Complementary Roles of <sup>18</sup>F-DOPA PET/CT and <sup>18</sup>F-FDG PET/CT in Medullary Thyroid Cancer

Kauhanen, Saila; Schalin‐Jäntti, Camilla; Seppänen, Marko; Kajander, Sami; Virtanen, Seppo; Schildt, Jukka; Lisinen, Irina; Ahonen, Aapo; Heiskanen, Ilkka; Väisänen, Mika; Arola, Johanna; Korsoff, Pirkko; Ebeling, Tapani; Sane, Timo; Minn, Heikki; Välimäki, Matti; Nuutila, Pirjo

doi:10.2967/jnumed.111.094771

Cited by 76 publications

(48 citation statements)

References 31 publications

(54 reference statements)

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“…In line with this, Skoura et al [5] reported an overall per-patient sensitivity of 44.1 % in 51 MTC patients with increased Ct The meta-analysis by Treglia et al [4] reported increased detection rates of 18 F-FDG-PET/(CT) of 69 % if CEA was [5 ng/mL, 75 % if Ct was [1,000 ng/L, 76 % if Ct Dt was \12 months and as high as 91 % if CEA Dt was \24 months. In line with this, we observed a strong correlation between elevated tumor marker concentrations and 18 F-FDG PET/CT SUV max [6]. However, the same trend was observed for fluorine-18 dihydroxyphenylalanine ( 18 F-DOPA) PET/CT [6].…”

supporting

confidence: 74%

“…In line with this, we observed a strong correlation between elevated tumor marker concentrations and 18 F-FDG PET/CT SUV max [6]. However, the same trend was observed for fluorine-18 dihydroxyphenylalanine ( 18 F-DOPA) PET/CT [6]. Skoura et al [5] reported a sensitivity of 86.7 % for Ct [1,000 ng/L and Ong et al [7] reported that the sensitivity of 18 F-FDG-PET decreases from 78 % for Ct [1,000 ng/L, to 20 % for Ct \500 ng/L.…”

supporting

confidence: 73%

“…Importantly, we reported that 18 F-DOPA-PET/CT was the only method that accurately localized a metastasis in a patient with a Ct of only 155 pg/mL (44.8 pmol/L) in the neck/mediastinal region, with a low Ki 67 % tumor proliferation index of 5 % [6]. 18 F-DOPA-PET/CT seems to be of particular value for detection of occult recurrent MTC characterized by a low proliferation index.…”

mentioning

confidence: 99%

“…Since MTC belongs to the group of NETs that are capable of taking up and decarboxylating amine precursors, PET/CT using aminoacid precursor tracers such as 18 F-DOPA has been proposed to be more specific [6,[8][9][10]. Importantly, we reported that 18 F-DOPA-PET/CT was the only method that accurately localized a metastasis in a patient with a Ct of only 155 pg/mL (44.8 pmol/L) in the neck/mediastinal region, with a low Ki 67 % tumor proliferation index of 5 % [6].…”

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confidence: 99%

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Is there a role for fluorine-18 fluorodeoxyglucose positron emission tomography imaging in medullary thyroid cancer?

Kauhanen

Schalin‐Jäntti

2012

Endocrine

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Medullary thyroid cancer (MTC) is an uncommon and challenging malignancy. In spite of aggressive primary treatment with total thyroidectomy and modified neck lymph node dissection, approximately 50 % of the patients have persistent or recurrent disease [1,2]. The recent European Thyroid Association guidelines [3] recommend surgery and other local treatment modalities (such as external beam radiation therapy, radiofrequency ablation, and chemoembolization) for the treatment of distant metastases in patients with low tumor burden (distant metastases limited to single organ) and stable disease, while patients with symptoms, significant tumor burden and progressive disease should receive novel targeted systemic therapies. However, imaging of recurrent disease in MTC is difficult and still poses a major problem in the management of the disease.The serum tumor markers calcitonin (Ct) and carcinoembryonic antigen (CEA) and their doubling times (Dt) are used to assess progression rate and also reflect tumor burden in MTC. However, conventional imaging (CI) is often negative in patients with Ct concentrations \150 pg/ mL [3]. It is estimated that CI identifies metastases in about 40 % of patients with biochemical evidence of recurrence. The probability of detecting metastases increases in patients with increasing Ct and CEA concentrations and shortening Dts. Of note, some patients with poorly differentiated and aggressive metastatic MTC have low Ct or discrepantly high CEA concentrations. The recommended CI protocol is extensive and comprises neck ultrasonography for detection of cervical lymph node metastases, computed tomography (CT) of thorax for lung and mediastinal lesions, magnetic resonance imaging (MRI) for liver and bone metastases of the spine and pelvis and bone scintigraphy. Modern whole body imaging with positron emission tomography (PET) and integrated CT could thus represent an alternative to CI, at least for patients with negative CI imaging.In this issue of the Endocrine, Treglia et al.[4] report a meta-analysis consisting of 24 studies comprising altogether 538 patients on the performance of fluorine-18 fluorodeoxyglucose ( 18 F-FDG) PET or PET/CT in detection of recurrent MTC. The pooled detection rate on a per patient-based analysis was 59 % (range 24-95 %). The authors conclude that 18 F-FDG-PET/(CT) is non-optimal in surveillance of MTC since about 40 % of suspected recurrences remain unidentified. Of note, the definition of false negative and true negative imaging results differed. Some considered patients with increased Ct concentrations and negative 18 F-FDG-PET/other imaging as false negative results, while other considered them as true negative. However, a detection rate of 59 % should be related to the corresponding overall detection rates of CI of about 40 %. The current meta-analysis did not present data on whether the 18 F-FDG-PET studies primarily included patients for whom CI remained negative or not. In clinical practice, 18 F-FDG-PET is performed in patients with biochemical proof of re...

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supporting

confidence: 74%

supporting

confidence: 73%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Is there a role for fluorine-18 fluorodeoxyglucose positron emission tomography imaging in medullary thyroid cancer?

Kauhanen

Schalin‐Jäntti

2012

Endocrine

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“…They reported a sensitivity and specificity of 100% for FDOPA PET/CT in patients with a basal [27,30,35], it is assumed that the combination of the two radiopharmaceuticals would probably provide the highest diagnostic sensitivity and specificity [34][35], in particular in patients with short (<6 months) Ct doubling times [27]. FDOPA seems to provide more reliable prognostic information whereas FDG allows prognostic evaluation [36].…”

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confidence: 99%

Evolving paradigms for successful molecular imaging of medullary thyroid carcinoma

Rubello

Wong

Marzola

et al. 2012

Eur J Nucl Med Mol Imaging

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Medullary thyroid cancer diagnosis: An appraisal

et al. 2014

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Since its first description in 1951, a timely diagnosis of medullary thyroid carcinoma (MTC) may represent a diagnostic challenge in clinical practice. Several contributions have been addressed to the treatment and follow-up of MTC, but review articles focused on the diagnostic problems of this cancer in clinical practice are sparse. As a delayed diagnosis and an inadequate initial treatment may severely affect the prognosis of this thyroid malignancy, the appropriate use and the correct interpretation of the available diagnostic tools for MTC are of crucial importance. The purpose of the present article is to provide an easy-to-use guide reviewing the main issues of MTC diagnosis: (1) basal serum calcitonin; (2) stimulated serum calcitonin; (3) additional serum markers for MTC; (4) ultrasound and other imaging techniques; (5) fine-needle aspiration (FNA) cytology; (6) calcitonin measurement on FNA washout; (7) rearranged during transfection (RET) mutations; and (8) scope of the problem.

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Complementary Roles of ¹⁸F-DOPA PET/CT and ¹⁸F-FDG PET/CT in Medullary Thyroid Cancer

Cited by 76 publications

References 31 publications

Is there a role for fluorine-18 fluorodeoxyglucose positron emission tomography imaging in medullary thyroid cancer?

Is there a role for fluorine-18 fluorodeoxyglucose positron emission tomography imaging in medullary thyroid cancer?

Evolving paradigms for successful molecular imaging of medullary thyroid carcinoma

Medullary thyroid cancer diagnosis: An appraisal

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Complementary Roles of 18F-DOPA PET/CT and 18F-FDG PET/CT in Medullary Thyroid Cancer

Cited by 76 publications

References 31 publications

Is there a role for fluorine-18 fluorodeoxyglucose positron emission tomography imaging in medullary thyroid cancer?

Is there a role for fluorine-18 fluorodeoxyglucose positron emission tomography imaging in medullary thyroid cancer?

Evolving paradigms for successful molecular imaging of medullary thyroid carcinoma

Medullary thyroid cancer diagnosis: An appraisal

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Complementary Roles of ¹⁸F-DOPA PET/CT and ¹⁸F-FDG PET/CT in Medullary Thyroid Cancer