Nascimento Camila, Borget Isabelle, Al Ghuzlan Abir, Deandreis Désirée, Hartl Dana, Lumbroso Jean, Berdelou Amandine, Lepoutre-Lussey Charlotte, Mirghani Haïtham, Baudin Eric, Schlumberger Martin, Leboulleux Sophie
1 Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy, University Paris Sud , Villejuif, France .
Thyroid. 2015 Apr;25(4):437-44. doi: 10.1089/thy.2014.0320. Epub 2015 Mar 16.
Aggressive histopathologic subtypes of differentiated thyroid cancer (DTC) are fluorodeoxyglucose (FDG)-avid tumors and are at high risk for persistent/recurrent disease. In these patients, fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is performed in cases of suspicion of recurrence based on thyroglobulin (Tg) levels or thyroglobulin antibodies (TgAb). The goals of this study were to evaluate the sensitivity of systematic postoperative FDG-PET/CT and to identify risk factors for abnormal FDG-PET/CT.
Single-center retrospective study of 38 consecutive patients (16 males, 22 females; mean age, 57 years) with aggressive histology DTC, without known persistent disease at the time of postoperative radioactive iodine (RAI) ablation. The most frequent aggressive histologic subtypes were tall cell papillary carcinoma (45%) and poorly differentiated carcinoma (42%).
A total of 86 lesions were found in 20 (53%) patients, distributed in 33 organs. FDG-PET/CT and the postablation whole-body scan (RAI WBS) showed persistent disease in 15 and 12 patients, respectively. FDG-PET/CT was more sensitive than WBS for the detection of individual lesions (69% vs. 59%). Both imaging techniques were complementary with 41% of the lesions detected only by FDG-PET/CT and 31% only by RAI WBS. The only risk factor of abnormal FDG-PET/CT was a stimulated Tg level (Tg/TSH) measured at ablation >10 ng/mL with persistent disease showing FDG uptake in 72% of the patients with a Tg/TSH >10 ng/mL and in 10% of the patients with Tg/TSH ≤10 ng/mL.
Postoperative FDG-PET/CT should be performed routinely in patients with aggressive histology DTC.
分化型甲状腺癌（DTC）的侵袭性组织病理学亚型是氟脱氧葡萄糖（FDG）摄取阳性肿瘤，且存在持续性/复发性疾病的高风险。对于这些患者，基于甲状腺球蛋白（Tg）水平或甲状腺球蛋白抗体（TgAb）怀疑复发时，会进行氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）检查。本研究的目的是评估系统性术后FDG-PET/CT的敏感性，并确定FDG-PET/CT异常的危险因素。
对38例连续性侵袭性组织学DTC患者（16例男性，22例女性；平均年龄57岁）进行单中心回顾性研究，这些患者在术后放射性碘（RAI）消融时无已知的持续性疾病。最常见的侵袭性组织学亚型是高细胞乳头状癌（45%）和低分化癌（42%）。
20例（53%）患者共发现86个病灶，分布于33个器官。FDG-PET/CT和消融后全身扫描（RAI WBS）分别显示15例和12例患者存在持续性疾病。FDG-PET/CT在检测单个病灶方面比WBS更敏感（69%对59%）。两种成像技术具有互补性，41%的病灶仅由FDG-PET/CT检测到，31%仅由RAI WBS检测到。FDG-PET/CT异常的唯一危险因素是消融时测得的刺激Tg水平（Tg/TSH）>10 ng/mL，持续性疾病患者中Tg/TSH>10 ng/mL的患者有72%显示FDG摄取，而Tg/TSH≤10 ng/mL的患者中有10%显示FDG摄取。
侵袭性组织学DTC患者术后应常规进行FDG-PET/CT检查。
