Vogel Jonas, Sekler Julia, Gückel Brigitte, Pfannenberg Christina, Nikolaou Konstantin, La Fougère Christian, Dittmann Helmut, Reinert Christian Philipp
Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University Hospital of Tuebingen, Otfried-Mueller-Strasse 14, 72076 Tuebingen, Germany.
Diagnostic and Interventional Radiology, Department of Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany.
Cancers (Basel). 2024 Jan 30;16(3):588. doi: 10.3390/cancers16030588.
To investigate the impact of [F]FDG-PET/CT on the management of differentiated thyroid carcinoma (DTC) in routine clinical settings.
In total, 98 patients (55 females, age 56 ± 18 years) with histologically confirmed thyroid cancer, including all types of DTC and poorly differentiated thyroid cancer (PDTC, n = 7), underwent [F]FDG-PET/CT for staging or recurrence diagnostics performed using a state-of-the art clinical scanner (Biograph mCT, Siemens Healthineers) with a standardized examination protocol. The impact of PET/CT on clinical decision making was prospectively evaluated using standardized questionnaires completed by the referring physicians before and after PET/CT. Patient outcome was analyzed for OS drawn from patient records.
Referring physicians were unable to establish a treatment plan for 81% of patients with thyroid cancer in the absence of PET/CT. The use of PET/CT had a notable influence on patient management, leading to the development of a well-defined treatment plan for 92% of patients. Moreover, after PET/CT a change in pre-PET/CT-intended treatments occurred in 32% of cases, and further invasive diagnostic could be waived in 7% of cases. [F]FDG-PET/CT revealed a tumor detection rate of 68% (local tumor: 19%, lymph node metastases: 40%, distant metastases: 42%). HTg levels, when stimulated via TSH, were considerably higher in patients with metastases detected on PET/CT, compared to those without metastatic findings ( = 0.02). OS was significantly worse in patients with PDTC ( = 0.002) compared to follicular thyroid cancer (FTC) and PTC or even in patients with distant metastases at first diagnosis ( = 0.03).
This prospective registry study confirms that [F]FDG-PET/CT used in a routine clinical setting has a very important impact on the management of patients with thyroid cancer by initiating treatments and reducing the uses of additional imaging and invasive tests.
探讨[F]FDG-PET/CT在常规临床环境中对分化型甲状腺癌（DTC）治疗管理的影响。
总共98例经组织学确诊为甲状腺癌的患者（55例女性，年龄56±18岁），包括所有类型的DTC和低分化甲状腺癌（PDTC，n = 7），使用先进的临床扫描仪（西门子医疗的Biograph mCT）及标准化检查方案进行[F]FDG-PET/CT检查以进行分期或复发诊断。通过转诊医生在PET/CT检查前后填写的标准化问卷对PET/CT对临床决策的影响进行前瞻性评估。从患者记录中分析患者的总生存期（OS）。
在没有PET/CT的情况下，81%的甲状腺癌患者转诊医生无法制定治疗计划。PET/CT的使用对患者管理有显著影响，使92%的患者制定了明确的治疗计划。此外，PET/CT检查后，32%的病例改变了PET/CT检查前预定的治疗方案，7%的病例可避免进一步的侵入性诊断。[F]FDG-PET/CT的肿瘤检出率为68%（局部肿瘤：19%，淋巴结转移：40%，远处转移：42%）。与未发现转移的患者相比，PET/CT发现有转移的患者经促甲状腺激素（TSH）刺激后的甲状腺球蛋白（HTg）水平显著更高（P = 0.02）。与滤泡状甲状腺癌（FTC）和乳头状甲状腺癌（PTC）相比，PDTC患者的总生存期明显更差（P = 0.002），甚至在初次诊断时有远处转移的患者也是如此（P = 0.03）。
这项前瞻性注册研究证实，在常规临床环境中使用的[F]FDG-PET/CT通过启动治疗并减少额外影像学检查和侵入性检查的使用，对甲状腺癌患者的治疗管理具有非常重要的影响。
