Abstract
Introduction
DTC patients having detectable Tg and negative post-therapeutic 131I-WBS have to be investigated by different imaging techniques to detect metastases.
Purpose
Comparison of neck US, CT and [18F]-FDG PET scan.
Methods
In 49 DTC patients with biochemical disease, neck was examined by US, CT and [18F]-FDG PET. FNA was performed and Tg was determined by FNA-Tg in selected cases of suspicious lymph nodes. Thorax was examined by CT and PET. Serum Tg was measured on LT4 therapy (basal Tg) and after the stimulation with recombinant human TSH (peak Tg).
Results
A thyroid remnant was seen by US, CT and PET in eight patients; recurrences were seen by US, CT and PET in six, five and five patients, respectively. Two metastatic nodes were identified by US and CT but not by PET. Lung micronodules were detected by CT in 7/49 (14.3 %) patients and by FDG PET in three of them. Basal Tg ranged from 0.5–1,725 ng/ml while peak Tg ranged from 0.5 to 2,135 ng/ml: the distribution between positive and negative patients was similar. Bone scan was negative in all cases.
Conclusions
In DTC patients with detectable Tg and negative I-131 post-therapy WBS, imaging examination revealed remnant or metastases in 43 % of cases. Remnant and recurrences were equally detected by the three techniques; US was better than [18F]-FDG PET for lymph node metastases since this latter method can give false both positive and negative results; chest examination is best made by CT versus FDG PET due to its higher spatial resolution.
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References
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Pacini F, Pinchera A, Giani C, Grasso L, Baschieri L (1980) Serum thyroglobulin concentration and 131-I whole body scans in the diagnosis of metastases from differentiated thyroid carcinoma (after thyroidectomy). Clin Endocrinol 13:107–110
Pacini F, Lippi F, Formica N et al (1987) Therapeutic doses of iodine-131 reveal undiagnosed metastases in thyroid cancer patients with detectable serum thyroglobulin levels. J Nucl Med 28(12):1888–1889
Pineda JD, Lee T, Ain K, Reynolds JC, Robbins J (1995) Iodine-131 therapy for thyroid cancer patients with elevated thyroglobulin and negative diagnostic scan. J Clin Endocrinol Metab 80:1488–1492
Pacini F, Castagna MG (2012) New insight in the follow-up strategies of differentiated thyroid cancer. J Endocrinol Invest 35(6 Suppl):36–39
Elisei R, Pinchera A (2012) Advances in the follow-up of differentiated or medullary thyroid cancer. Nat Rev Endocrinol 8(8):466–475
Pacini F, Agate L, Elisei R et al (2001) Outcome of differentiated thyroid cancer with detectable serum thyroglobulin and negative diagnostic 131I whole body scan: comparison of patients treated with high 131I activities versus untreated patients. J Clin Endocrinol Metab 86:4092–4097
Pacini F, Cetani F, Miccoli P et al (1994) Outcome of 309 patients with metastatic thyroid carcinoma. World J Surg 18:600–604
Arturi F, Russo D, Schlumberger M, Du Villard JA, Caillou B, Vigneri P (1998) Iodide symporter gene expression in human thyroid tumors. J Clin Endocrinol Metab 83:2193–2196
Westbury C, Vini L, Fisher C, Harmer C (2000) Recurrent differentiated thyroid cancer without elevation of serum thyroglobulin. Thyroid 10:171–176
Petrich T, Widjaij A, Musholt TJ et al (2001) Outcome after radioiodine therapy in 107 patients with differentiated thyroid carcinoma and initial bone metastases: side effects and influence of age. Eur J Nucl Med 28:203–208
Ceccarelli C, Bianchi F, Trippi D et al (2004) Location of functioning metastases from differentiated thyroid carcinoma by simultaneous double isotope acquisition of I-131 whole body scan and bone scan. J Endocrinol Invest 27:866–869
Bachelot A, Cailleux AF, Klain M, Baudin E, Ricard M, Bellon N (2002) Relationship between tumour burden and serum thyroglobulin level in patients with papillary and follicular thyroid carcinoma. Thyroid 12:707–711
Grunwald F, Kalicke T, Feine U et al (1999) Fluorine-18-fluorodeoxyglucose positron emission tomography in thyroid cancer: results of a multicentre study. Eur J Nucl Med 26:1547–1552
Schluter B, Bohuslaviziki KH, Beyer W et al (2001) Impact of FDG-PET on patients with differentiated thyroid cancer who present with elevated thyroglobulin and negative 131I scan. J Nucl Med 42:71–76
Menzel C, Zaplatnikov K, Diehl M et al (2004) The influence of thyroglobulin on functional imaging in differentiated thyroid cancer. Nucl Med Commun 25:239–243
Filetti S, Damante G, Foti D (1987) Thyrotropin stimulates glucose transport in cultured rat thyroid cells. Endocrinology 120:2576–2581
Moog F, Linke R, Manthey N et al (2000) Influence of thyroid-stimulating hormone levels on uptake of FDG in recurrent and metastatic differentiated thyroid carcinoma. J Nucl Med 41:1989–1995
Leboulleux S, Schroeder PR, Schlumberger M, Ladenson PW (2007) The role of PET in follow-up pf patients treated for differentiated epithelial thyroid cancers. Surgery 142:952–958
Petrich T, Borner AR, Otto D, Hofmann M, Knapp WH (2002) Influence of rhTSH on [(18)F] fluorodeoxyglucose uptake by differentiated thyroid carcinoma. Eur J Nucl Med Mol Imaging 29:641–647
Wang W, Macapinlac H, Larson SM et al (1999) [18F]-2-fluoro-2-deoxy-d-glucose positron emission tomography localizes residual thyroid cancer in patients with negative diagnostic (131)I whole body scans and elevated serum thyroglobulin levels. J Clin Endocrinol Metab 84:2291–2302
Pacini F, Molinaro E, Castagna MG et al (2003) Recombinant human thyrotropin-stimulated serum thyroglobulin combined with neck ultrasonography has the highest sensitività in monitoring differentiated thyroid carcinoma. J Clin Endocrinol Metab 88:3668–3673
Grant CS, Thompson GB, Farley DR, Richards ML, Mullan BP, Hay ID (2008) The value of positron emission tomography in the surgical management of recurrent papillary thyroid carcinoma. World J Surg 32:708–715
Yeung HW, Grewal RK, Gonen M, Schoder H, Larson SM (2003) Patterns of (18)F-FDG uptake in adipose tissue and muscle: a potential source of false-positives for PET. J Nucl Med 44:1789–1796
Aquino SL, Kuester LB, Muse VV, Halpern EF, Fischman AJ (2006) Accuracy of transmission CT and FDG-PET in the detection of small pulmonary nodules with integrated PET/CT. Eur J Nucl Med Mol Imaging 33:692–696
Palmedo H, Bucerius J, Joe A et al (2006) Integrated PET/CT in differentiated thyroid cancer: diagnostic accuracy and impact on patient management. J Nucl Med 47:616–624
Finkelstein SE, Grigsby PW, Siegel BA, Dehdashti F, Moley JF, Hall BL (2007) Combined (18F)Fluorodeoxyglucose positron emission tomography and computed tomography (FDG-PET/CT) for detection of recurrent, 131I-negative thyroid cancer. Ann Surg Oncol 15:286–292
Shammas A, Degirmenci B, Mountz JM et al (2007) F-18-FDG PET/CT in patients with suspected recurrent or metastatic well-differentiated thyroid cancer. J Nucl Med 48:221–226
Acknowledgments
Supported in part by Grants from Associazione Italiana Ricerca sul Cancro (AIRC).
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L. Agate and F. Bianchi equally contributed to this study.
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Agate, L., Bianchi, F., Giorgetti, A. et al. Detection of metastases from differentiated thyroid cancer by different imaging techniques (neck ultrasound, computed tomography and [18F]-FDG positron emission tomography) in patients with negative post-therapeutic 131I whole-body scan and detectable serum thyroglobulin levels. J Endocrinol Invest 37, 967–972 (2014). https://doi.org/10.1007/s40618-014-0134-1
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DOI: https://doi.org/10.1007/s40618-014-0134-1