Evaluating Positron Emission Tomography Use in Differentiated Thyroid Cancer
Abstract
Background: Using the Surveillance, Epidemiology, and End Results—Medicare database, a substantial increase was found in the use of positron emission tomography (PET) scans after 2004 in differentiated thyroid cancer (DTC) patients. The reason for the increased utilization of the PET scan was not clear based on available the data. Therefore, the indications for and outcomes of PET scans performed at an academic institution were evaluated.
Methods: A retrospective cohort study was performed of DTC patients who underwent surgery at the University of Michigan Health System from 2006 to 2011. After identifying patients who underwent a PET scan, indications, rate of positive PET scans, and impact on management were evaluated. For positive scans, the location of disease was characterized, and presence of disease on other imaging was determined.
Results: Of the 585 patients in the cohort, 111 (19%) patients had 200 PET scans performed for evaluation of DTC. Indications for PET scan included: elevated thyroglobulin and negative radioiodine scan in 52 scans (26.0%), thyroglobulin antibodies in 13 scans (6.5%), rising thyroglobulin in 18 scans (9.0%), evaluation of abnormality on other imaging in 22 scans (11.0%), evaluation of extent of disease in 33 scans (16.5%), follow-up of previous scan in 57 scans (28.5%), other indications in two scans (1.0%), and unclear indications in three scans (1.5%). The PET scan was positive in 124 studies (62.0%); positivity was identified in the thyroid bed on 25 scans, cervical or mediastinal lymph nodes on 105 scans, lung on 28 scans, bone on four scans, and other areas on 14 scans. Therapy following PET scan was surgery in 66 cases (33.0%), chemotherapy or radiation in 23 cases (11.5%), observation in 110 cases (55.0%), and palliative care in one case (0.5%). Disease was identifiable on other imaging in 66% of cases. PET scan results changed management in 59 cases (29.5%).
Conclusions: In this academic medical center, the PET scan was utilized in 19% of patients. Indications for the PET scan included conventional indications, such as elevated thyroglobulin with noniodine avid disease, and more controversial uses, such as evaluation of extent of disease or abnormalities on other imaging tests. PET scan results changed management in about 30% of cases.
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References
1.
Davies L, Welch HG 2006 Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA 295:2164–2167.
2.
Davies L, Welch HG 2014 Current thyroid cancer trends in the United States. JAMA Otolaryngol Head Neck Surg 140:317–322.
3.
Mazzaferri EL, Jhiang SM 1994 Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med 97:418–428.
4.
Tuttle RM, Tala H, Shah J, Leboeuf R, Ghossein R, Gonen M, Brokhin M, Omry G, Fagin JA, Shaha A 2010 Estimating risk of recurrence in differentiated thyroid cancer after total thyroidectomy and radioactive iodine remnant ablation: using response to therapy variables to modify the initial risk estimates predicted by the new American Thyroid Association staging system. Thyroid 20:1341–1349.
5.
Pacini F, Castagna MG, Brilli L, Pentheroudakis G, Group EGW 2012 Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 23:vii110–119.
6.
American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM 2009 Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214.
7.
Smallridge RC, Diehl N, Bernet V 2014 Practice trends in patients with persistent detectable thyroglobulin and negative diagnostic radioiodine whole body scans: a survey of American Thyroid Association members. Thyroid 24:1501–1507.
8.
Palaniswamy SS, Subramanyam P 2013 Diagnostic utility of PETCT in thyroid malignancies: an update. Ann Nucl Med 27:681–693.
9.
Pomerri F, Cervino AR, Al Bunni F, Evangelista L, Muzzio PC 2014 Therapeutic impact of (18)F-FDG PET/CT in recurrent differentiated thyroid carcinoma. Radiol Med 119:97–102.
10.
Rosenbaum-Krumme SJ, Gorges R, Bockisch A, Binse I 2012 (1)(8)F-FDG PET/CT changes therapy management in high-risk DTC after first radioiodine therapy. Eur J Nucl Med Mol Imaging 39:1373–1380.
11.
Vera P, Kuhn-Lansoy C, Edet-Sanson A, Hapdey S, Modzelewski R, Hitzel A, d'Anjou J, Basuyau JP 2010 Does recombinant human thyrotropin-stimulated positron emission tomography with [18F]fluoro-2-deoxy-D-glucose improve detection of recurrence of well-differentiated thyroid carcinoma in patients with low serum thyroglobulin? Thyroid 20:15–23.
12.
Caetano R, Bastos CR, de Oliveira IA, da Silva RM, Fortes CP, Pepe VL, Reis LG, Braga JU 2014 Accuracy of PET and PET-CT in the detection of differentiated thyroid cancer recurrence with negative I whole body scan results: a meta-analysis. Head Neck 2014 Sep 23 [Epub ahead of print].
13.
Lal G, Fairchild T, Howe JR, Weigel RJ, Sugg SL, Menda Y 2010 PET-CT scans in recurrent or persistent differentiated thyroid cancer: is there added utility beyond conventional imaging? Surgery 148:1082–1089; discussion 1089–1090.
14.
Asa S, Aksoy SY, Vatankulu B, Aliyev A, Uslu L, Ozhan M, Sager S, Halac M, Sonmezoglu K 2014 The role of FDG-PET/CT in differentiated thyroid cancer patients with negative iodine-131 whole-body scan and elevated anti-Tg level. Ann Nucl Med 28:970–979.
15.
Ozkan E, Aras G, Kucuk NO 2013 Correlation of 18F-FDG PET/CT findings with histopathological results in differentiated thyroid cancer patients who have increased thyroglobulin or antithyroglobulin antibody levels and negative 131I whole-body scan results. Clin Nucl Med 38:326–331.
16.
Wiebel JL, Banerjee M, Muenz DG, Worden FP, Haymart MR 2015 Trends in imaging after diagnosis of thyroid cancer. Cancer 121:1387–1394.
17.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG 2009 Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381.
18.
Fritz A, Percy C, Jack A, Shanmurgarathnam K, Sobin L, Parkin DM, Whelan S (Eds) 2000 International Classification of Diseases for Oncology. Third edition. World Health Organization, Geneva, Switzerland.
19.
Greene FL, Page DL, Fleming ID, Fritz A, Balch CM, Haller DG, Morrow M (Eds) 2002 AJCC Cancer Staging Manual. Sixth edition. Springer, New York, NY.
20.
Weber T, Ohlhauser D, Hillenbrand A, Henne-Bruns D, Reske SN, Luster M 2012 Impact of FDG-PET computed tomography for surgery of recurrent or persistent differentiated thyroid carcinoma. Horm Metab Res 44:904–908.
21.
Razfar A, Branstetter BFt, Christopoulos A, Lebeau SO, Hodak SP, Heron DE, Escott EJ, Ferris RL 2010 Clinical usefulness of positron emission tomography-computed tomography in recurrent thyroid carcinoma. Arch Otolaryngol 136:120–125.
22.
Kim MH, O JH, Ko SH, Bae JS, Lim DJ, Kim SH, Baek KH, Lee JM, Kang MI, Cha BY, Lee KW 2012 Role of [(18)F]-fluorodeoxy-D-glucose positron emission tomography and computed tomography in the early detection of persistent/recurrent thyroid carcinoma in intermediate-to-high risk patients following initial radioactive iodine ablation therapy. Thyroid 22:157–164.
23.
Look Hong NJ, Petrella T, Chan K 2014 Cost-effectiveness analysis of staging strategies in patients with regionally metastatic melanoma. J Surg Oncol 111:423–430.
24.
Guttikonda R, Herts BR, Dong F, Baker ME, Fenner KB, Pohlman B 2014 Estimated radiation exposure and cancer risk from CT and PET/CT scans in patients with lymphoma. Eur J Radiol 83:1011–1015.
25.
Jeong HS, Baek CH, Son YI, Choi JY, Kim HJ, Ko YH, Chung JH, Baek HJ 2006 Integrated 18F-FDG PET/CT for the initial evaluation of cervical node level of patients with papillary thyroid carcinoma: comparison with ultrasound and contrast-enhanced CT. Clin Endocrinol 65:402–407.
26.
Ozdemir E, Yildirim Poyraz N, Polat SB, Turkolmez S, Ersoy R, Cakir B 2014 Diagnostic value of 18F-FDG PET/CT in patients with TENIS syndrome: correlation with thyroglobulin levels. Ann Nucl Med 28:241–247.
27.
Vural GU, Akkas BE, Ercakmak N, Basu S, Alavi A 2012 Prognostic significance of FDG PET/CT on the follow-up of patients of differentiated thyroid carcinoma with negative 131I whole-body scan and elevated thyroglobulin levels: correlation with clinical and histopathologic characteristics and long-term follow-up data. Clin Nucl Med 37:953–959.
28.
Petrich T, Borner AR, Otto D, Hofmann M, Knapp WH 2002 Influence of rhTSH on [(18)F]fluorodeoxyglucose uptake by differentiated thyroid carcinoma. Eur J Nucl Med Mol Imaging 29:641–647.
29.
Leboulleux S, Schroeder PR, Busaidy NL, Auperin A, Corone C, Jacene HA, Ewertz ME, Bournaud C, Wahl RL, Sherman SI, Ladenson PW, Schlumberger M 2009 Assessment of the incremental value of recombinant thyrotropin stimulation before 2-[18F]-Fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography imaging to localize residual differentiated thyroid cancer. J Clin Endocrinol Metab 94:1310–1316.
30.
Durante C, Costante G, Filetti S 2013 Differentiated thyroid carcinoma: defining new paradigms for postoperative management. Endocr Relat Cancer 20:R141–154.
31.
Nixon IJ, Ganly I, Patel SG, Palmer FL, Di Lorenzo MM, Grewal RK, Larson SM, Tuttle RM, Shaha A, Shah JP 2013 The results of selective use of radioactive iodine on survival and on recurrence in the management of papillary thyroid cancer, based on Memorial Sloan-Kettering Cancer Center risk group stratification. Thyroid 23:683–694.
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Copyright 2015, Mary Ann Liebert, Inc.
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Published in print: September 2015
Published online: 31 August 2015
Published ahead of print: 3 August 2015
Published ahead of production: 2 July 2015
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