scholarly journals RADIOISOTOPE DIAGNOSTIC ALGORITHM FOR THE RELAPSE AND METASTASES DETECTION IN THE IODINE-NEGATIVE DIFFERENTIATED THYROID CANCER

2020 ◽  
Vol 25 ◽  
pp. 579-591
Author(s):  
O. Solodyannikova ◽  
◽  
Y. Kmetyuk ◽  
V. Danilenko ◽  
G. Sukach ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Ct Scan ◽  
Surgical Management ◽  
Differentiated Thyroid Cancer ◽  
Whole Body ◽  
Technetium 99M ◽  
99Mtc Pertechnetate ◽  
18Fdg Pet ◽  
Pet Ct ◽  
99Mtc Mibi

Objective. Developing of algorithm for the post-surgical management of patients with iodine-negative metastases of differentiated thyroid cancer (DTC). Materials and methods. The DTC patients with iodine-negative metastases (n = 115) were enrolled in the study. Of them the whole body scintigraphy (WBS) was performed with technetium-99m-hexakis-2-methoxyisobutylisonitrile (99mTc-MIBI) (n = 30), WBS with technetium-99m dimercaptosuccinic acid (99mTc-DMSA) (n = 30), 18FDG PET (n = 30), and computer tomography (CT-scan) (n = 25). Complex 99mTc-pertechnetate scans including the dynamic and static scintigraphy was performed supplementary to 99mTc-MIBI WBS in 10 patients to obtain the angiographic curves from DTC metastatic foci. The non-radioiodine radiopharmaceutical technologies, namely the labeled 99mTc-MIBI, 99mTc-DMSA, 99mTc-pertechnetate, and 18FDG were applied to detect the iodine-negative DTC metastases. Radioisotopic examinations were performed at the dual-head gamma camera (Mediso Medical Imaging Systems Ltd., Hungary) and single photonemission computed tomography (SPECT) scanner «E.CAM» (Siemens, Germany). PET/CT scans were performed on the «Biograph 64 TruePoint» imaging platform (Siemens, Germany) in accordance with the European Association of Nuclear Medicine (EANM) recommendations for the Siemens imaging devices with 3D-mode data acquisition. Results. The conducted research suggested that it is feasible to use the non-radioiodine (99mTc-MIBI and 99mTc-DMSA) radiopharmaceutical technologies to detect the iodine-negative DTC metastases. 18FDG PET is a highly informative technology for the detection of iodine-negative DTC metastases in case of lung involvement in the process. Compare of the non-radioiodine radiopharmaceuticals, CT scan and 18FDG-PET/CT indicated the highest sensitivity of 18FDG PET/CT (p < 0.05). WBS with 99mTc-MIBI and 99mTc-DMSA featured the highest specificity (100 %, p < 0.05). X-ray CT is marked by the significantly lower either sensitivity, specificity, and accuracy rate (p > 0.05). Developing and application of algorithm for the post-surgical management of patients with iodine-negative forms of DTC will allow for the betimes detection of relapses and metastases with administration of adequate surgical, radiation, and targeted treatment. Conclusions. Obtained results offer the opportunity to optimize the post-surgical management of patients with iodine-negative DTC forms using the options of radionuclide diagnostics with non-radioiodine radiopharmaceuticals. The latter are readily available providing the cost-cutting of diagnostic support in these patients. Place of morphological methods of diagnosis is determined and stage of monitoring of patients with the iodine-negative metastases is established. Possibility of the 18FDG-PET tests for the early diagnosis of iodine-negative metastases in DTC for the first time have been studied and substantiated in Ukraine. A comprehensive radiation algorithm for the long-term monitoring of this category of patients will allow the timely detection of recurrences and metastases of DTC and appropriate surgery, radiation and targeted therapy administration. Data obtained as a result of the study allowed to improve the overall and recurrence-free survival rates in the able-bodied DTC patients and reduce the costs of follow-up of patients with iodine-negative forms of DTC. Key words: differentiated thyroid cancer, radioiodine-negative metastases, non-radioiodine radiopharmaceuticals, 18FDG-PET/CT.

scholarly journals Radionuclide monitoring of targeted therapy of iodine-negative differentiated thyroid cancer

2021 ◽  
Vol 29 (1) ◽  
pp. 141-155
Author(s):  
O. I. Solodiannykova ◽  
Ya. V. Kmetyuk ◽  
V. V. Danylenko ◽  
H. H. Sukach
Keyword(s):  
Thyroid Cancer ◽  
Targeted Therapy ◽  
Tyrosine Kinase ◽  
Tyrosine Kinase Inhibitors ◽  
Differentiated Thyroid Cancer ◽  
Kinase Inhibitors ◽  
Whole Body ◽  
Pet Ct ◽  
18F Fdg ◽  
99Mtc Mibi

Background. Current management of treating iodine-negative metastases of differentiated thyroid cancer has its features. In recent years, tyrosine kinase inhibitors (sorafenib, sunitinib) have been registered and indicated to treat refractory forms of differentiated thyroid cancer in Ukraine. However, there were only few studies dealing with cytologic aspects of predicting radioiodine resistance of papillary thyroid cancer, development of radionuclide monitoring and diagnostic algorithm to detect relapses and metastases in patients with iodine-negative forms of differentiated thyroid cancer. At the same time, scientific and clinical aspects of treatment of radioiodineresistant differentiated thyroid cancer in Ukrainian oncology and radiology are barely studied. Thus, the status of treatment and post-therapeutic monitoring of patients with iodine-negative forms of differentiated thyroid cancer, still remains insufficiently studied and requires further scientific and clinical development. Purpose – develop a technique of treatment of iodine-negative metastases of differentiated thyroid cancer. Materials and methods. Thirty-eight patients with iodine-negative metastases of differentiated thyroid cancer were provided with treatment, where in 10 patients the efficiency of treatment was assessed by means of whole body scintigraphy with 99mTc-MIBI, in 10 patients – with 99mTcDMCA. In 10 patients the short-term results of treatment with tyrosine kinase inhibitors were evaluated by PET with 18F-FDG. Eight patients represented a group where the bones were affected and treatment was provided by means of radionuclide or external-beam radiotherapy. The average age of patients varied from 43 to 76, the median was 57.8 + 3.9; out of those: 24 women, 14 men. Pathohistologically, papillary cancer was diagnosed in 31, follicular – in 5, papillary-follicular – in 2. The studies were performed by means of the two-detector gamma camera manufactured by Mediso (Hungary) and the single-photon emission computed tomography (SPECT) E. CAM 180, Siemens (Germany). PET/CT were performed on the Biograph-64-TruePoint-Siemens combined tomograph (Germany), according to the guidelines of the European Association of Nuclear Physicians. Results. Prior to initiating therapy, 10 patients with differentiated thyroid cancer underwent whole body scintigraphy with 99mTc-MIBI and re-examination in three months in order to assess treatment success. After diagnostic examination, the patient was prescribed targeted therapy with Nexavar according to the treatment protocol. Regression of the focus in the lungs was achieved within 70 %. Further monitoring of antitumor treatment success was performed by means of whole body scintigraphy with 99mTc-MIBI. Ten patients, who had PET/CT with 18F-FDG made before treatment, also underwent targeted therapy by means of Nexavar. Diagnostic scanning with 18F-FDG after therapy revealed decreased functional activity of the lesion in the neck, however no decrease in the dimensions of the lesion was observed. Conclusions. Treatment of iodine-negative metastases of differentiated thyroid cancer by means of tyrosine kinase inhibitors was accompanied by a decreasing number of metastatic foci and reducing level of their functional activity. The studies have confirmed the possibility of applying techniques with non-iodine RP (99mTc-MIBI, 99mTc-DMCA) to assess the effectiveness of treatment of iodine-negative metastases of differentiated thyroid cancer . PET/CT with 18F-FDG is a highly informative technique for assessing the effect of tyrosine kinase inhibitors on the functional activity of metastatic foci according to metabolic scans in treatment of iodine-negative metastases of differentiated thyroid cancer. If there are no positive changes after 3–4 courses, external-beam radiotherapy with total radiation dose of 30–50 Gy is indicated, which is capable of reducing the volume of metastatic foci as well as their metabolic activity. The social and economic significance of the obtained findings have made it possible to improve the overall and recurrence-free survival rates in the working population of patients with differentiated thyroid cancer and reduce the cost of following-up patients with iodine-negative forms of differentiated thyroid cancer.

scholarly journals Impact of 18F-FDG PET/CT on Clinical Management of Suspected Radio-Iodine Refractory Differentiated Thyroid Cancer (RAI-R-DTC)

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1430
Author(s):  
Elisa Lodi Rizzini ◽  
Andrea Repaci ◽  
Elena Tabacchi ◽  
Lucia Zanoni ◽  
Valentina Vicennati ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Ct Scan ◽  
Fdg Pet ◽  
Therapeutic Approach ◽  
Differentiated Thyroid Cancer ◽  
Whole Body ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct ◽  
Pet Ct Scan

Background: As reported in the literature, [18F]-fluorodeoxyglucose positron emission tomography/computed tomography ([18F]-FDG PET/CT) provides useful qualitative and semi-quantitative data for the prognosis of advanced differentiated thyroid cancer. Instead, there is a lack of data about the real clinical impact of 18F-FDG PET/CT on the choice of the more effective therapeutic approach for advanced differentiated thyroid cancer (DTC) that starts to lose iodine avidity. The primary aim of this retrospective study was to assess how 18F-FDG PET/CT can guide the choice of the best therapeutic approach to RAI-refractory DTC (RAI-R-DTC) in patients with a doubtful iodine uptake/negative 18F-FDG PET/CT I whole-body scan after several radioactive iodine therapies (RAIT). The secondary aim was to assess the prognostic role of clinical and semi-quantitative metabolic 18F-FDG PET/CT parameters in comparison to published data. Materials and methods: A monocentric retrospective observational study was performed, reviewing the medical records of 53 patients recruited from a database of 208 patients treated at our Institution between 2011 and 2019, with advanced DTC that underwent FDG PET/CT scan for a suspected RAI-R-DTC. Selected patients had to perform a 18F-FDG PET/CT scan after the second RAIT based on a doubtful iodine uptake/negative 131 I whole-body scan and/or persistent elevated thyroglobulin levels. Metabolic response was defined according to positron emission tomography response criteria in solid tumors (PERCIST) guidelines. Standardized uptake value (SUV)max, SUVmean, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were calculated. The association between metabolic features, clinical parameters and progression free survival (PFS) was assessed applying Kruskal–Wallis, chi-square-Pearson correlation tests, and Cox regression analyses when appropriate. Results: Among our sample of 53 patients (mean age 52.0 ± 19.9 years; 31 women and 22 men), 27 (51.0%) presented a positive 18F-FDG PET/CT scan: 16 (59.0%) underwent watchful waiting, 4 (15.0%) received external-beam radiation therapy (EBRT), 4 (15.0%) underwent surgery, 2 (7.4%) received another course of RAI therapy, and 1 underwent surgery + EBRT. PERCIST response was evaluated in 14/27 patients. Median follow-up was 5.8 ± 3.9 years and median PFS was 38.0 ± 21.8 months. At the last follow-up assessment, 14/53 (26.4%) demonstrated disease progression, 13/53 (24.5) persistence of structural disease, 25/53 (47%) persistence of biochemical disease, and 15/53 (28%) had an excellent response. A significant association was found between therapeutic approach, metabolic response, and final disease response evaluation, as well as a linear correlation between MTV and TLG with thyroglobulin level. Conclusions: Our Institutional experience confirmed the role of 18F-FDG PET/CT as a useful guide in the clinical management of RAI-R-DTC and obviated further unnecessary RAIT.

scholarly journals Incremental diagnostic value of [18F]tetrafluoroborate PET-CT compared to [131I]iodine scintigraphy in recurrent differentiated thyroid cancer

2020 ◽  
Vol 47 (11) ◽  
pp. 2639-2646 ◽  
Author(s):  
Matthias Dittmann ◽  
José Manuel Gonzalez Carvalho ◽  
Kambiz Rahbar ◽  
Michael Schäfers ◽  
Michael Claesener ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Fdg Pet ◽  
Differentiated Thyroid Cancer ◽  
Imaging Techniques ◽  
Diagnostic Value ◽  
Whole Body ◽  
Sodium Iodide Symporter ◽  
Cervical Lymph Nodes ◽  
Pet Ct ◽  
Fdg Pet Ct

Abstract Introduction Efficient therapy of recurrent differentiated thyroid cancer (DTC) is dependent on precise molecular imaging techniques targeting the human sodium iodide symporter (hNIS), which is a marker both of thyroid and DTC cells. Various iodine isotopes have been utilized for detecting DTC; however, these come with unfavorable radiation exposure and image quality ([131I]iodine) or limited availability ([124I]iodine). In contrast, [18F]tetrafluoroborate (TFB) is a novel radiolabeled PET substrate of hNIS, results in PET images with high-quality and low radiation doses, and should therefore be suited for imaging of DTC. The aim of the present study was to compare the diagnostic performance of [18F]TFB-PET to the clinical reference standard [131I]iodine scintigraphy in patients with recurrent DTC. Methods Twenty-five patients with recurrent DTC were included in this retrospective analysis. All patients underwent [18F]TFB-PET combined with either CT or MRI due to newly discovered elevated TG levels, antiTG levels, sonographically suspicious cervical lymph nodes, or combinations of these findings. Correlative [131I]iodine whole-body scintigraphy (dxWBS) including SPECT-CT was present for all patients; correlative [18F]FDG-PET-CT was present for 21 patients. Histological verification of [18F]TFB positive findings was available in 4 patients. Results [18F]TFB-PET detected local recurrence or metastases of DTC in significantly more patients than conventional [131I]iodine dxWBS and SPECT-CT (13/25 = 52% vs. 3/25 = 12%, p = 0.002). The diagnosis of 6 patients with cervical lymph node metastases that showed mildly increased FDG metabolism but negative [131I]iodine scintigraphy was changed: [18F]TFB-PET revealed hNIS expression in the metastases, which were therefore reclassified as only partly de-differentiated (histological confirmation present in two patients). Highest sensitivity for detecting recurrent DTC had the combination of [18F]TFB-PET-CT/MRI with [18F]FDG-PET-CT (64%). Conclusion In the present cohort, [18F]TFB-PET shows higher sensitivity and accuracy than [131I]iodine WBS and SPECT-CT in detecting recurrent DTC. The combination of [18F]TFB-PET with [18F]FDG-PET-CT seems a reasonable strategy to characterize DTC tumor manifestations with respect to their differentiation and thereby also individually plan and monitor treatment. Future prospective studies evaluating the potential of [18F]TFB-PET in recurrent DTC are warranted.

The role of FDG-PET/CT in differentiated thyroid cancer patients with negative iodine-131 whole-body scan and elevated anti-Tg level

2014 ◽  
Vol 28 (10) ◽  
pp. 970-979 ◽  
Author(s):  
Sertac Asa ◽  
Sabire Yılmaz Aksoy ◽  
Betül Vatankulu ◽  
Anar Aliyev ◽  
Lebriz Uslu ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Cancer Patients ◽  
Fdg Pet ◽  
Differentiated Thyroid Cancer ◽  
Whole Body ◽  
Whole Body Scan ◽  
Pet Ct ◽  
Iodine 131 ◽  
Fdg Pet Ct

scholarly journals Cost-Effectiveness of The Use of 18fdg-Pet/Ct In The Detection of Recurrent Differentiated Thyroid Cancer

2015 ◽  
Vol 18 (7) ◽  
pp. A859
Author(s):  
AN Biz ◽  
LF Schluckebier ◽  
CR Bastos ◽  
RM Silva ◽  
JU Braga ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Cost Effectiveness ◽  
Differentiated Thyroid Cancer ◽  
18Fdg Pet ◽  
Pet Ct

Diagnostic value and therapeutic impact of 18F-FDG-PET/CT in differentiated thyroid cancer

2013 ◽  
Vol 52 (01) ◽  
pp. 1-6 ◽  
Author(s):  
M. Dietlein ◽  
D. Schmidt ◽  
T. Kuwert ◽  
R. Dorn ◽  
J. Sciuk ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Fdg Pet ◽  
Differentiated Thyroid Cancer ◽  
Tumour Tissue ◽  
Therapeutic Management ◽  
Whole Body ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct ◽  
The Impact

SummaryThe clinical significance of 18F-FDG-PET/CT in the follow-up of patients with differentiated thyroid carcinoma was evaluated and the results were compared with those of 18F-FDGPET, 131I-whole-body scintigraphy including SPECT/CT (WBS) and ultrasound. In addition, it was the aim to investigate the impact of 18F-FDG-PET/CT on the therapeutic management. Patients, methods: 327 patients (209 women, 118 men; mean age 53 ± 18 years) with differentiated thyroid cancer (242 papillary, 75 follicular, 6 mixed, 1 Hürthle cell and 3 poorly differentiated tumours) were analyzed retrospectively at four tertiary referral centres. 289 18F-FDG-PET/CT and 118 18F-FDG-PET studies were performed in these patients between 2007 and 2010. In addition, an overall clinical evaluation was performed, including cytology, histology, thyroglobulin level, ultrasound, WBS, and subsequent clinical course in order to compare the molecular imaging results. Finally, the change in therapeutic management due to findings of 18F-FDG-PET/CT was investigated. Results: The sensitivity of 18F-FDG-PET/CT was 92%, the specificity was 95%. Sensitivity and specificity of 18F-FDG-PET alone were 67% and 93%, respectively. WBS showed a sensitivity of 65% and a specificity of 94%. The corresponding values of ultrasound were 37% and 94%, respectively. The sensitivity of 18F-FDG-PET/CT in the group of patients with a negative WBS (n=194) amounted to 96%. When 18F-FDG-PET/CT and WBS were considered in combination, tumour tissue was missed in only 2 out of 133 patients; when 18F-FDG-PET and WBS were combined, tumour tissue was missed in 1 out of 24 patients. 18F-FDG-PET/CT resulted in management change in 43% (n=57/133) with a decision on surgical approach in 20% (n=27/133). Conclusions: 18F-FDG-PET/CT is superior to 18F-FDG-PET alone in patients with differentiated thyroid cancer and has a direct impact on the therapeutic management of patients with suspected local recurrence or metastases, particularly in those with negative WBS.

[ 18F]-FDG-PET/CT correlates with the response of radiorefractory thyroid cancer to lenvatinib and patients’ survival

2021 ◽  
Author(s):  
Laura Valerio ◽  
Federica Guidoccio ◽  
Carlotta Giani ◽  
Elisa Tardelli ◽  
Giulia Puccini ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Ct Scan ◽  
Fdg Pet ◽  
Metabolic Response ◽  
Whole Body ◽  
Morphological Response ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct ◽  
Pet Ct Scan

Abstract Introduction [18F]-FDG-PET/CT positive metastatic lesions in radioiodine-refractory differentiated thyroid cancer (RAI-R DTC) have a poor prognosis and lenvatinib represents the best therapy. We investigated the role of [ 18F]-FDG-PET/CT in the evaluation of metabolic response and prediction of the outcome of RAI-R DTC patients treated with lenvatinib. Materials and Methods Thirty-three progressive metastatic RAI-R DTC patients treated with lenvatinib were investigated at baseline and during follow-up with biochemical (Tg/TgAb), morphological (whole-body CT scan) and metabolic evaluation ([ 18F]-FDG-PET/CT). Results Nineteen of thirty-three (57.6%) patients showed the greatest metabolic response at the first [ 18F]-FDG-PET/CT scan, performed after 4 weeks of lenvatinib, while 5/33 (15.1%) patients had this response later. Moreover, 66.7% of patients had both a metabolic response at the first [ 18F]-FDG-PET/CT scan and a morphological response at the first CT scan. We observed a correlation between the metabolic response at [ 18F]-FDG-PET/CT scan performed after 4 weeks of treatment and the biochemical response at the same time in 60.6% of patients. The median overall survival (OS) was significantly longer in patients with either a metabolic response at last [ 18F]-FDG-PET/CT (40.00 vs 8.98 months) or a morphological response at last CT scan (37.22 vs 9.53 months) than in those without response. Moreover, the OS was longer in patients with a metabolic response at [ 18F]-FDG-PET/CT performed after 4 weeks of treatment (36.53 vs 11.28 months). Conclusions Our data show that [ 18F]-FDG-PET/CT can early predict the response to lenvatinib and correlates with the OS of RAI-R DTC patients treated with this drug.

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