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The author(s) declare that they have no competing interests.
JS participation in conception and design, collected data, carried out statistical analysis and drafted the manuscript. MV participation in conception and design, analysis of data, and revision of the manuscript. NMP collected data and drafted the manuscript. MG participation in conception and design, analysis of data and revision of manuscript. IS analysis of data and drafted the manuscript. JG participation in conception and design, review of analysis and revision of manuscript. WS participation in conception and design, review of analysis and revision of manuscript. OC participation in conception and design, review of analysis and revision of manuscript. QYD participation in conception and design, review of analysis and revision of manuscript. All authors read and approved the final manuscript.
To compare outcomes for patients with recurrent or persistent papillary thyroid cancer (PTC) who had metastatic tumors that were fluorodeoxyglucose-positron emission tomography (FDG-PET) positive or negative, and to determine whether the FDG-PET scan findings changed the outcome of medical and surgical management.
From a prospective thyroid cancer database, we retrospectively identified patients with recurrent or persistent PTC and reviewed data on demographics, initial stage, location and extent of persistent or recurrent disease, clinical management, disease-free survival and outcome. We further identified subsets of patients who had an FDG-PET scan or an FDG-PET/CT scan and whole-body radioactive iodine scans and categorized them by whether they had one or more FDG-PET-avid (PET-positive) lesions or PET-negative lesions. The medical and surgical treatments and outcome of these patients were compared.
Between 1984 and 2008, 41 of 141 patients who had recurrent or persistent PTC underwent FDG-PET (n = 11) or FDG-PET/CT scans (n = 30); 22 patients (54%) had one or more PET-positive lesion(s), 17 (41%) had PET-negative lesions, and two had indeterminate lesions. Most PET-positive lesions were located in the neck (55%). Patients who had a PET-positive lesion had a significantly higher TNM stage (P = 0.01), higher age (P = 0.03), and higher thyroglobulin (P = 0.024). Only patients who had PET-positive lesions died (5/22 vs. 0/17 for PET-negative lesions; P = 0.04). In two of the seven patients who underwent surgical resection of their PET-positive lesions, loco-regional control was obtained without evidence of residual disease.
Patients with recurrent or persistent PTC and FDG-PET-positive lesions have a worse prognosis. In some patients loco-regional control can be obtained without evidence of residual disease by reoperation if the lesion is localized in the neck or mediastinum.
Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Sherman SI, Tuttle RM, American Thyroid Association Guidelines Taskforce: Management guidelines of patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2006, 16: 109-142. 10.1089/thy.2006.16.109. CrossRefPubMed
Rouxel A, Hejblum G, Bernier MO, Boelle PY, Menegaux F, Mansour G, Hoang C, Aurengo A, Leenhardt L: Prognostic factors associated with the survival of patients developing loco-regional recurrences of differentiated thyroid carcinomas. J Clin Endocrinol Metab. 2004, 89: 5362-5368. 10.1210/jc.2003-032004. CrossRefPubMed
Giammarile F, Hafdi Z, Bournaud C, Janier M, Houzard C, Desuzinges C, Itti R, Sassolas G, Borson-Chazot F: Is [18 F]-2-fluoro-2-deoxy-d-glucose (FDG) scintigraphy with non-dedicated positron emission tomography useful in the diagnostic management of suspected metastatic thyroid carcinoma in patients with no detectable radioiodine uptake?. Eur J Endocrinol. 2003, 149: 293-300. 10.1530/eje.0.1490293. CrossRefPubMed
Finkelstein SE, Grigsby PW, Siegel BA, Dehdashti F, Moley JF, Hall BL: Combined [18 F]Fluorodeoxyglucose positron emission tomography and computed tomography (FDG-PET/CT) for detection of recurrent, 131I-negative thyroid cancer. Ann Surg Oncol. 2008, 15: 286-292. 10.1245/s10434-007-9611-5. CrossRefPubMed
Frilling A, Tecklenborg K, Görges R, Weber F, Clausen M, Broelsch EC: Preoperative diagnostic value of [(18)F] fluorodeoxyglucose positron emission tomography in patients with radioiodine-negative recurrent well-differentiated thyroid carcinoma. Ann Surg. 2001, 234: 804-811. 10.1097/00000658-200112000-00012. PubMedCentralCrossRefPubMed
Wang W, Larson SM, Fazzari M, Tickoo SK, Kolbert K, Sgouros G, Yeung H, Macapinlac H, Rosai J, Robbins RJ: Prognostic value of [18 F]fluorodeoxyglucose positron emission tomographic scanning in patients with thyroid cancer. J Clin Endocrinol Metab. 2000, 85: 1107-1113. 10.1210/jc.85.3.1107. PubMed
Helal BO, Merlet P, Toubert ME, Franc B, Schvartz C, Gauthier-Koelesnikov H, Prigent A, Syrota A: Clinical impact of (18)F-FDG PET in thyroid carcinoma patients with elevated thyroglobulin levels and negative (131)I scanning results after therapy. J Nucl Med. 2001, 42: 1464-1469. PubMed
Mirallie E, Guillan T, Bridji B, Resche I, Rousseau C, Ansquer C, Bodet-Milin C, Curtet C, Carnaille B, Murat A, Charbonnel B, Kraeber-Bodere F: Therapeutic impact of 18FDG-PET/CT in the management of iodine-negative recurrence of differentiated thyroid carcinoma. Surgery. 2007, 142: 952-958. 10.1016/j.surg.2007.09.015. CrossRefPubMed
- Fluorodeoxyglucose-positron emission tomography scan-positive recurrent papillary thyroid cancer and the prognosis and implications for surgical management
Jennifer MJ Schreinemakers
Menno R Vriens
Marlon A Guerrero
Inne HM Borel Rinkes
Wen T Shen
Orlo H Clark
- BioMed Central
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