Eshghi Naghmehossadat, Garland Linda L, Nia Emily, Betancourt Robert, Krupinski Elizabeth, Kuo Phillip H
Department of Medical Imaging, Banner University Medical Center, Tucson, Arizona
Department of Medicine, Section of Hematology and Medical Oncology, Banner University Medical Center, Tucson, Arizona.
J Nucl Med Technol. 2018 Sep;46(3):260-264. doi: 10.2967/jnmt.117.204933. Epub 2018 Mar 29.
Our primary purpose was to determine whether increased F-FDG uptake in the thyroid gland predicts development of thyroiditis with subsequent hypothyroidism in patients undergoing immunotherapy with nivolumab for lung cancer. Secondarily, we determined whether F-FDG uptake in the thyroid gland correlates with number of administered cycles of nivolumab. Retrospective chart review over 2 y found 18 lung cancer patients treated with nivolumab who underwent F-FDG PET/CT before and during therapy. SUV, SUV, and total lesion glycolysis of the thyroid gland were measured. SUVs were also measured for the pituitary gland, liver, and spleen. Patients underwent monthly thyroid testing. PET/CT parameters were analyzed by unpaired testing for differences between 2 groups (patients who developed hypothyroidism and those who did not). Correlation between development of thyroiditis and number of cycles of nivolumab was also tested. Six of 18 patients developed hypothyroidism. The test comparing the 2 groups demonstrated significant differences in SUV ( = 0.04), SUV ( = 0.04), and total lesion glycolysis ( = 0.02) of the thyroid gland. Two of 4 patients who developed thyroiditis and had increased F-FDG uptake in the thyroid gland had a normal TSH level at the time of follow-up F-FDG PET/CT. Patients who developed thyroiditis with subsequent hypothyroidism stayed longer on therapy (10.6 cycles) than patients without thyroiditis (7.6 cycles), but the trend was not statistically significant. No significant difference in PET/CT parameters was observed for pituitary gland, liver, or spleen. F-FDG PET/CT can predict the development of thyroiditis with subsequent hypothyroidism before laboratory testing. Further study is required to confirm the positive trend between thyroiditis and duration of therapy.
我们的主要目的是确定在接受纳武单抗免疫治疗的肺癌患者中，甲状腺摄取¹⁸F - FDG增加是否预示着甲状腺炎的发生及随后的甲状腺功能减退。其次，我们确定甲状腺摄取¹⁸F - FDG是否与纳武单抗的给药周期数相关。对2年期间的病历进行回顾性分析，发现18例接受纳武单抗治疗的肺癌患者在治疗前和治疗期间接受了¹⁸F - FDG PET/CT检查。测量了甲状腺的SUVmax、SUVmean和总病变糖酵解。还测量了垂体、肝脏和脾脏的SUV。患者每月进行甲状腺功能检测。通过非配对检验分析PET/CT参数，以比较两组（发生甲状腺功能减退的患者和未发生甲状腺功能减退的患者）之间的差异。还检测了甲状腺炎的发生与纳武单抗周期数之间的相关性。18例患者中有6例发生了甲状腺功能减退。比较两组的检验显示，甲状腺的SUVmax（P = 0.04）、SUVmean（P = 0.04）和总病变糖酵解（P = 0.02）存在显著差异。4例发生甲状腺炎且甲状腺摄取¹⁸F - FDG增加的患者中，有2例在随访¹⁸F - FDG PET/CT时TSH水平正常。发生甲状腺炎并随后出现甲状腺功能减退的患者接受治疗的时间（10.6个周期）比未发生甲状腺炎的患者（7.6个周期）长，但这一趋势无统计学意义。垂体、肝脏或脾脏的PET/CT参数未观察到显著差异。¹⁸F - FDG PET/CT可在实验室检测之前预测甲状腺炎的发生及随后的甲状腺功能减退。需要进一步研究来证实甲状腺炎与治疗持续时间之间的正向趋势。
