Clinical Value of 99mTc-3PRGD2 SPECT/CT in Differentiated Thyroid Carcinoma with Negative 131I Whole-Body Scan and Elevated Thyroglobulin Level

Abstract

The aim of this study was to assess the usefulness of integrin imaging with 99mTc-PEG4-E[PEG4-c(RGDfK)]2 (99mTc-3PRGD2) single photon emission computed tomography (SPECT)/computed tomography (CT) in detecting recurrent disease in patients with differentiated thyroid cancer (DTC), negative radioiodine whole-body scan (WBS) and high serum thyroglobulin (Tg). Thirty-seven patients who underwent total thyroidectomy followed by radioactive iodine ablation and had negative radioiodine WBS but elevated Tg levels were included. 99mTc-3PRGD2 SPECT/CT was performed 1 week after the negative diagnostic 131I WBS. Diagnostic performance indicators, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), for 99mTc-3PRGD2 SPECT/CT was calculated. The correlations between SPECT/CT results and clinic-pathological characteristics were examined. In 30 (81.1%) of the 37 patients, 99mTc-3PRGD2 SPECT/CT showed positive uptake. The sensitivity, specificity, PPV, and NPV of SPECT/CT to detect recurrent disease at follow-up were 96.6%, 75%, 93.3% and 85.7%, respectively. The sensitivity and PPV of SPECT/CT increased with increasing serum Tg levels. 99mTc-3PRGD2 SPECT/CT showed high sensitivity and PPV in the detection of recurrence among DTC patients with higher Tg levels and negative WBS, and the probability of obtaining a positive SPECT/CT result was related with the level of Tg.

Papillary Thyroid Micro Carcinoma: The Incidence of High-Risk Features and Its Prognostic Implications

“…After primary treatment, all the patients received levothyroxine at TSH-suppressive doses and were periodically (every 3–6 months) followed up with measurement of thyroid hormones, TSH, serum thyroglobulin (Tg) and anti-thyroglobulin antibody (Tg-Ab). Additional diagnostic imaging tests such as 131I whole-body scan (WBS), neck ultrasonography and/or contrast enhanced computed tomography were performed every 6–12 months, as needed (10, 11, 18). Information on the last follow-up and the date of disease recurrence/metastasis was also collected.…”

Prognostic Impact of Direct 131I Therapy After Detection of Biochemical Recurrence in Intermediate or High-Risk Differentiated Thyroid Cancer: A Retrospective Cohort Study

“…More sensitive iodine scanners and studies proposing the rational use of 18 FDG-PETCT might confirm our results. Prospective and multi-institutional studies to confirm these findings with possible impact on survival are warranted (8, 34, 35).…”

“…Patients with a progressive increase in TG or anti-TG antibodies levels –even when high-risk factors are present– and a negative DWBS, the so called TENIS syndrome (7), are continuously followed with periodic DWBS until clinical recurrence, a positive DWBS or a greater increase in TG or anti-TG antibodies occurs. Moreover, some studies suggest performance of a 99mTc-3PRGD2 SPECT/CT in these circumstances (8). This policy delays treatment, increases costs, and induces stunning in the recurrent thyroid tissue, with its possible deleterious impact on prognosis.…”

Advances in Clinical Oncology Research on 99mTc-3PRGD2 SPECT Imaging

“…Gao et al. ( 51 ) assessed the value of 99m Tc-3PRGD 2 SPECT imaging for the monitoring of differentiated thyroid cancer recurrence. Their results indicated that among patients with differentiated thyroid cancer with high serum thyroglobulin levels and negative radioiodine whole-body scan results, 99m Tc-3PRGD 2 SPECT showed higher sensitivity (96.6%) and positive predictive value (93.3%) for monitoring recurrence, while the probability of obtaining a positive SPECT finding was related to the thyroglobulin levels (p=0.006).…”