不同成像模态在分化型甲状腺癌（WDTC）管理中的作用评估，重点关注氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG PET/CT）

Assessment of the Role of Different Imaging Modalities with Emphasis on Fdg Pet/Ct in the Management of Well Differentiated Thyroid Cancer (WDTC).

作者信息

Kendi A Tuba Karagulle, Mudalegundi Shwetha, Switchenko Jeffrey, Lee Daniel, Halkar Raghuveer, Chen Amy Y

机构信息

Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA.

Winship Scholar Program, Winship Cancer Institute, Emory University, Atlanta, GA, USA.

出版信息

J Thyroid Disord Ther. 2016;5. doi: 10.4172/2167-7948.1000202. Epub 2016 Feb 29.

DOI:10.4172/2167-7948.1000202

PMID:28966886

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5616213/

Abstract

BACKGROUND

Positron emission tomography/computed tomography is suggested to have a role in detection of iodine negative recurrence in well differentiated thyroid cancer. The aim of this study is to identify role of different imaging modalities in the management of well differentiated thyroid cancer.

METHODS

We reviewed 900 well differentiated thyroid cancer patients after post-thyroidectomy who underwent recombinant human thyroid stimulating hormone stimulated Sodium Iodide I 131 imaging. Out of 900 patients, 74 had positron emission tomography/computed tomography. Multivariate analysis was performed by controlling positron emission tomography/computed tomography, Sodium Iodide I 131 scan, neck ultrasonography, age, sex, primary tumor size, stage, histology, thyroglobulin. Patients were grouped according to results of Sodium Iodide I 131 scan and positron emission tomography/computed tomography.

RESULTS

Positron emission tomography/computed tomography was positive in 23 of 74 patients. The sensitivity for positron emission tomography was 11/11(100%), the specificity was 51/63 (81.0%), the positive predictive value was 11/23 (47.8%), and the negative predictive value was 51/51 (100%). The sensitivity for the neck ultrasonography was 4/8 (50%), the specificity was 53/60 (88.3%), positive predictive value was 4/11 (36.4%), and negative predictive value was 53/57 (93.0%). 50% of patients who had Sodium Iodide I 131 negative scan and positive positron emission tomography/computed tomography had a change in management. Thirty-six percent with positive neck ultrasonography had a change in management. Out of 11 recurrences, 6 had distant metastatic disease, and 5/11 had regional nodal disease. Neck ultrasonography showed nodal metastasis in 4/5 (80%).

CONCLUSION

Positron emission tomography/computed tomography altered management in the presence of a high thyroglobulin level and a negative Sodium Iodide I 131 scan. Neck ultrasonography should be the first line of imaging with rising thyroglobulin levels. Positron emission tomography/computed tomography should be considered for cases with high thyroglobulin levels and normal neck ultrasonography to look for distant metastatic disease.

摘要

背景

正电子发射断层扫描/计算机断层扫描被认为在分化型甲状腺癌碘阴性复发的检测中具有一定作用。本研究的目的是确定不同成像方式在分化型甲状腺癌管理中的作用。

方法

我们回顾了900例甲状腺切除术后接受重组人促甲状腺激素刺激的碘化钠I 131显像的分化型甲状腺癌患者。在这900例患者中，74例接受了正电子发射断层扫描/计算机断层扫描。通过控制正电子发射断层扫描/计算机断层扫描、碘化钠I 131扫描、颈部超声、年龄、性别、原发肿瘤大小、分期、组织学、甲状腺球蛋白进行多变量分析。患者根据碘化钠I 131扫描和正电子发射断层扫描/计算机断层扫描的结果进行分组。

结果

74例患者中23例正电子发射断层扫描/计算机断层扫描呈阳性。正电子发射断层扫描的敏感性为11/11（100%），特异性为51/63（81.0%），阳性预测值为11/23（47.8%），阴性预测值为51/51（100%）。颈部超声的敏感性为4/8（50%），特异性为53/60（88.3%），阳性预测值为4/11（36.4%），阴性预测值为53/57（93.0%）。碘化钠I 131扫描阴性而正电子发射断层扫描/计算机断层扫描阳性的患者中有50%的管理方式发生了改变。颈部超声阳性的患者中有36%的管理方式发生了改变。在11例复发患者中，6例有远处转移疾病，5/11例有区域淋巴结疾病。颈部超声显示4/5（80%）有淋巴结转移。