甲状腺髓样癌：超声检查和 F-DOPA-PET-CT 是否影响初始手术策略？
Medullary Thyroid Carcinoma: Do Ultrasonography and F-DOPA-PET-CT Influence the Initial Surgical Strategy?
机构信息
Section "Endocrine Surgery", Division of General Surgery, Department of Surgery, Medical University Vienna, Vienna, Austria.
Department of Anesthesiology, Medical University Vienna, Vienna, Austria.
出版信息
Ann Surg Oncol. 2018 Dec;25(13):3919-3927. doi: 10.1245/s10434-018-6829-3. Epub 2018 Oct 10.
BACKGROUND
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.
OBJECTIVE
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.
METHODS
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.
RESULTS
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.
CONCLUSION
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.
背景
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。
目的
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。
方法
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。
结果
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。
结论
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。
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