Value of preoperative diagnostic modalities in patients with recurrent thyroid carcinoma

Abstract

Background The prognosis of differentiated thyroid carcinoma is usually excellent, but the majority of patients who develop a recurrence have a higher risk of death from the disease. Beside clinical examination, several diagnostic tools, such as ultrasonography, 131I scanning, [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) and thyroglobulin (TG) measurement under raised thyroid-stimulating hormone in serum can detect tumour recurrences. This prospective study compared the value of different diagnostic modalities in the detection of recurrent differentiated thyroid cancer. Methods From April 1992 to October 1999, 181 patients with thyroid carcinoma, of whom 150 had a well differentiated tumour, subjected to surgical treatment were identified prospectively. Some 107 patients (71 per cent) presented with primary tumour and 43 patients (29 per cent) with recurrent disease. The patients with tumour recurrence were evaluated regarding the mode of detection of recurrent disease, including clinical examination, ultrasonography, fine-needle biopsy (FNB), TG measurement and FDG-PET, the surgical treatment and outcome. Results Some 63 per cent of patients presented with regional lymph node metastases and 37 per cent with local recurrence. None of the patients with local recurrence was operated on for primary tumour in this department. In 87 per cent the recurrence was detected by clinical examination. Ultrasonography and 131I scan revealed suspicious findings in 97 and 69 per cent respectively. FNB disclosed abnormal cytological findings in 95 per cent. There were pathological TG levels in 86 per cent of patients. Among patients with a raised level of TG and negative scan results, 13 underwent FDG-PET, with pathological findings in 82 per cent. Conclusion In patients with well differentiated thyroid carcinoma, ultrasonography and FNB are the most sensitive methods for the detection of local recurrence or regional lymph node metastases. FDG-PET is a useful diagnostic tool in patients with a negative 131I scan and a raised level of TG.

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

“…In the report previously published by our group the sensitivity was only 84.6%; however, at that time only 13 patients were tested. 1 The low specificity of 25.0% and negative predictive value of 33.3% might be explained by the fact that there was only one true-negative result. As for the detection of local or regional cancer recurrence, the method had three false-positive and two false-negative results.…”

“…In the neck, where metastases most frequently occur, the sensitivity and specificity of ultrasound are strongly dependent on subjective factors. 1 For CT and MRI, the overall error rate of assessment of cervical lymph node metastases is 7.5%. 2 The results of nonspecific scintigraphic examinations with 201 Tl and 99m…”

“…1 Briefly, we used a high-resolution imaging device with a small-part real-time transducer (7.5 L 40; Siemens, Erlangen, Germany) with a frequency of 9 MHz in B-mode. Nodular blood flow was measured with color Doppler sonography (PRF 1250 Hz for conventional color Doppler and 868 Hz for power mode).…”

Uso da ultra-sonografia no diagnóstico e seguimento do carcinoma bem diferenciado da tireóide

“…Sempre que houver algum conteúdo líquido em um gânglio cervical, a PAAF deverá ser guiada pela ultrasonografia para atingir a área sólida com maior probabilidade de apresentar material satisfatório para análise (44). O exame ultra-sonográfico bem realizado é capaz de detectar metástases ganglionares não identificadas ao exame físico ou mesmo quando a PCI é negativa e a tireoglobulina, indetectável (45)(46)(47).…”

La Tomografía por Emisión de Positrones (PET) en la práctica clínica oncológica

“…La PET-FDG ha demostrado la existencia de metástasis en ganglios de tamaño normal y en un 45% de pacientes sin elevación de Tg. Los resultados de la PET-FDG en estos pacientes implican cambios en el manejo terapéutico de los mismos, llevándoles en determinados casos a cirugías con intención curativa [18][19][20][21][22][23][24] . Por otro lado, el hecho de realizar la PET-FDG con estimulación, preferentemente exógena de la TSH, puede producir un incremento de su rendimiento diagnóstico.…”