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Can 18F-FDG-PET/CT be generally recommended in patients with differentiated thyroid carcinoma and elevated thyroglobulin levels but negative I-131 whole body scan?

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Abstract

Background

Exact localization of recurrent iodine-negative thyroid cancer is mandatory, since surgery is the only curative therapy option in patients with iodine-negative tumor tissue. The aim of this study was to evaluate the impact of 18F-FDG-PET/CT as a routine diagnostic tool on clinical management in patients with suspected thyroid cancer recurrence and elevated serum thyroglobulin (Tg) but negative radioiodine whole body scan.

Methods and materials

After total thyroidectomy followed by radioiodine ablation, 30 consecutive patients with differentiated thyroid cancer, elevated serum thyroglobulin levels and negative whole body radioiodine scan underwent 18F-FDG-PET/CT. Results were verified by histology, ultrasound, or clinical follow-up. Diagnostic accuracy was determined for the whole study population and for subgroups with serum thyroglobulin below and above 10 ng/ml, respectively. Impact of PET/CT on clinical management was assessed.

Results

PET/CT identified FDG accumulating lesions in 19 of 30 patients. 17 were true-positive and 2 false-positive. In the true-positive group, 11 of the 17 patients had loco-regional disease, 3 had distant metastases only and 3 patients had both loco-regional and distant metastatic involvement. 18F-FDG-PET/CT was true-negative in 3 patients and false-negative in 8 patients. Overall sensitivity, specificity and accuracy were 68.0, 60.0, and 66.7%, respectively. In the subgroup of patients with serum thyroglobulin above 10 ng/ml (n = 21) the sensitivity, specificity and accuracy were substantially higher with 70.0, 100.0, and 71.4%, respectively. Clinical management was changed for 17 (57%) of 30 patients, guiding to a curative surgical intervention in 9 patients (30%).

Conclusions

18F-FDG-PET/CT enables detection and precise localization of loco-regional recurrence and distant metastases of differentiated thyroid cancer in patients with elevated serum thyroglobulin but negative radioiodine with significant impact on patient management and can therefore be recommended as a routine diagnostic tool.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    Peter Bannas, Michael Groth & Gerhard Adam

  2. Department of Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Thorsten Derlin, Janos Mester & Susanne Klutmann

  3. Department of Nuclear Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany

    Ivayla Apostolova

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  1. Peter Bannas
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  2. Thorsten Derlin
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Correspondence to Peter Bannas.

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Bannas, P., Derlin, T., Groth, M. et al. Can 18F-FDG-PET/CT be generally recommended in patients with differentiated thyroid carcinoma and elevated thyroglobulin levels but negative I-131 whole body scan?. Ann Nucl Med 26, 77–85 (2012). https://doi.org/10.1007/s12149-011-0545-4

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  • DOI: https://doi.org/10.1007/s12149-011-0545-4

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