Assessment of the Incremental Value of Recombinant Thyrotropin Stimulation before 2-[18F]-Fluoro-2-Deoxy-<scp>d</scp>-Glucose Positron Emission Tomography/Computed Tomography Imaging to Localize Residual Differentiated Thyroid Cancer

Leboulleux, Sophie; Schroeder, Pamela; Busaidy, Naifa L.; Aupérin, Anne; Corone, C.; Jacene, Heather A.; Ewertz, Marjorie; Bournaud, Claire; Wahl, Richard L.; Sherman, Steven I.; Ladenson, Paul W.; Schlumberger, Martin

doi:10.1210/jc.2008-1747

Cited by 137 publications

(82 citation statements)

References 29 publications

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“…As a matter of fact, more important than the influence of rhTSH or thyroid hormone withdrawal in 18 F-FDG PET/CT is the presence of high levels of Tg (Tg/ TSH or Tg/LT4 > 10 ng/mL). Over the last years, it has been demonstrated that both strategies, with or without TSH stimulation, do not considerably lead to management changes (12,32). Additional factors than sTg that influence 18 F-FDG PET/CT sensitivity are tumor de-differentiation and larger tumor burden (6), as we have seen in our results.…”

Section: Discussionsupporting

confidence: 58%

“…Patients with histological findings of aggressive DTC variants (n = 21): oncocytic (n = 3), poorly differentiated areas (n = 2), tall-cell (n = 4), diffuse sclerosing (n = 4), insular (n = 5) and solid variant (n = 3) with incomplete biochemical or structural disease. (12,14). Consequently, the remaining 36 scans were performed using LT4 (Tg/LT4).…”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, current applications extend to disease extension, including the detection of undifferentiated metastases (3), guidance of therapy assessments and prediction of prognosis (4)(5)(6). Some studies have shown that 18 F-FDG PET and 18 F-FDG PET/CT can induce changes in clinical management plans in 10-78% of patients with DTC (7)(8)(9)(10)(11)(12), thereby improving clinical judgment. In the Brazilian population, there has been only one study using 18 F-FDG PET/CT in thyroid cancer patients with negative WBS and positive sTg in a small patient sample (13).…”

Section: Introductionmentioning

confidence: 99%

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Clinical utility of 18F-FDG PET/CT in the follow-up of a large cohort of patients with high-risk differentiated thyroid carcinoma

Yang

Maciel

Nakabashi

et al. 2017

Arch. Endocrinol. Metab.

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Objective: To evaluate the clinical utility of 18 F-FDG PET/CT in patients with high-risk DTC. Subjects and methods: Single-center retrospective study with 74 patients with high-risk differentiated thyroid cancer (DTC), classified in 4 groups. Group 1: patients with positive sTg or TgAb, subdivided in Group 1A: negative RxWBS and no foci of metastases identified at conventional image (n = 9); Group 1B: RxWBS not compatible with suspicious foci at conventional image or not proportional to sTg level (n = 13); Group 2: patients with histological findings of aggressive DTC variants (n = 21) and Group 3: patients with positive RxWBS (n = 31). Results: 18 F-FDG PET/CT identified undifferentiated lesions and helped restage the disease in groups 1B and 2. The scan helped guide clinical judgment in 9/13 (69%) patients of group 1B, 10/21 (48%) patients of group 2 and 2/31 (6%) patients of group 3. There was no clinical benefit associated with group 1A. 18 F-FDG PET/CT was associated with progressive disease. Conclusion: 18 F-FDG PET/CT is a useful tool in the follow-up of patients with high-risk DTC, mainly in the group of RxWBS not compatible with suspicious foci at conventional image or not proportional to sTg level and in those with aggressive DTC variants. Additionally, this study showed that 18 F-FDG PET/CT was associated with progression and helped display undifferentiated lesions guiding clinical assessments regarding surgeries or expectant treatments. Arch Endocrinol Metab. 2017;61(5):416-25.

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Section: Discussionsupporting

confidence: 58%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical utility of 18F-FDG PET/CT in the follow-up of a large cohort of patients with high-risk differentiated thyroid carcinoma

Yang

Maciel

Nakabashi

et al. 2017

Arch. Endocrinol. Metab.

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“…Petrich et al found that the number of positive scans, as well as the number of lesions and standardized uptake values (SUV), increased with the use of rhTSH stimulation (28). In contrast, Leboulleux et al found that the number of positive scans did not increase, but the number of identified lesions did increase after stimulation with rhTSH; the increased number of lesions changed management in about 6% of cases (29). Despite studies showing that sensitivity of PET imaging improves under TSH stimulation, a high proportion of PET scans being done without stimulation was observed in the present study.…”

Section: Discussionmentioning

confidence: 99%

Evaluating Positron Emission Tomography Use in Differentiated Thyroid Cancer

Wiebel

Esfandiari

Papaleontiou

et al. 2015

Thyroid

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Background: Using the Surveillance, Epidemiology, and End Results-Medicare database, a substantial increase was found in the use of positron emission tomography (PET) scans after 2004 in differentiated thyroid cancer (DTC) patients. The reason for the increased utilization of the PET scan was not clear based on available the data. Therefore, the indications for and outcomes of PET scans performed at an academic institution were evaluated. Methods: A retrospective cohort study was performed of DTC patients who underwent surgery at the University of Michigan Health System from 2006 to 2011. After identifying patients who underwent a PET scan, indications, rate of positive PET scans, and impact on management were evaluated. For positive scans, the location of disease was characterized, and presence of disease on other imaging was determined. Results: Of the 585 patients in the cohort, 111 (19%) patients had 200 PET scans performed for evaluation of DTC. Indications for PET scan included: elevated thyroglobulin and negative radioiodine scan in 52 scans (26.0%), thyroglobulin antibodies in 13 scans (6.5%), rising thyroglobulin in 18 scans (9.0%), evaluation of abnormality on other imaging in 22 scans (11.0%), evaluation of extent of disease in 33 scans (16.5%), followup of previous scan in 57 scans (28.5%), other indications in two scans (1.0%), and unclear indications in three scans (1.5%). The PET scan was positive in 124 studies (62.0%); positivity was identified in the thyroid bed on 25 scans, cervical or mediastinal lymph nodes on 105 scans, lung on 28 scans, bone on four scans, and other areas on 14 scans. Therapy following PET scan was surgery in 66 cases (33.0%), chemotherapy or radiation in 23 cases (11.5%), observation in 110 cases (55.0%), and palliative care in one case (0.5%). Disease was identifiable on other imaging in 66% of cases. PET scan results changed management in 59 cases (29.5%). Conclusions: In this academic medical center, the PET scan was utilized in 19% of patients. Indications for the PET scan included conventional indications, such as elevated thyroglobulin with noniodine avid disease, and more controversial uses, such as evaluation of extent of disease or abnormalities on other imaging tests. PET scan results changed management in about 30% of cases.

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“…However, evidence from a number of studies of resected thyroid tissue suggests that TSHR is more persistently expressed than other differentiation markers, including NIS and thyroglobulin proteins , Lazar et al 1999, Gerard et al 2003, indicating not only that TSHR may remain an important signaling pathway for cellular growth but also its utility as a conserved therapeutic target. Further in vivo evidence of continued TSHR expression in the absence of NIS is provided by a study of 63 patients with metastatic DTC, and no radioactive iodine uptake on whole body scan, who underwent 18 F-fludeoxyglucose positron emission tomography ( 18 F-FDG-PET) both under basal conditions and after rhTSH stimulation (Leboulleux et al 2009). This study found that the sensitivity of FDG-PET was significantly increased after rhTSH stimulation on a per lesion basis (95% vs 81%), suggesting that these lesions continued to express TSHR in the absence of the ability to concentrate radioiodine.…”

Section: Persistence Of Tshr Expression In the Setting Of Loss Of Othmentioning

confidence: 99%

Targeting the TSH receptor in thyroid cancer

Rowe¹,

Paul²,

Gedye³

et al. 2017

Endocrine-Related Cancer

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Recent advances in the arena of theranostics have necessitated a re-examining of previously established fields. The existing paradigm of therapeutic thyroid-stimulating hormone receptor (TSHR) targeting in the post-surgical management of differentiated thyroid cancer using levothyroxine and recombinant human thyroid-stimulating hormone (TSH) is well understood. However, in an era of personalized medicine, and with an increasing awareness of the risk profile of longstanding pharmacological hyperthyroidism, it is imperative clinicians understand the molecular basis and magnitude of benefit for individual patients. Furthermore, TSHR has been recently re-conceived as a selective target for residual metastatic thyroid cancer, with pilot data demonstrating effective targeting of nanoparticles to thyroid cancers using this receptor as a target. This review examines the evidence for TSHR signaling as an oncogenic pathway and assesses the evidence for ongoing TSHR expression in thyroid cancer metastases. Priorities for further research are highlighted.

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Assessment of the Incremental Value of Recombinant Thyrotropin Stimulation before 2-[18F]-Fluoro-2-Deoxy-d-Glucose Positron Emission Tomography/Computed Tomography Imaging to Localize Residual Differentiated Thyroid Cancer

Cited by 137 publications

References 29 publications

Clinical utility of 18F-FDG PET/CT in the follow-up of a large cohort of patients with high-risk differentiated thyroid carcinoma

Clinical utility of 18F-FDG PET/CT in the follow-up of a large cohort of patients with high-risk differentiated thyroid carcinoma

Evaluating Positron Emission Tomography Use in Differentiated Thyroid Cancer

Targeting the TSH receptor in thyroid cancer

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