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The value of [18F]FDG PET/CT in avoiding overtreatment of 131l avidity pulmonary metastasis of differentiated thyroid cancer
Affiliations- Department of Nuclear Medicine, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Abstract
Introduction: We usually use 131I-whole body scan (131I-WBS) and serum thyroglobulin (Tg) values to determine whether differentiated thyroid cancer (DTC) patients need to receive 131I treatment, but not all 131I-avid (functioning) patients have a good response to 131I therapy. Our study aims to assess the data of [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography ([18F] FDG PET/CT) to research the status of 131I-avid pulmonary metastases (PMs) and the prognosis of the patients.
Material and methods: The 131I-avid PMs of DTC patients who underwent [18F]FDG PET/CT scans were included. The maximum standardized uptake value (SUVmax), metabolic tumour volume (MTV), and total lesion glycolysis (TLG) were used to estimate [18F]FDG uptake. The mean follow-up period was 34.14 ± 18.64 months. Progression-free survival (PFS) was estimated by the Kaplan-Meier method. The study was based on per-patient and per-lesion analyses.
Results: Among the 42 included patients, 34 (34/42, 81%) showed [18F]FDG uptake, which was defined as abnormal foci (SUVmax > 1.0) in the lungs. SUVmax, MTV, TLG, and tumour size were the factors that influenced the outcome of 131I treatment based on Tg levels (p = 0.000, 0.016, 0.000, 0.000) in per-lesion analysis. The only independent factor was the size of the lesion. There was a significant difference in response to 131I therapy between PMs with F-I+ and F+/I+ according to both Tg levels and Response Evaluation Criteria in Solid Tumours (RECIST) (version 1.1) (p = 0.044, 0.001), in the per-lesion analysis. When the changes in size or metabolism of some lesions are inconsistent the prognosis of these patients is poor (p = 0.003).
Conclusions: We concluded that higher [18F]FDG uptake and larger tumour size predict poor therapeutic effects and a high risk of disease progression in 131I-avid PMs of DTC. For evaluating the efficiency of 131I treatment, per-lesion analyses and assessing the data of [18F] FDG PET/CT would be more reliable than per-patient evaluation only. And early focal treatment modalities may improve their life span.
Abstract
Introduction: We usually use 131I-whole body scan (131I-WBS) and serum thyroglobulin (Tg) values to determine whether differentiated thyroid cancer (DTC) patients need to receive 131I treatment, but not all 131I-avid (functioning) patients have a good response to 131I therapy. Our study aims to assess the data of [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography ([18F] FDG PET/CT) to research the status of 131I-avid pulmonary metastases (PMs) and the prognosis of the patients.
Material and methods: The 131I-avid PMs of DTC patients who underwent [18F]FDG PET/CT scans were included. The maximum standardized uptake value (SUVmax), metabolic tumour volume (MTV), and total lesion glycolysis (TLG) were used to estimate [18F]FDG uptake. The mean follow-up period was 34.14 ± 18.64 months. Progression-free survival (PFS) was estimated by the Kaplan-Meier method. The study was based on per-patient and per-lesion analyses.
Results: Among the 42 included patients, 34 (34/42, 81%) showed [18F]FDG uptake, which was defined as abnormal foci (SUVmax > 1.0) in the lungs. SUVmax, MTV, TLG, and tumour size were the factors that influenced the outcome of 131I treatment based on Tg levels (p = 0.000, 0.016, 0.000, 0.000) in per-lesion analysis. The only independent factor was the size of the lesion. There was a significant difference in response to 131I therapy between PMs with F-I+ and F+/I+ according to both Tg levels and Response Evaluation Criteria in Solid Tumours (RECIST) (version 1.1) (p = 0.044, 0.001), in the per-lesion analysis. When the changes in size or metabolism of some lesions are inconsistent the prognosis of these patients is poor (p = 0.003).
Conclusions: We concluded that higher [18F]FDG uptake and larger tumour size predict poor therapeutic effects and a high risk of disease progression in 131I-avid PMs of DTC. For evaluating the efficiency of 131I treatment, per-lesion analyses and assessing the data of [18F] FDG PET/CT would be more reliable than per-patient evaluation only. And early focal treatment modalities may improve their life span.
Keywords
differentiated thyroid cancer; pulmonary metastasis; FDG avidity; radioiodine
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About this articleTitle
The value of [18F]FDG PET/CT in avoiding overtreatment of 131l avidity pulmonary metastasis of differentiated thyroid cancer
Journal
Issue
Article type
Original paper
Pages
385-391
Published online
2023-07-21
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826
Article views/downloads
286
DOI
Pubmed
Bibliographic record
Endokrynol Pol 2023;74(4):385-391.
Keywords
differentiated thyroid cancer
pulmonary metastasis
FDG avidity
radioiodine
Authors
Zhongyun Xu
Chao Li
Fang Feng
Shuqi Wu
Hui Wang
Hongliang Fu
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