IMAGING IN ENDOCRINOLOGY: 2-[18F]-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography in differentiated thyroid carcinoma: clinical indications and controversies in diagnosis and follow-up

Introduction: Available methods, including serum thyroglobulin (Tg) measurement and whole-body scan (WBS) performed after radioiodine administration, allow for a precise diagnostics in differentiated thyroid cancer (DTC). However, some asymptomatic patients demonstrate negative WBS despite a high Tg serum concentration. In these subjects, fluorodeoxyglucose-positron emission tomography (FDG-PET) should be considered. The primary aim of our study was to evaluate a diagnostic value of FDG-PET in asymptomatic hyperthyroglobulinemia. The secondary one was to determine a prognostic value of a negative FDG-PET result in DTC patients with elevated Tg level. Material: One hundred and ten FDG-PET/CT scans were retrospectively analyzed, 85 scans were done under TSH stimulation and 25 on LT 4 suppressive therapy. Follow-up ranged between 4 and 9 years. Results: The first FDG-PET/CT detected cancer foci in 49 subjects with a global sensitivity of 45%. When the sensitivity was evaluated with reference to TSH stimulation and suppression, its values were 50 and 28% respectively. In 42 patients, FDG-PET failed to diagnose the reason for elevated Tg level. During further follow-up, in 17 of them, DTC recurrence was detected by other methods (CT, MRI, US). Fourteen subjects with asymptomatic hyperthyroglobulinemia were free of DTC progression for at least 4 years. Conclusions: FDG-PET in DTC patients with asymptomatic hyperthyroglobulinemia constitutes a valuable diagnostic tool. Negative FDG-PET demonstrated a limited prognostic significance, as only every third patient did not show DTC progression. Moreover, negative FDG-PET does not justify less strict DTC monitoring, because it is related to 40% risk of relapse during the 5-year follow-up.

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“…The most often recommended Tg value is 10 ng/mL (14,15). However, any detectable Tg level may be worrying.…”

Section: Introductionmentioning

confidence: 99%

The role of FDG-PET in localization of recurrent lesions of differentiated thyroid cancer (DTC) in patients with asymptomatic hyperthyroglobulinemia in a real clinical practice

Kukulska

Krajewska

Kołosza

et al. 2016

European Journal of Endocrinology

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“…Además, la TSH juega un rol importante, ya que estimula el transporte de glucosa y la actividad glucolítica en los tirocitos a través de la translocación de GLUT1, así como la neosíntesis de GLUT1 por la activación de su expresión génica, lo cual indica que la sensibilidad del PET/CT-FDG está influenciada por los niveles de TSH 63 . Salvatori, et al 64 sugieren que las indicaciones para practicar PET/CT-FDG se dividan en indicaciones fuertemente definidas y no completamente definidas. Las primeras incluyen pacientes con niveles elevados de Tg (> 10 ng/ml) y estudio de imagen negativo (ultrasonido, rastreo con yodo 131).…”

Section: F]-fluoro-2-deoxy-dglucosaunclassified

La medicina nuclear y el cáncer diferenciado de tiroides

Medina-Ornelas¹,

García-Pérez²,

Granados-García³

2022

GAMO

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Gaceta Mexicana de Oncologia. 2017;16(4):239-248 resumen: Los afectados por cáncer diferenciado de tiroides (CDT) suelen tener un curso clí-nico favorable, pero algunos pueden mostrar un curso agresivo con recaídas. El tratamiento óptimo aún es controvertido, en especial respecto a la extensión de la cirugía, las indicaciones de radioyodo y la supresión de hormona estimuladora del tiroides (TSH). La evaluación correcta de los riesgos facilita un enfoque selectivo de la terapia. Presentamos una revisión del papel de la medicina nuclear en la evaluación, tratamiento y seguimiento de pacientes afectados por esta interesante enfermedad. (creativecommons.org/licenses/by-nc-nd/4.0/). abstract Those affected by differentiated thyroid cancer tend to have a favorable clinical course, but some may show an aggressive course with relapses. The optimal treatment is still controversial, especially regarding the extent of surgery, indications for radioiodine and suppression of thyroid-stimulating hormone. Correct risk assessment facilitates a selective approach to therapy. We present a review of the role of nuclear medicine in the evaluation, treatment and follow-up of patients affected by this interesting disease. PalaBraS ClaVECáncer de tiroides; Radioyodo; Medicina nuclear; Tratamiento KEY WorDSThyroid cancer; Radioiodine; Nuclear medicine; Treatment introDuCCión Según Globocan, en 2012 en México ocurrieron 3,036 casos de cáncer de tiroides (725 en hombres y 2,311 en mujeres), que constituyeron el 2.1% del total de neoplasias malignas 1 . El CDT representa al menos el 85% de los casos e incluye los tipos papilar, folicular y de células de Hürtle. El cáncer papilar, el tipo más frecuente, se asocia a una excelente supervivencia, pero algunos pacientes tienen un curso clínico menos favorable, con metástasis o recaídas que afectan a los ganglios linfáticos cervicales y, con menor frecuencia, a los pulmones y el hueso 2,3 . La medicina nuclear se sirve de las peculiaridades de la fisiopatología del CDT y juega un papel muy importante tanto en el tratamiento adyuvante como en el seguimiento y manejo de las recaídas. El tratamiento debe ser el más eficaz posible, con las menores secuelas y el menor costo; por ello se enfatiza el tratamiento individualizado, acorde al tipo histológico, la extensión de la enfermedad y el riesgo de recaída. YoDo 131El yodo 131 ([131]I o radioyodo) es producido en un reactor nuclear mediante la irradiación neutrónica de dióxido de telurio durante la fisión del uranio. Su vida media física es de 8.02 días. Los átomos del yodo 131 emiten partículas β con

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“…However, the decision to abandon RAI therapy should not be based only on the presence or intensity of 18 FDG uptake (14)(15)(16)(17).…”

Section: Fdg On Pet/ct Scanmentioning

confidence: 99%

Radioactive iodine-refractory differentiated thyroid cancer: an uncommon but challenging situation

Schmidt

Iglesias

Klain

et al. 2017

Arch. Endocrinol. Metab.

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Radioiodine (RAI)-refractory thyroid cancer is an uncommon entity, occurring with an estimated incidence of 4-5 cases/year/million people. RAI refractoriness is more frequent in older patients, in those with large metastases, in poorly differentiated thyroid cancer, and in those tumors with high 18-fluordeoxyglucose uptake on PET/CT. These patients have a 10-year survival rate of less than 10%. In recent years, new therapeutic agents with molecular targets have become available, with multikinase inhibitors (MKIs) being the most investigated drugs. Two of these compounds, sorafenib and lenvatinib, have shown significant objective response rates and have significantly improved the progression-free survival in the two largest published prospective trials on MKI use. However, no overall survival benefit has been achieved yet. This is probably related to the crossover that occurs in most patients who progress on placebo treatment to the open treatment of these studies. In consequence, the challenge is to correctly identify which patients will benefit from these treatments. It is also crucial to understand the appropriate timing to initiate MKI treatment and when to stop it. The purpose of this article is to define RAI refractoriness, to summarize which therapies are available for this condition, and to review how to select patients who are suitable for them. Arch Endocrinol Metab. 2017;61(1):81-9

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IMAGING IN ENDOCRINOLOGY: 2-[18F]-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography in differentiated thyroid carcinoma: clinical indications and controversies in diagnosis and follow-up

Cited by 50 publications

References 94 publications

The role of FDG-PET in localization of recurrent lesions of differentiated thyroid cancer (DTC) in patients with asymptomatic hyperthyroglobulinemia in a real clinical practice

The role of FDG-PET in localization of recurrent lesions of differentiated thyroid cancer (DTC) in patients with asymptomatic hyperthyroglobulinemia in a real clinical practice

La medicina nuclear y el cáncer diferenciado de tiroides

Radioactive iodine-refractory differentiated thyroid cancer: an uncommon but challenging situation

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