Current Roles of PET/CT in Thymic Epithelial Tumours: Which Evidences and Which Prospects? A Pictorial Review

Lococo, Filippo; Chiappetta, Marco; Evangelista, Jessica; Congedo, Maria Teresa; Pizzuto, Daniele Antonio; Brascia, Debora; Marulli, Giuseppe; Annunziata, Salvatore; Margaritora, Stefano

doi:10.3390/cancers13236091

Cited by 7 publications

(5 citation statements)

References 65 publications

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“…Thymic carcinomas present with high FDG uptake, typically with SUVmax > 7 ( 24 ), SUV max values <4 as being most consistent with benign thymic processes ( 25 ). On the other hand, there is a marked overlap in FDG uptake between physiological thymic FDG uptake and thymic neoplasia in the literature, indicating that 18F-FDG-PET-CT has a limited ability to assess the thymus and an equivocal role in the differentiation of a normal thymus from thymic neoplasia ( 26 ). Among all described cases of EAS-related NETTs in the literature in which 18F-FDG-PET-CT was indicated as one of the diagnostic step, the primary tumor was visualized in all of them ( 27 – 38 ).…”

Section: Discussionmentioning

confidence: 99%

Case report: A challenging case of severe Cushing’s syndrome in the course of metastatic thymic neuroendocrine carcinoma with a synchronous adrenal tumor

Dzialach,

Wojciechowska-Luzniak,

Maksymowicz

et al. 2024

Front. Endocrinol.

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Ectopic ACTH syndrome (EAS) remains one of the most demanding diagnostic and therapeutic challenges for endocrinologists. Thymic neuroendocrine tumors account for 5%–10% of all EAS cases. We report a unique case of a 31-year-old woman with severe EAS caused by primary metastatic combined large-cell neuroendocrine carcinoma and atypical carcinoid of the thymus. The patient presented with severe hypercortisolemia, which was successfully controlled with continuous etomidate infusion. Complex imaging initially failed to detect thymic lesion; however, it revealed a large, inhomogeneous, metabolically active left adrenal mass infiltrating the diaphragm, suspected of primary disease origin. The patient underwent unilateral adrenalectomy, which resulted in hypercortisolemia resolve. The pathology report showed an adenoma with adrenal infarction and necrosis. The thymic tumor was eventually revealed a few weeks later on follow-up imaging studies. Due to local invasion and rapid progression, only partial resection of the thymic tumor was possible, and the patient was started on radio- and chemotherapy.

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Section: Discussionmentioning

confidence: 99%

Case report: A challenging case of severe Cushing’s syndrome in the course of metastatic thymic neuroendocrine carcinoma with a synchronous adrenal tumor

Dzialach,

Wojciechowska-Luzniak,

Maksymowicz

et al. 2024

Front. Endocrinol.

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“…However, FDG can be taken by infection, thymic hyperplasia, fibrosing mediastinitis, and other non-neoplastic processes, which cause false-positive results. On the other hand, the lack of increased FDG uptake is seen in some histological types of thymic malignancy, and there is a lack of standardization in techniques which can result in quantitative variability and controversy between studies [ 25 ]. In addition, PET/CT and MRI are generally not the preferred examination modalities for the vast majority of patients due to financial burden and accessibility.…”

Section: Discussionmentioning

confidence: 99%

How can the rate of nontherapeutic thymectomy be reduced?

Wang

Jiang

et al. 2022

Interactive CardioVascular and Thoracic Surgery

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Objectives To determine the prevalence of nontherapeutic thymectomy and define a clinical standard to reduce it. Methods From 2016 to 2020, consecutive patients who underwent thymectomy were retrospective reviewed. Univariable and multivariable analyses were used to identify the correlation factors of nontherapeutic thymectomy. A receiver operating characteristic (ROC) curve was analyzed to assess the cutoff threshold of factors correlated with nontherapeutic thymectomy. Results A total of 1,039 patients were included in this study. Overall, 78.4% (n = 814) of thymectomies were therapeutic and 21.6% (n = 225) were nontherapeutic. Thymoma (57.9%, n = 602) was the most common diagnoses in therapeutic thymectomy. Among those of nontherapeutic thymectomy, thymic cysts (11.9%, n = 124) were the most common lesion. Compared with therapeutic thymectomy, patients with nontherapeutic thymectomy were more likely to be younger (median age 50.1 vs 55.6 years, P < 0.001) with a smaller precontrast and postcontrast CT value (p < 0.001, p < 0.001), as well as ΔCT value [10.7 vs 23.5 Hounsfield units (HU), p < 0.001]. Multivariable analysis indicated that only age and ΔCT value were significantly different between therapeutic and nontherapeutic thymectomy groups. ROC curve analysis showed that cutoff values of age and ΔCT value were 44 years and 6 HU, respectively. Patients with age ≤ 44 years and a ΔCT value ≤ 6 HU had a 95% probability of nontherapeutic thymectomy. Conclusions Surgeons should be cautious to perform thymectomy for patients with age ≤ 44 years and ΔCT value ≤6 HU. This simple clinical standard is helpful to reduce the rate of nontherapeutic thymectomy.

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“…No further positron-emitter radiotracer other than 18 F-FDG has been introduced in the standard workup of patients with thymic neoplasms. However, some cases in the literature described incidental thymic findings during PET/CTs with radiolabelled Choline, 11 C-acetate and 68 Ga-PSMA [41].…”

Section: New "Stromal" Tracers and Other Future Perspectivesmentioning

confidence: 99%

Is PET/CT Able to Predict Histology in Thymic Epithelial Tumours? A Narrative Review

et al. 2022

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Background: The usefulness of 18FDG PET/CT scan in the evaluation of thymic epithelial tumours (TETs) has been reported by several authors, but data are still limited and its application in clinical practice is far from being defined. Methods: We performed a narrative review of pertinent literature in order to clarify the role of 18FDG PET/CT in the prediction of TET histology and to discuss clinical implications and future perspectives. Results: There is only little evidence that 18FDG PET/CT scan may distinguish thymic hyperplasia from thymic epithelial tumours. On the other hand, it seems to discriminate well thymomas from carcinomas and, even more, to predict the grade of malignancy (WHO classes). To this end, SUVmax and other PET variables (i.e., the ratio between SUVmax and tumour dimensions) have been adopted, with good results. Finally, however promising, the future of PET/CT and theranostics in TETs is far from being defined; more robust analysis of imaging texture on thymic neoplasms, as well as new exploratory studies with “stromal PET tracers,” are ongoing. Conclusions: PET may play a role in predicting histology in TETs and help physicians in the management of these insidious malignancies.

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Current Roles of PET/CT in Thymic Epithelial Tumours: Which Evidences and Which Prospects? A Pictorial Review

Cited by 7 publications

References 65 publications

Case report: A challenging case of severe Cushing’s syndrome in the course of metastatic thymic neuroendocrine carcinoma with a synchronous adrenal tumor

Case report: A challenging case of severe Cushing’s syndrome in the course of metastatic thymic neuroendocrine carcinoma with a synchronous adrenal tumor

How can the rate of nontherapeutic thymectomy be reduced?

Is PET/CT Able to Predict Histology in Thymic Epithelial Tumours? A Narrative Review

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