Initial [18F]FDG PET/CT in high-risk DTC patients

Marcus Ruhlmann; Ina Binse; Andreas Bockisch; Sandra J. Rosenbaum-Krumme

doi:10.3413/Nukmed-0766-15-09

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2016; 55(03): 99-103
DOI: 10.3413/Nukmed-0766-15-09

Original article

Schattauer GmbH

Initial [¹⁸F]FDG PET/CT in high-risk DTC patients

A three-year follow-upInitiale [¹⁸F]FDG-PET/CT bei Hochrisikopatientenmit differenziertem Schilddrüsenkarzinom Follow-up von drei Jahren

Marcus Ruhlmann

¹Department of Nuclear Medicine, University Hospital, University Duisburg-Essen, Essen, Germany

,

Ina Binse

¹Department of Nuclear Medicine, University Hospital, University Duisburg-Essen, Essen, Germany

,

Andreas Bockisch

¹Department of Nuclear Medicine, University Hospital, University Duisburg-Essen, Essen, Germany

,

Sandra J. Rosenbaum-Krumme

¹Department of Nuclear Medicine, University Hospital, University Duisburg-Essen, Essen, Germany

› Author Affiliations

Abstract

Summary

In a previous paper, we published the impact of initial [¹⁸F]FDG PET/CT (FDG-PET/CT) in high-risk patients with differentiated thyroid cancer (DTC) and described the changes in therapy management. The aim of the present study was to evaluate the prognostic impact of the initial FDG-PET/CT on a patient’s follow-up over three years and the rate of complete remission. Patients, methods: This study included 109 DTC patients who underwent radioiodine treatment (RIT), including posttherapeutic whole-body scintigraphy with FDG-PET/CT and a follow-up over three years. The follow-up included high-resolution sonography of the neck and determination of serum Tg as well as Tg antibodies every six months. The results of initial FDG-PET/CT and whole-body scintigraphy were compared with the status after three years of follow-up. Results: 24/109 patients (22%) presented FDG-positive lesions, 22/109 patients (20%) only iodine-positive lesions, and 63/109 patients (58%) neither FDG-positive nor iodine-positive lesions. After three years, 83/109 patients (76%) revealed full remission, 15/109 patients (14%) tumour persistence and 11/109 patients (10%) a progressive disease. The negative predictive value (NPV) was calculated for patients without FDG-positive lesions (NPV 85%) and patients without any lesions (NPV 91%) regarding full remission in the follow-up. Conclusion: FDG-PET/CT has a high NPV (85% to 91%) in DTC patients regarding recurrence-free follow-up after three years. The change in patient management in patients with iodine-negative lesions can lead to a higher rate of full remissions in the follow-up after additional surgery. Therefore, FDG-PET/ CT should be performed in all high-risk DTC patients in the context of the first RIT to improve patient management and risk stratification.

Zusammenfassung

In einem früheren Paper haben wir die Bedeutung der initialen [¹⁸F]FDG PET/CT (FDG-PET/ CT) bei Hochrisikopatienten mit differenziertem Schilddrüsenkarzinom (DTC) untersucht und die Änderungen im Therapiemanagement beschrieben. Das Ziel dieser Studie war, den prognostischen Einfluss der initialen FDG-PET/CT auf die Nachsorge über drei Jahre und die Rate der Vollremissionen zu untersuchen. Patienten, Methoden: 109 DTC- Patienten nahmen teil, bei denen eine Radioiodtherapie (RIT) mit posttherapeutischer Ganzkörperszintigraphie und eine FDG- PET/CT durchgeführt wurde sowie eine Nachsorge von drei Jahren. Die Nachsorge be inhaltete halbjährliche Ultraschalluntersuchungen des Halses mit Thyreoglobulinbestimmungen (inkl. Antikörper). Die Ergebnisse der posttherapeutischen Ganzkörperszintigraphie und FDG-PET/ CT wurden mit den Ergebnissen der Nachsorge nach drei Jahren verglichen. Ergebnisse: 24/109 Patienten (22%) zeigten FDG-positive Läsionen, 22/109 Patienten (20%) nur Iod-positive Läsionen und 63/109 Patienten (58%) weder FDG- noch Iod-positive Läsionen. Nach drei Jahren erreichten 83/109 Patienten (76%) eine Vollremission, 15/109 Patienten (14%) zeigten eine Tumorpersistenz und 11/109 Patienten (10%) waren progredient. Der negative prädiktive Wert wurde für Patienten ohne FDG-positive Läsionen (NPV 85%) und für Patienten ohne Läsionen (NPV 91%) bezüglich Vollremission nach drei Jahren berechnet. Schlussfolgerung: Die FDG-PET/CT hat einen hohen NPV (85% bis 91%) bei DTC-Patienten bezüglich einer Vollremission nach drei Jahren. Die Therapieänderung bei Patienten mit Iod-negativen und FDG-positiven Läsionen kann zu einer Verbesserung der Zahl von Vollremissionen führen. Daher sollte die FDG-PET/CT im Rahmen der ersten Radioiodtherapie bei Hochrisikopatienten zur Verbesserung des Patienten managements und der Risiko stratifizierung regelhaft erfolgen.

Keywords

Differentiated thyroid cancer - FDG-PET/CT - thyroid cancer - follow-up - iodine negative - radioiodine therapy

Schlüsselwörter

Differenziertes Schilddrüsenkarzinom - FDG-PET/CT - Schilddrüsenkrebs - Follow-up - Iod-negativ - Radioiodtherapie

Full Text

References

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