Section "Endocrine Surgery", Division of General Surgery, Department of Surgery, Medical University Vienna, Vienna, Austria.
Department of Anesthesiology, Medical University Vienna, Vienna, Austria.
Ann Surg Oncol. 2018 Dec;25(13):3919-3927. doi: 10.1245/s10434-018-6829-3. Epub 2018 Oct 10.
At the time of diagnosis, one-third of medullary thyroid carcinoma (MTC) patients show lymph node (LN) or distant metastasis. A metastasized MTC requires different surgical strategies.
This study aimed to determine the value of ultrasound and [18F]fluoro-dihydroxyphenylalanine positron emission tomography with computed tomography (F-DOPA-PET-CT) in localizing MTC, as well as LN and distant metastasis.
The study included 50 patients (24 males/26 females) with preoperative ultrasound, F-DOPA-PET-CT, and histologically proven MTC. Imaging results were correlated with both preoperative basal calcitonin (bCt) levels and final histology.
Tumors were classified as pT1a:17 (diameter, mean ± standard deviation: 5.8 ± 3.0 mm), pT1b:15 (15.0 ± 3.2 mm), pT2:9 (27.3 ± 7.0 mm), and pT3:9 (38.3 ± 24.2 mm). The median bCt level was 202 pg/mL (lower/upper quartile: 82/1074 pg/mL). Ultrasound was positive for tumor in 45/50 (92%) patients (20.0 ± 16.0 mm) and negative in 5 patients (3.2 ± 2.2 mm). Overall, 43/50 (86%) patients had positive F-DOPA local scans (20.0 ± 16.4 mm), while 7 (14%) patients were negative (7.7 ± 8.1 mm). Lastly, 21/50 (42%) patients had LN metastasis; 8/21 (38%) patients had positive LNs suspected with ultrasound, and 12/21 (57%) patients had positive LNs suspected with F-DOPA. Tumor and LN sensitivity of ultrasound was 92% and 43%, respectively, and 86% and 57% of F-DOPA-PET-CT, respectively. In 3/50 (6%) patients and 3/50 (6%) patients, mediastinal LN metastasis and distant metastasis, respectively, were diagnosed only by F-DOPA-PET-CT.
Ultrasound and F-DOPA-PET-CT are sensitive for the localization of MTC but not for the presence and location of LN metastasis (limitations: size/number). Only F-DOPA ensures the diagnosis of distant metastasis and influences the extent of LN surgery. Surgical strategy cannot be predicted based on neither ultrasound nor F-DOPA-PET-CT.
在诊断时，1/3 的甲状腺髓样癌（MTC）患者存在淋巴结（LN）或远处转移。转移性 MTC 需要不同的手术策略。
本研究旨在确定超声和[18F]氟代二羟苯丙氨酸正电子发射断层扫描（F-DOPA-PET-CT）在定位 MTC、LN 和远处转移方面的价值。
本研究纳入了 50 例术前接受超声、F-DOPA-PET-CT 检查且组织学证实为 MTC 的患者（男 24 例，女 26 例）。将影像学结果与术前基础降钙素（bCt）水平和最终组织学结果进行相关性分析。
肿瘤分为 pT1a 期 17 例（直径，平均值±标准差：5.8±3.0mm），pT1b 期 15 例（15.0±3.2mm），pT2 期 9 例（27.3±7.0mm），pT3 期 9 例（38.3±24.2mm）。中位 bCt 水平为 202pg/mL（下四分位数/上四分位数：82/1074pg/mL）。50 例患者中，超声检查阳性 45 例（92%）（20.0±16.0mm），阴性 5 例（3.2±2.2mm）。总体而言，43 例（86%）患者的 F-DOPA 局部扫描阳性（20.0±16.4mm），7 例（14%）患者阴性（7.7±8.1mm）。最后，21 例（42%）患者存在淋巴结转移；21 例患者中，8 例（38%）患者的超声检查怀疑存在淋巴结转移，12 例（57%）患者的 F-DOPA 检查怀疑存在淋巴结转移。超声检查的肿瘤和淋巴结敏感度分别为 92%和 43%，F-DOPA-PET-CT 的敏感度分别为 86%和 57%。在 3 例（6%）患者和 3 例（6%）患者中，仅通过 F-DOPA-PET-CT 诊断出纵隔淋巴结转移和远处转移。
超声和 F-DOPA-PET-CT 对 MTC 的定位均敏感，但对淋巴结转移的存在和位置不敏感（局限性：大小/数量）。只有 F-DOPA 可以诊断远处转移并影响淋巴结手术范围。不能仅根据超声或 F-DOPA-PET-CT 来预测手术策略。
