Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seocho-Gu, Seoul, Korea.
Thyroid. 2012 Feb;22(2):157-64. doi: 10.1089/thy.2011.0177. Epub 2012 Jan 6.
Positron emission tomography/computed tomography (PET/CT) scan has a role in the surveillance of patients with a history of thyroid carcinoma. Its efficacy after remnant ablation as far as detecting persistent or recurrent thyroid carcinoma before other surveillance methods is not known, however. In intermediate-to-high risk thyroid carcinoma patients we studied whether PET/CT scan, performed 6-12 months after the first remnant ablation, could provide more information than ultrasonography (US) and thyrotropin-stimulated serum thyroglobulin (Tg) determination with diagnostic whole-body scan (DxWBS).
We studied 71 subjects with differentiated thyroid cancer (DTC) who were intermediate-to-high risk for persistent/recurrent disease and who had received PET/CT scan, US, and DxWBS simultaneously with stimulated Tg levels 6-12 months after remnant ablation. To evaluate the diagnostic efficacy of PET/CT scan, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were calculated.
Ten subjects (14%) had persistent/recurrent disease detected 6-12 months after remnant ablation. Persistence/recurrence was detected in nine (12.7%) of these patients by conventional methods, including US and DxWBS, along with stimulated Tg levels. The remaining case was detected solely by a PET/CT scan, which showed a mediastinal prevascular lesion; this was confirmed by a therapeutic WBS after additional radioiodine therapy. Among the six patients whose PET/CT scan showed positive results, five had persistent/recurrent disease. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of PET/CT scan for detecting persistent/recurrent thyroid carcinoma were 50%, 98.4%, 83.3%, 92.3%, and 91.5%, respectively.
In intermediate-to-high risk patients with DTC seen 6-12 months after their first remnant ablation, there is almost no complementary role for adding a PET/CT scan to conventional follow-up methods, an US and a DxWBS simultaneously with stimulated Tg levels.
正电子发射断层扫描/计算机断层扫描（PET/CT）在监测甲状腺癌病史患者方面具有一定作用。然而，在其他监测方法之前，其在残余物消融后检测持续性或复发性甲状腺癌的效果尚不清楚。在中高危甲状腺癌患者中，我们研究了在首次残余物消融后 6-12 个月进行 PET/CT 扫描是否能比超声（US）和促甲状腺素刺激的血清甲状腺球蛋白（Tg）测定与诊断性全身扫描（DxWBS）提供更多信息。
我们研究了 71 例中高危甲状腺癌（DTC）患者，这些患者患有持续性/复发性疾病，且在残余物消融后 6-12 个月接受了同时进行的 PET/CT 扫描、US 和 DxWBS 以及刺激 Tg 水平。为了评估 PET/CT 扫描的诊断效能，计算了灵敏度、特异性、阳性预测值、阴性预测值和诊断准确性。
10 例（14%）患者在残余物消融后 6-12 个月发现持续性/复发性疾病。在这 9 例患者（12.7%）中，包括 US 和 DxWBS 以及刺激 Tg 水平，常规方法检测到了持续性/复发性疾病。而其余病例仅通过 PET/CT 扫描发现，该扫描显示了纵隔前血管病变；在进行额外的放射性碘治疗后，通过治疗性 WBS 得到了证实。在 6 例 PET/CT 扫描结果阳性的患者中，有 5 例存在持续性/复发性疾病。PET/CT 扫描检测持续性/复发性甲状腺癌的灵敏度、特异性、阳性预测值、阴性预测值和诊断准确性分别为 50%、98.4%、83.3%、92.3%和 91.5%。
在首次残余物消融后 6-12 个月的中高危 DTC 患者中，添加 PET/CT 扫描至常规随访方法（同时进行 US 和 DxWBS 以及刺激 Tg 水平）几乎没有互补作用。
