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Outcome of 18f-Fluorodeoxyglucose Positron Emission Tomography (PET)-Directed Resections in Differentiated Thyroid Carcinoma (DTC): Experience in a Developing Country

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Abstract

The aim of this study was to assess the accuracy of 18F-fluorodeoxyglucose positron emission tomography (18-FDG-PET scan) in localizing the disease in differentiated thyroid carcinoma patients undergoing re-operations. This is a retrospective analysis of a prospectively maintained data (December 2007 to December 2016). The patients included had elevated serum thyroglobulin (Tg) levels and negative iodine uptake (TENIS) and planned for re-operation with one or more accessible site of metastasis detected on FDG-PET scan. Clinical details, FDG-PET/CT findings, operative findings, histology, pre-, and post-operative Tg levels were recorded. Thirty-two patients were included. The mean age of the patients was 46.8 ± 15.8 years (M:F = 1:1.6) and mean pre-operative Tg value was 247.6 ± 92.3 ng/ml. FDG-PET disclosed a total of 77 hot spots in these 32 patients, 56 of which were surgically explored and resections performed. Patient- and lesion-based positive predictive value (PPV) of FDG-PET in detecting recurrent/metastatic DTC lesions was 87.5 and 71%, respectively. Remaining cases had granulomatous or nonspecific inflammatory lesions. A total of 12.5% of recurrent DTC patients explored could achieve biochemical cure. All these had disease confined to neck. Remaining patients continued to have high serum Tg level, though it fell substantially in majority of patients. False positive scans are frequent in regions with high prevalence of inflammatory diseases. Hence, FDG-PET directed re-operations should be taken up judiciously.

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Abbreviations

PTC:

Papillary thyroid carcinoma

FTC:

Follicular thyroid carcinoma

PDTC:

Poorly differentiated thyroid carcinoma

CC:

Central compartment

RL:

Right lateral compartment

LL:

Left lateral compartment

ML:

Mediastinal lymph nodes

RB:

Right breast

RA:

Right axilla

LA:

Left axilla

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Authors and Affiliations

  1. Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India

    Chandan Kumar Jha, Anjali Mishra, Gaurav Agarwal, Gyan Chand, Amit Agarwal & Saroj Kanta Mishra

  2. Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

    Prasanta Kumar Pradhan & Sanjay Gambhir

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  1. Chandan Kumar Jha
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  7. Amit Agarwal
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  8. Saroj Kanta Mishra
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Contributions

Chandan Kumar Jha, Anjali Mishra - literature search, figures, study, design, data collection, data analysis, data interpretation, writing.

Prasanta Kumar Pradhan, Sanjay Gambhir, Gaurav Agarwal, Gyan Chand, Amit Agarwal, Saroj Kanta Mishra - revision and editing of manuscript.

Corresponding author

Correspondence to Anjali Mishra.

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The authors declare that they have no conflict of interest.

Ethical Approval

This retrospective study does not involve any experiment on human participation. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed written consent was obtained from the patient.

This is to declare that all authors have contributed to the study. No part of the manuscript has been sent for consideration elsewhere or published in any International or National journal.

The authors clearly certify that there is no aspect of plagiarism. In case of any dispute, the authors will be held fully responsible for the statement disclosed in the cover letter. The authors are also aware of the copyright rules and also declare that they will not reproduce any published text without due permission from the journal.

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Jha, C.K., Mishra, A., Pradhan, P.K. et al. Outcome of 18f-Fluorodeoxyglucose Positron Emission Tomography (PET)-Directed Resections in Differentiated Thyroid Carcinoma (DTC): Experience in a Developing Country. Indian J Surg Oncol 13, 23–27 (2022). https://doi.org/10.1007/s13193-020-01087-6

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