1 Department of Internal Medicine (Division of Endocrinology and Metabolism), The Catholic University of Korea , College of Medicine, Seoul, Korea.
Thyroid. 2013 Nov;23(11):1452-60. doi: 10.1089/thy.2013.0051. Epub 2013 Sep 19.
FDG (2-[(18)F]Fluoro-2-D-deoxyglucose-positron emission tomography (PET)/computed tomography (CT), which can detect a change in glucose metabolism in cancer cells, has been introduced as a diagnostic and prognostic tool in papillary thyroid carcinoma (PTC). However, differences in the clinicopathological and biological characteristics between primary PTCs with FDG uptake and those without FDG uptake are not well established.
A total of 188 patients with PTC who had preoperative PET/CT scans were enrolled to compare the differences of clinicopathological parameters between FDG-avid (F-PTC; n = 150) and non-FDG-avid tumors (FN-PTC; n = 38). Immunohistochemical staining for glucose transporter (GLUT)-1 and hypoxia-inducible factor-1 alpha (HIF-1α) was performed.
FN-PTCs were smaller; had a lower incidence of lymphatic invasion, vascular invasion, multifocality, and central lymph node metastasis; and had a lower maximum standardized uptake value than F-PTCs. After exclusion of high-risk patients for recurrence, FN-PTCs remained smaller (p < 0.001) and had less lymphatic invasion (p = 0.061). Among tumors larger than the spatial resolution of the PET/CT scan, macrocalcification was more frequent in FN-PTC than in F-PTC (p = 0.043). While FN-PTC and F-PTC showed no difference in GLUT-1 expression (50% vs. 75%, p = 0.363), FN-PTC showed lower HIF-1α immunoreactivity than F-PTC (25.0% vs. 75.0%, p = 0.032).
Tumor size and macrocalcification are clinicopathological differences between FN-PTC and F-PTC. Biologically, HIF-1α may be responsible for increased FDG uptake in PTC.
FDG（2-[(18)F]氟-2-脱氧葡萄糖-正电子发射断层扫描（PET）/计算机断层扫描（CT），可检测癌细胞葡萄糖代谢的变化，已作为甲状腺乳头状癌（PTC）的诊断和预后工具。然而，FDG 摄取的原发性 PTC 与无 FDG 摄取的原发性 PTC 的临床病理和生物学特征之间的差异尚未得到充分证实。
共纳入 188 例接受术前 PET/CT 扫描的 PTC 患者，比较 FDG 摄取阳性（F-PTC；n=150）和非 FDG 摄取阳性肿瘤（FN-PTC；n=38）的临床病理参数差异。进行葡萄糖转运蛋白（GLUT）-1 和缺氧诱导因子-1α（HIF-1α）的免疫组织化学染色。
FN-PTC 较小；侵袭性淋巴管、血管侵犯、多灶性和中央淋巴结转移的发生率较低；最大标准化摄取值较低。排除复发高风险患者后，FN-PTC 仍然较小（p＜0.001），侵袭性淋巴管较少（p=0.061）。在 PET/CT 扫描空间分辨率大于肿瘤的情况下，FN-PTC 中微钙化的发生率高于 F-PTC（p=0.043）。FN-PTC 和 F-PTC 的 GLUT-1 表达无差异（50%比 75%，p=0.363），但 FN-PTC 的 HIF-1α免疫反应性低于 F-PTC（25.0%比 75.0%，p=0.032）。
FN-PTC 和 F-PTC 之间的临床病理差异在于肿瘤大小和微钙化。从生物学角度来看，HIF-1α可能是 PTC 中 FDG 摄取增加的原因。
