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Combined [18F]Fluorodeoxyglucose Positron Emission Tomography and Computed Tomography (FDG-PET/CT) for Detection of Recurrent, 131I-Negative Thyroid Cancer

  • Endocrine Tumors
  • Original Paper
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Whole-body 131I scintigraphy (WBS) and serial thyroglobulin measurement (Tg) are standard methods for detecting thyroid cancer recurrence after total/near total thyroidectomy and 131I ablation. Some patients develop elevated Tg (Tg-positive) or there is clinical suspicion of recurrence, but WBS are negative (WBS-negative). This may reflect non-iodine-avid recurrence or metastasis. In 2002, the Centers for Medicare and Medicaid Services (CMS) approved positron emission tomography with [18F]fluorodeoxyglucose (FDG-PET) for Tg-positive/WBS-negative patients with follicular-cell-origin thyroid cancer. Limited data are available regarding the performance of combined FDG-PET/computed tomography (FDG-PET/CT) for detecting recurrent thyroid cancer in WBS-neg patients.

Methods

This retrospective review of prospectively collected data analyzed 65 patients who had FDG-PET/CT for suspected thyroid cancer recurrence (April 1998–August 2006). Patients were WBS-negative but were suspected to have recurrence based on Tg levels or clinical grounds. Suspected FDG-PET/CT abnormalities were reported as benign or malignant. Lesions were ultimately declared benign or malignant by surgical pathology or clinical outcome (disease progression).

Results

Of 65 patients who underwent FDG-PET/CT, 47 had positive FDG-PET/CT. Of the positive FDG-PET/CT, 43 studies were true positives, with 21 (49%) confirmed pathologically by surgical resection. The four false positives (3/4 confirmed pathologically) included an infundibular cyst, an inflamed supraclavicular cyst, pneumonitis, and degenerative disc disease. Of the 18 FDG-PET/CT studies that were negative, 17 were true negatives and one was a false negative (metastatic papillary carcinoma). Thus, FDG-PET/CT demonstrated a patient-based sensitivity of 98%, specificity of 81%, positive predictive value of 91%, and negative predictive value of 94%.

Conclusions

FDG-PET/CT is useful for detecting thyroid cancer recurrence in WBS-negative patients, and can assist decision making.

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Ackowledgments

Dr. Hall was supported by the Center for Health Policy, under the auspices of Dr. William Peck, Washington University in St. Louis, St. Louis, MO. The authors declare no conflicts of interest.

Presented at Society of Surgical Oncology (SSO) 60th Annual Cancer Symposium, Washington D.C., March 16, 2007 as an oral presentation.

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Authors and Affiliations

  1. Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Steven E. Finkelstein MD, Jeffrey F. Moley MD & Bruce L. Hall MD, PhD

  2. Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA

    Perry W. Grigsby MD

  3. Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA

    Barry A. Siegel MD & Farrokh Dehdashti MD

  4. Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA

    Perry W. Grigsby MD, Barry A. Siegel MD, Farrokh Dehdashti MD, Jeffrey F. Moley MD & Bruce L. Hall MD, PhD

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  1. Steven E. Finkelstein MD
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  2. Perry W. Grigsby MD
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  3. Barry A. Siegel MD
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  4. Farrokh Dehdashti MD
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  5. Jeffrey F. Moley MD
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  6. Bruce L. Hall MD, PhD
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Correspondence to Bruce L. Hall MD, PhD.

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Finkelstein, S.E., Grigsby, P.W., Siegel, B.A. et al. Combined [18F]Fluorodeoxyglucose Positron Emission Tomography and Computed Tomography (FDG-PET/CT) for Detection of Recurrent, 131I-Negative Thyroid Cancer. Ann Surg Oncol 15, 286–292 (2008). https://doi.org/10.1245/s10434-007-9611-5

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