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Postsurgical diagnostic evaluation of patients with differentiated thyroid carcinoma: comparison of ultrasound, iodine-131 scintigraphy and PET with fluorine-18 fluorodeoxyglucose

Valutazione diagnostica post-chirurgica di pazienti con carcinoma tiroideo differenziato: confronto tra ecografia, scintigrafia con iodio-131 e PET con fluoro-18 fluorodesossiglucosio

  • Head and Neck Radiology Radiologia Del Capo e Del Collo
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An Erratum/Erratum to this article was published on 19 November 2009

Abstract

Purpose

The aim of this study was to compare the results of ultrasound (US), whole-body scintigraphy with iodine-131 (I-131 WBS) and positron emission tomography with fluorine-18 deoxyglucose (FDG-PET) in the follow-up of patients after thyroidectomy for differentiated thyroid carcinoma (DTC).

Materials and methods

Thirteen patients (3 men, 10 women) were evaluated by neck US, I-131 WBS and FDG-PET. In each patient six anatomical regions (right and left thyroid bed, right and left cervical region, right and left supraclavicular region) were investigated, for a total of 78 regions. Distant metastases were investigated by I-131 WBS and FDG-PET and considered separately in the analysis. Imaging findings were compared with the reference standards, such as fine-needle aspiration cytology (2), biopsy (4) or clinical-radiological studies (7).

Results

US, FDG-PET and I-131 WBS showed concordant negative results in most (70, 90%) of the anatomical sites considered. In one patient with left cervical lymph node metastasis, the imaging techniques showed concordant positive results (1%). In the remaining 7 regions (9%), the imaging results were discordant; in particular, tumour lesions, nodal metastases (4) and thyroid bed recurrences (3) were detected by US only (3), by US and I-131 WBS (1) and by FDG-PET only (3). With regard to distant metastases, FDG-PET and I-131 WBS yielded concordant negative results in the majority (77%) of patients (9); in one patient only were the two imaging techniques concordant in their positive result. In the last three patients, the results were discordant; in particular, distant metastases were detected by I-131 WBS only in two patients and by FDG-PET only in one patient.

Conclusions

Our work indicates a fundamental role for US in evaluation of the neck after surgery for DTC. WBS is useful to determine differentiation of tumour lesions, to identify thyroid remnants and to look for distant metastases. FDG-PET has an important role in cases of dedifferentiated thyroid carcinoma in which WBS and thyroglobulin measurements are unable to detect tumour lesions.

Riassunto

Obiettivo

Scopo dello studio è stato quello di confrontare i risultati ecografici, della scintigrafia “total-body” con I-131 (TB I-131) e della PET con fluorodesossiglucosio (FDG-PET) in un gruppo di pazienti con carcinoma tiroideo differenziato (CDT) sottoposti a terapia chirurgica.

Materiali e metodi

Tredici pazienti (3M, 10F) sono stati studiati con esame ecografico del collo (ECO), TB I-131 e FDG-PET. In ogni paziente sono state valutate 6 regioni anatomiche (loggia tiroidea destra e sinistra, regione latero-cervicale destra e sinistra, regione sovra-claveare destra e sinistra) per un totale di 78 regioni; le lesioni “a distanza” (LAD) sono state considerate come un ulteriore gruppo dell’analisi valutato in base al risultato della TB I-131 e della FDG-PET; i risultati sono stati confrontati con gli standard di riferimento quali dati citologici (n=2), istologici (n=4) o clinico-strumentali (n=7).

Risultati

L’ECO, la FDG-PET e il TB I-131 hanno mostrato una concordanza dei risultati in termini di negatività nella maggioranza (n=70; 90%) delle regioni anatomiche valutate; in un solo caso con metastasi linfonodali in regione latero-cervicale sinistra i risultati sono stati concordanti in termini di positività (1%). Nelle restanti 7 (9%) regioni, il risultato delle tre metodiche è stato discordante; in particolare, le lesioni tumorali, metastasi linfonodali (n=4) e ripresa di malattia in loggia tiroidea (n=3), sono state evidenziate dalla sola ECO (n=3), dall’ECO e dalla TB I-131 (n=1), esclusivamente dalla PET (n=3). Per le LAD, i risultati della FDG-PET e del TB I-131 sono stati concordanti nella maggioranza dei pazienti prevalentemente in termini di negatività (n=9); in un solo paziente è stata osservata concordanza dei risultati in termini di positività; nei restanti tre pazienti il risultato delle due tecniche è stato discordante; in particolare, in due pazienti solo l’esame TB I-131 ha mostrato le LAD, mentre in un paziente unicamente la FDG-PET dimostrava un reperto patologico.

Conclusioni

I risultati del nostro studio dimostrano un ruolo fondamentale dell’ECO per la valutazione delle diverse regioni anatomiche del collo in pazienti affetti da CDT durante il follow-up post-chirurgico allo scopo di identificare le lesioni tumorali loco-regionali; l’esame TB I-131, con dose terapeutica, resta altrettanto importante per la caratterizzazione della differenziazione tessutale delle lesioni, per la corretta valutazione e quantizzazione del residuo ghiandolare e per l’eventuale identificazione di LAD in pazienti con tumori differenziati. La FDG-PET mostra un suo ruolo in particolare nei casi di CDT che, nel corso del follow-up, sono andati incontro ad un processo di sdifferenziazione di eventuali lesioni recidivanti e, come tali, non diagnosticabili dal dosaggio della Tg e dal TB I-131.

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Authors and Affiliations

  1. Dipartimento di Scienze Biomorfologiche e Funzionali (DSBMF), Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini (IBB), Consiglio Nazionale delle Ricerche (CNR), Napoli, Italy

    O. Caleo, S. Maurea, M. Klain, B. Salvatore, G. Storto, M. Mancini, L. Pace & M. Salvatore

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  1. O. Caleo
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  2. S. Maurea
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  3. M. Klain
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  7. L. Pace
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Correspondence to O. Caleo.

Additional information

An erratum to this article can be found online at http://dx.doi.org/10.1007/s11547-009-0499-y.

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Caleo, O., Maurea, S., Klain, M. et al. Postsurgical diagnostic evaluation of patients with differentiated thyroid carcinoma: comparison of ultrasound, iodine-131 scintigraphy and PET with fluorine-18 fluorodeoxyglucose. Radiol med 113, 278–288 (2008). https://doi.org/10.1007/s11547-008-0243-z

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