Document Detail

Increasing the yield of recombinant thyroid-stimulating hormone-stimulated 2-(18-fluoride)-flu-2-deoxy-D-glucose positron emission tomography-CT in patients with differentiated thyroid carcinoma.
MedLine Citation:
PMID:  22972977     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The aim of this study was to assess the accuracy of recombinant thyroid-stimulating hormone (rTSH)-stimulated 2-(18-fluoride)-flu-2-deoxy-D-glucose ((18)F-FDG) positron emission tomography (PET)-CT in detecting recurrence in patients with differentiated thyroid cancer.
METHODS: Consecutive (18)F-FDG PET-CT scans performed with rTSH stimulation between 2007 and 2010 in patients with a history of papillary or follicular thyroid carcinoma were reviewed. PET-CT findings were correlated with thyroglobulin levels, and histological, clinical and radiological follow-up.
RESULTS: 58 rTSH PET-CT scans were performed in 47 patients with a previous thyroidectomy and radioiodine ablation. The only indication for PET-CT was a raised thyroglobulin level in 46 of 58 scans, with the remainder for characterisation of equivocal radiology or staging. 25 (43%) of PET-CT scans were positive for recurrent disease. Histological correlation was available for 21 (36%) scans. The overall sensitivity, specificity, positive predictive value and negative predictive value were 69%, 76%, 72% and 73%, respectively. Median unstimulated thyroglobulin in true-positive scans was 33 µg l(-1) and 2.2 µg l(-1) in the remainder (p=0.12). 4 of 35 (11%) patients with unstimulated thyroglobulin levels <10 µg l(-1) had true-positive scans. Median stimulated thyroglobulin in true-positive scans was 320 µg l(-1), and 10 µg l(-1) in the remainder (p=0.046), with no positive scans with a stimulated thyroglobulin <8 µg l(-1). PET-CT directly influenced patient management in 17/58 (29%) scans.
CONCLUSION: rTSH PET-CT is a useful imaging technique for detecting disease recurrence in patients with iodine-resistant differentiated thyroid cancer. Low stimulated thyroglobulin levels are potentially useful in identifying patients unlikely to benefit from a PET-CT scan.
R J D Prestwich; S Viner; G Gerrard; C N Patel; A F Scarsbrook
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The British journal of radiology     Volume:  85     ISSN:  1748-880X     ISO Abbreviation:  Br J Radiol     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-09-13     Completed Date:  2012-11-19     Revised Date:  2013-10-09    
Medline Journal Info:
Nlm Unique ID:  0373125     Medline TA:  Br J Radiol     Country:  England    
Other Details:
Languages:  eng     Pagination:  e805-13     Citation Subset:  AIM; IM    
Department of Nuclear Medicine, St James's Institute of Oncology, Leeds, UK.
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MeSH Terms
Adenocarcinoma, Follicular / blood,  radionuclide imaging
Aged, 80 and over
Carcinoma / blood,  radionuclide imaging
Fluorodeoxyglucose F18 / diagnostic use*
Middle Aged
Neoplasm Recurrence, Local / radionuclide imaging*
Positron-Emission Tomography and Computed Tomography / methods*
Radiopharmaceuticals / diagnostic use*
Recombinant Proteins / diagnostic use
Retrospective Studies
Sensitivity and Specificity
Thyroglobulin / blood
Thyroid Neoplasms / blood,  radionuclide imaging*
Thyrotropin Alfa / diagnostic use*
Young Adult
Reg. No./Substance:
0/Radiopharmaceuticals; 0/Recombinant Proteins; 0/Thyrotropin Alfa; 63503-12-8/Fluorodeoxyglucose F18; 9010-34-8/Thyroglobulin

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