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Evaluation of the usefulness of positron emission tomography with [18F]fluorodeoxylglucose performed to detect non-radioiodine avid recurrence and/or metastasis of differentiated thyroid cancer — a preliminary study
, 1, 2, 1, 3, 3, 4, 1
Affiliations- Department of Endocrinology and Isotope Therapy, Military Institute of Medicine, Warsaw, Poland
- Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
- Nuclear Medicine Department, Military Institute of Medicine, Warsaw, Poland
- Department of Laboratory Diagnostics, Military Institute of Medicine, Warszawa, Poland
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Abstract
Background: About 30% of patients with disseminated differentiated thyroid cancer (DTC) may experience a loss of iodine uptake. It is associated with higher aggressiveness of the tumour and a reduced 10-year survival rate. The diagnosis of non-radioiodine avid DTC metastases remains a diagnostic challenge. A helpful technique for this diagnosis is positron emission tomography with 2-[18F]fluoro-2-deoxy-D-glucose (PET/CT with [18F]FDG). On the other hand, there are still discussions about the clinical value of using exogenous thyroid-stimulating hormone (TSH) stimulation before PET/CT with [18F]FDG. The aim of the study was the assessment of the usefulness of PET/CT with [18F]FDG under TSH suppression and stimulation of TSH performed in the detection of non-radioiodine avid DTC metastases, as well as determination of the thyroglobulin concentration under suppression and stimulation of TSH, which influences the result of PET/CT with [18F]FDG in patients with non-radioiodine avid DTC.
Material and methods: Retrospective analysis of 37 PET/CT with [18F]FDG performed in patients with DTC diagnosed and treated at the Department of Endocrinology and Isotope Therapy of the Military Institute of Medicine from January 2018 to July 2020. Of these, PET/CT with [18F]FDG under exogenous rhTSH stimulation was performed in 22 patients and PET/CT with [18F]FDG under TSH suppression in 15 was performed. In all analyzed patients, the result of diagnostic whole-body scintigraphy (WBS) using 80 MBq 131I under rhTSH stimulation was negative, and the concentration of thyroglobulin after stimulation (sTg) was greater than 1.0 ng/mL.
Results: In the group of patients examined under TSH suppression, non-radioiodine avid in PET/CT with [18F]FDG were found in 6 out of 15 patients (40%) and in the group of patients examined under rhTSH stimulation in 10 out of 22 patients (45%). The differences between the groups were not statistically significant. The analysis of the receiver operating characteristic (ROC) curves allowed to determine the cut-off point for the positive result of PET/CT performed under TSH suppression with sTg concentration of 11.03 ng/mL. In the group of studies performed under rhTSH stimulation, the cut-off point for sTg was 6.3 ng/mL. There was no statistically significant difference between the baseline thyroglobulin (natTg) and sTg levels and the positive PET/CT result. The administration of rhTSH before the PET/CT examination also had no statistically significant effect on the maximum standard uptake value (SUVmax) of the dominant lesion identified in the PET/CT.
Conclusions: 1) PET/CT with [18F]FDG is a useful tool for detection of non-radioiodine avid recurrence and/or metastases of DTC. 2) The concentration of natTg and sTg is highly correlated with a positive result of PET/CT with [18F]FDG. 3) The concentration of natTg is comparable with sTg in predicting a positive result of PET/CT with [18F]FDG. 4) The cut-off point for a positive result of PET/CT for natTg was 1.36 ng/mL and for sTg was 7.05 ng/mL.
Abstract
Background: About 30% of patients with disseminated differentiated thyroid cancer (DTC) may experience a loss of iodine uptake. It is associated with higher aggressiveness of the tumour and a reduced 10-year survival rate. The diagnosis of non-radioiodine avid DTC metastases remains a diagnostic challenge. A helpful technique for this diagnosis is positron emission tomography with 2-[18F]fluoro-2-deoxy-D-glucose (PET/CT with [18F]FDG). On the other hand, there are still discussions about the clinical value of using exogenous thyroid-stimulating hormone (TSH) stimulation before PET/CT with [18F]FDG. The aim of the study was the assessment of the usefulness of PET/CT with [18F]FDG under TSH suppression and stimulation of TSH performed in the detection of non-radioiodine avid DTC metastases, as well as determination of the thyroglobulin concentration under suppression and stimulation of TSH, which influences the result of PET/CT with [18F]FDG in patients with non-radioiodine avid DTC.
Material and methods: Retrospective analysis of 37 PET/CT with [18F]FDG performed in patients with DTC diagnosed and treated at the Department of Endocrinology and Isotope Therapy of the Military Institute of Medicine from January 2018 to July 2020. Of these, PET/CT with [18F]FDG under exogenous rhTSH stimulation was performed in 22 patients and PET/CT with [18F]FDG under TSH suppression in 15 was performed. In all analyzed patients, the result of diagnostic whole-body scintigraphy (WBS) using 80 MBq 131I under rhTSH stimulation was negative, and the concentration of thyroglobulin after stimulation (sTg) was greater than 1.0 ng/mL.
Results: In the group of patients examined under TSH suppression, non-radioiodine avid in PET/CT with [18F]FDG were found in 6 out of 15 patients (40%) and in the group of patients examined under rhTSH stimulation in 10 out of 22 patients (45%). The differences between the groups were not statistically significant. The analysis of the receiver operating characteristic (ROC) curves allowed to determine the cut-off point for the positive result of PET/CT performed under TSH suppression with sTg concentration of 11.03 ng/mL. In the group of studies performed under rhTSH stimulation, the cut-off point for sTg was 6.3 ng/mL. There was no statistically significant difference between the baseline thyroglobulin (natTg) and sTg levels and the positive PET/CT result. The administration of rhTSH before the PET/CT examination also had no statistically significant effect on the maximum standard uptake value (SUVmax) of the dominant lesion identified in the PET/CT.
Conclusions: 1) PET/CT with [18F]FDG is a useful tool for detection of non-radioiodine avid recurrence and/or metastases of DTC. 2) The concentration of natTg and sTg is highly correlated with a positive result of PET/CT with [18F]FDG. 3) The concentration of natTg is comparable with sTg in predicting a positive result of PET/CT with [18F]FDG. 4) The cut-off point for a positive result of PET/CT for natTg was 1.36 ng/mL and for sTg was 7.05 ng/mL.
Keywords
differentiated thyroid cancer; human recombinant TSH; thyroglobulin; whole-body scintigraphy; PET/CT; [18F]FDG; non-radioiodine avid thyroid cancer
About this articleTitle
Evaluation of the usefulness of positron emission tomography with [18F]fluorodeoxylglucose performed to detect non-radioiodine avid recurrence and/or metastasis of differentiated thyroid cancer — a preliminary study
Journal
Issue
Article type
Research paper
Pages
63-69
Published online
2021-07-30
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6753
Article views/downloads
632
DOI
Pubmed
Bibliographic record
Nucl. Med. Rev 2021;24(2):63-69.
Keywords
differentiated thyroid cancer
human recombinant TSH
thyroglobulin
whole-body scintigraphy
PET/CT
[18F]FDG
non-radioiodine avid thyroid cancer
Authors
Maciej Kolodziej
Marek Saracyn
Arkadiusz Lubas
Dorota Brodowska-Kania
Andrzej Mazurek
Mirosław Dziuk
Jolanta Dymus
Grzegorz Kaminski
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