Department of Endocrinology, Instituto de Oncología AH Roffo, Ciudad Autónoma de Buenos Aires, Argentina.
Division of Endocrinology, Hospital de Clínicas, University of Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.
Endocrine. 2022 Jun;77(1):143-150. doi: 10.1007/s12020-022-03062-3. Epub 2022 Apr 30.
F-DOPA Positron Emission Tomography/Computed Tomography (F-DOPA PET/CT) is a sensitive functional imaging method (65-75%) for detecting disease localization in medullary thyroid cancer (MTC). We aimed: (i) to assess the clinical usefulness of F-DOPA PET/CT in patients with MTC and elevated calcitonin (Ctn) and CEA levels and, (ii) to evaluate changes in disease management secondary to the findings encountered with this methodology.
Thirty-six patients with MTC and Ctn levels ≥150 pg/ml were prospectively included. Neck ultrasound, chest contrast-enhanced CT, liver magnetic resonance imaging/abdominal three-phase contrast-enhanced CT and bone scintigraphy were carried out up to 6 months before the F DOPA PET/CT.
Seventy eight percent of patients were female and 27% had hereditary MTC. Median Ctn level was 1450 pg/ml [150-56620], median CEA level 413 ng/ml [2.9-7436]. Median Ctn DT was 37.5 months [5.7-240]; median CEA DT was 31.8 [4.9-180]. F-DOPA PET/CT was positive in 33 patients (91.6%); in 18 (56%) uptake was observed in lymph nodes in the neck or mediastinum, in seven cases (22%) distant metastases were diagnosed, and in eight additional patients (24%) both locoregional and distant sites of disease were found. Ctn and CEA levels were higher in patients with ≥3 foci of distant metastases. In 14 patients (38.8%), findings on F-DOPA PET/CT led to changes in management; surgery for locoregional lymph nodes was the most frequent procedure in 8 patients (22%).
F-DOPA PET/CT was useful for the detection of recurrent disease in MTC, providing incremental value over conventional imaging procedures that led to modification in treatment strategies in nearly 40% of patients.
F-DOPA 正电子发射断层扫描/计算机断层扫描（F-DOPA PET/CT）是一种敏感的功能成像方法（65-75%），用于检测甲状腺髓样癌（MTC）中的疾病定位。我们的目的是：（i）评估 F-DOPA PET/CT 在降钙素（Ctn）和癌胚抗原（CEA）水平升高的 MTC 患者中的临床应用价值，（ii）评估该方法发现的疾病管理变化。
前瞻性纳入 36 例 MTC 患者，Ctn 水平≥150pg/ml。在 F-DOPA PET/CT 前 6 个月内进行颈部超声、胸部增强 CT、肝脏磁共振成像/腹部三期增强 CT 和骨闪烁扫描。
78%的患者为女性，27%为遗传性 MTC。中位 Ctn 水平为 1450pg/ml[150-56620]，中位 CEA 水平为 413ng/ml[2.9-7436]。中位 Ctn DT 为 37.5 个月[5.7-240]，中位 CEA DT 为 31.8[4.9-180]。F-DOPA PET/CT 阳性 33 例（91.6%）；18 例（56%）颈部或纵隔淋巴结摄取，7 例（22%）诊断远处转移，另外 8 例（24%）发现局部和远处疾病部位。CEA 水平较高的患者远处转移灶≥3 个。14 例（38.8%）患者的 F-DOPA PET/CT 结果导致治疗方案的改变；8 例（22%）患者进行了局部淋巴结手术。
F-DOPA PET/CT 有助于检测 MTC 的复发性疾病，与常规成像方法相比具有附加价值，近 40%的患者因该方法而改变了治疗策略。
