Conti P S, Durski J M, Bacqai F, Grafton S T, Singer P A
Department of Radiology, University of Southern California, Los Angeles.
Thyroid. 1999 Aug;9(8):797-804. doi: 10.1089/thy.1999.9.797.
Serum thyroglobulin and imaging have been routinely used in the evaluation of thyroid cancer patients suspected of having metastatic or recurrent disease. A more sensitive technique capable of identifying the sites of disease not detected by current imaging methods might improve overall management. The objective in this study was to demonstrate the feasibility of using positron emission tomography (PET) for the detection of recurrent thyroid cancer. Thirty patients with a history of either papillary/follicular or medullary thyroid cancer suspected of having locally recurrent or metastatic cancer on the basis of elevated or rising blood markers were evaluated with PET. Imaging studies were performed with the radiotracer [F-18] fluorodeoxyglucose (FDG). A retrospective review of other imaging results was performed and compared to the PET results. PET was able to identify locally recurrent or metastatic papillary/follicular disease in all 24 patients studied with elevated or rising thyroglobulin. Similar results were obtained in 6 patients with medullary cancer recurrences in the presence of elevated calcitonin. In cases where follow-up data was obtainable (17/24 papillary/follicular cancers and 4/6 medullary cancers), disease was confirmed either directly by surgery and/or indirectly through changes or persistence of laboratory findings. The results support the hypothesis that in the presence of elevated blood markers indicative of recurrent thyroid cancer, PET may prove valuable as an adjunctive imaging test for identifying disease and influencing management in cases where conventional imaging fails to detect suspected disease.
血清甲状腺球蛋白检测和影像学检查已常规用于评估疑似患有转移性或复发性疾病的甲状腺癌患者。一种更敏感的技术，能够识别当前影像学方法未检测到的疾病部位，可能会改善整体治疗。本研究的目的是证明使用正电子发射断层扫描（PET）检测复发性甲状腺癌的可行性。对30例有乳头状/滤泡状或髓样甲状腺癌病史、基于血液标志物升高或上升而疑似患有局部复发或转移性癌的患者进行了PET评估。使用放射性示踪剂[F-18]氟脱氧葡萄糖（FDG）进行影像学检查。对其他影像学结果进行回顾性分析并与PET结果进行比较。PET能够在所有24例甲状腺球蛋白升高或上升的研究患者中识别出局部复发或转移性乳头状/滤泡状疾病。在6例降钙素升高的髓样癌复发患者中也获得了类似结果。在可获得随访数据的病例中（24例乳头状/滤泡状癌中的17例和6例髓样癌中的4例），疾病通过手术直接确认和/或通过实验室检查结果的变化或持续间接确认。结果支持以下假设：在存在提示复发性甲状腺癌的血液标志物升高的情况下，PET作为一种辅助影像学检查，在传统影像学未能检测到疑似疾病时，对于识别疾病和影响治疗可能具有价值。
