Comparison of 18FDG-PET with 131Iodine and 99mTc-Sestamibi Scintigraphy in Differentiated Thyroid Cancer

Grünwald, Frank; Menzel, Christian; Bender, Hans; Palmedo, Holger; Willkomm, P.; Ruhlmann, J.; Franckson, Tom; Biersack, Hans‐Jürgen

doi:10.1089/thy.1997.7.327

Cited by 143 publications

(57 citation statements)

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“…Our data strongly support the recommendation that FDG-PET should be used as the whole-body imaging method of choice in the follow-up of patients with thyroid cancer suspected of having tumor recurrence in the presence of negative 131 I scanning results, 25,27 particularly because it seems to be superior to other whole-body imaging techniques (i.e., 201 Tl and 99m Tc-sestamibi scintigraphy 16,21,[27][28][29] ). …”

Section: Discussionsupporting

confidence: 80%

Preoperative Diagnostic Value of [18F] Fluorodeoxyglucose Positron Emission Tomography in Patients With Radioiodine-Negative Recurrent Well-Differentiated Thyroid Carcinoma

Frilling

Tecklenborg²,

Görges³

et al. 2001

Annals of Surgery

114

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ObjectiveTo assess the utility of 2-[18 F] fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) to detect recurrent disease in the follow-up of patients with well-differentiated thyroid cancer (WDTC) who have negative diagnostic 131 I scans and abnormal thyroglobulin levels. Summary Background DataIn general, patients with WDTC have an excellent long-term prognosis when appropriate surgical treatment and follow-up are carried out. After total thyroid ablation, whole-body 131 I scintigraphy and measurement of serum thyroglobulin are useful diagnostic tools to detect persistent or recurrent malignancy. In case of tumor dedifferentiation, decreased or lost iodine-accumulating ability may lead to false-negative 131 I scanning results. The diagnostic and therapeutic delay is responsible for a poor prognosis in this subgroup of patients. Efforts have been made in the search for suitable imaging modalities capable of early detection of recurrent thyroid carcinoma. MethodsThe authors prospectively analyzed 24 patients with WDTC, negative results of whole-body 131 I scintigraphy, and elevated serum thyroglobulin concentrations. Attenuation-corrected whole-body FDG-PET scans from the neck to the upper legs were performed. In addition, all patients underwent cervical ultrasonography. The results of the imaging studies were compared with histopathologic findings. If no resection of the suspicious lesion was carried out, computed tomography data were used as control criteria. ResultsOverall, FDG-PET disclosed 38 hot spots. The sensitivity of the method was 94.6%, but the specificity was lower (25.0%). The diagnostic accuracy was 87.8%. There were three false-positive results in two patients with benign cervical lymph nodes. In one patient with regional lymph node metastases in the neck, two false-negative results were obtained. Ultrasound classified both findings as malignant, however. Because of unexpected findings, FDG-PET suggested potential modification of the surgical management in nine patients. Distant metastases could be disclosed using FDG-PET in only three patients. ConclusionsFDG-PET is a useful diagnostic tool in the follow-up of thyroidectomized patients with WDTC, negative 131 I scanning results, and abnormal serum thyroglobulin concentrations. The method detects metastatic disease in 94.6% of cases. PET results changed surgical tactics in a significant number of patients. Accurate staging of locoregional cancer recurrence in the neck may be consummately obtained by concomitant analysis of PET and ultrasound results.

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Section: Discussionsupporting

confidence: 80%

Preoperative Diagnostic Value of [18F] Fluorodeoxyglucose Positron Emission Tomography in Patients With Radioiodine-Negative Recurrent Well-Differentiated Thyroid Carcinoma

Frilling

Tecklenborg²,

Görges³

et al. 2001

Annals of Surgery

114

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“…18 However, there is published evidence suggesting MIBI is not specific for thyroid malignancy, 6,7 although most workers have established the usefulness of whole-body MIBI scintigraphy in the follow-up of patients with metastatic thyroid cancer. [13][14][15][16][17] In this study, MIBI accumulation seemed to depend on the pathologic condition of the nodule, because all but two malignant lesions were positive on MIBI. The two malignant cases that where MIBI negative showed an intense uptake on the 20-minute images with continual washout on the 2-hour delayed images.…”

Section: Discussionmentioning

confidence: 98%

“…At present, there is no radiopharmaceutical with satisfactory specificity in the detection of thyroid malignancy. 12 Most workers have confirmed the usefulness of wholebody MIBI scintigraphy in the detection of metastases in thyroid cancer, [13][14][15][16][17] but the results of primary tumor imaging, especially in the differentiation between benign and malignant nodules, have been inconclusive. 18 The purpose of this work was twofold: first, to evaluate specificity of MIBI versus three-phase thyroid pertechnetate scan, and second, to assess whether the MIBI uptake is influenced by malignant thyroid nodules.…”

mentioning

confidence: 99%

Evaluation of thyroid nodules with technetium‐99m MIBI and technetium‐99m pertechnetate

et al. 2001

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“…FDG uptake was detected more frequently in patients with poorly differentiated thyroid carcinoma, in whom no detectable iodine-131 uptake could be demonstrated. It was detected in neck lymph-node metastases, and even in nodes of less than 1 cm in diameter (57,58). Although highly useful in specific contexts, FDG PET scan cannot supersede recurrent disease and a negative high-dose 131 I-TBS.…”

Section: Radioiodine In the Follow-upmentioning

confidence: 99%

Sodium/iodide symporter: a key transport system in thyroid cancer cell metabolism

Filetti¹,

Bidart

Arturi³

et al. 1999

European Journal of Endocrinology

252

144

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The recent cloning of the gene encoding the sodium/iodide symporter (NIS) has enabled better characterization of the molecular mechanisms underlying iodide transport, thus opening the way to clarifying its role in thyroid diseases. Several studies, at both the mRNA and the protein expression levels, have demonstrated that TSH, the primary regulator of iodide uptake, upregulates NIS gene expression and NIS protein abundance, both in vitro and in vivo. However, other factors, including iodide, retinoic acid, transforming growth factor-b, interleukin-1a and tumour necrosis factor a, may participate in the regulation of NIS expression. Investigation of NIS mRNA expression in different thyroid tissues has revealed increased levels of expression in Graves' disease and toxic adenomas, whereas a reduction or loss of NIS transcript was detected in differentiated thyroid carcinomas, despite the expression of other specific thyroid markers. NIS mRNA was also detected in non-thyroid tissues able to concentrate radioiodine, including salivary glands, stomach, thymus and breast.The production of specific antibodies against the NIS has facilitated study of the expression of the symporter protein. Despite of the presence of high levels of human (h)NIS mRNA, normal thyroid glands exhibit a heterogeneous expression of NIS protein, limited to the basolateral membrane of the thyrocytes. By immunohistochemistry, staining of hNIS protein was stronger in Graves' and toxic adenomas and reduced in thyroid carcinomas.Measurement of iodide uptake by thyroid cancer cells is the cornerstone of the follow-up and treatment of patients with thyroid cancer. However, radioiodide uptake is found only in about 67% of patients with persistent or recurrent disease. Several studies have demonstrated a decrease in or a loss of NIS expression in primary human thyroid carcinomas, and immunohistochemical studies have confirmed this considerably decreased expression of the NIS protein in thyroid cancer tissues, suggesting that the low expression of NIS may represent an early abnormality in the pathway of thyroid cell transformation, rather than being a consequence of cancer progression.The relationship between radioiodine uptake and NIS expression by thyroid cancer cells require further study. New strategies, based on manipulation of NIS expression, to obtain NIS gene reactivation or for use as NIS gene therapy in the treatment of radiosensitive cancer, are also being investigated. European Journal of Endocrinology 141 443-457 Role of iodine in thyroid physiology and pathophysiology Iodine in thyroid physiologyIodine represents an essential element in thyroid physiology, being a critical component of thyroxine and tri-iodothyronine molecules, and a key regulator of thyroid gland function. Thus dietary iodide supply influences the functional activity of the thyroid gland, iodine deficiency being the main cause of endemic goiter. Furthermore, iodine directly modulates thyroid sensitivity to thyroid-stimulating hormone (TSH), and intrathyroidal iodin...

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Comparison of ¹⁸FDG-PET with ¹³¹Iodine and ^99mTc-Sestamibi Scintigraphy in Differentiated Thyroid Cancer

Cited by 143 publications

References 9 publications

Preoperative Diagnostic Value of [18F] Fluorodeoxyglucose Positron Emission Tomography in Patients With Radioiodine-Negative Recurrent Well-Differentiated Thyroid Carcinoma

Preoperative Diagnostic Value of [18F] Fluorodeoxyglucose Positron Emission Tomography in Patients With Radioiodine-Negative Recurrent Well-Differentiated Thyroid Carcinoma

Evaluation of thyroid nodules with technetium‐99m MIBI and technetium‐99m pertechnetate

Sodium/iodide symporter: a key transport system in thyroid cancer cell metabolism

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