological characteristics according to radioiodine avidity in pulmonary metastases of differentiated thyroid cancer. Nucl Med Mol Imaging. 2014;48:55–62.CrossRefPubMedGoogle Scholar
  16. 16.
    Robbins RJ, Wan Q, Grewal RK, Reibke R, Gonen M, Strauss HW, et al. Real-time prognosis for metastatic thyroid carcinoma based on 2-[18F]fluoro-2-deoxy-D-glucose-positron emission tomography scanning. J Clin Endocrinol Metab. 2006;91:498–505.CrossRefPubMedGoogle Scholar
  17. 17.
    Berghmans T, Dusart M, Paesmans M, Hossein-Foucher C, Buvat I, Castaigne C, et al. Primary tumor standardized uptake value (SUVmax) measured on fluorodeoxyglucose positron emission tomography (FDG-PET) is of prognostic value for survival in non-small cell lung cancer (NSCLC): a systematic review and meta-analysis (MA) by the European lung cancer working party for the IASLC lung cancer staging project. J Thorac Oncol. 2008;3:6–12.CrossRefPubMedGoogle Scholar
  18. 18.
    Wu Z, Zhao J, Gao P, Song Y, Sun J, Chen X, et al. Prognostic value of pretreatment standardized uptake value of F-18-fluorodeoxyglucose PET in patients with gastric cancer: a meta-analysis. BMC Cancer. 2017;17:275.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Kim S, Chung JK, Min HS, Kang JH, Park DJ, Jeong JM, et al. Expression patterns of glucose transporter-1 gene and thyroid specific genes in human papillary thyroid carcinoma. Nucl Med Mol Imaging. 2014;48:91–7.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, 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;26:1–133.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Oh SW, Moon SH, Park DJ, Cho BY, Jung KC, Lee DS, et al. Combined therapy with 131I and retinoic acid in Korean patients with radioiodine-refractory papillary thyroid cancer. Eur J Nucl Med Mol Imaging. 2011;38:1798–805.CrossRefPubMedGoogle Scholar
  22. 22.
    Ho AL, Grewal RK, Leboeuf R, Sherman EJ, Pfister DG, Deandreis D, et al. Selumetinib-enhanced radioiodine uptake in advanced thyroid cancer. N Engl J Med. 2013;368:623–32.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Brose MS, Nutting CM, Jarzab B, Elisei R, Siena S, Bastholt L, et al. Sorafenib in radioactive iodine-refractory, locally advanced or metastatic differentiated thyroid cancer: a randomised, double-blind, phase 3 trial. Lancet. 2014;384:319–28.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Wang W, Larson SM, Fazzari M, Tickoo SK, Kolbert K, Sgouros G, et al. Prognostic value of [18F]fluorodeoxyglucose positron emission tomographic scanning in patients with thyroid cancer. J Clin Endocrinol Metab. 2000;85:1107–13.PubMedGoogle Scholar

Copyright information

© Korean Society of Nuclear Medicine 2017

Authors and Affiliations

  • Joon Ho Choi
    • 1
  • Byung Hyun Byun
    • 1
  • Ilhan Lim
    • 1
  • Hansol Moon
    • 1
  • Jihyun Park
    • 1
  • Kyoung Jin Chang
    • 1
  • Byung Il Kim
    • 1
  • Chang Woon Choi
    • 1
  • Sang Moo Lim
    • 1
  1. 1.Department of Nuclear Medicine, Korea Cancer Center HospitalKorea Institute of Radiological and Medical Sciences (KIRAMS)SeoulRepublic of Korea

Personalised recommendations