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Oh SW, Park S, Chong A, Kim K, Bang JI, Seo Y, Hong CM, Lee SW. Nuclear Medicine Imaging in Differentiated Thyroid Cancer: Summary of the Korean Thyroid Association Guidelines 2024 from Nuclear Medicine Perspective, Part-I. Nucl Med Mol Imaging 2025; 59:1-7. [PMID: 39881973 PMCID: PMC11772645 DOI: 10.1007/s13139-024-00885-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Revised: 09/25/2024] [Accepted: 09/26/2024] [Indexed: 01/31/2025] Open
Abstract
Thyroid cancer, one of the most common endocrine tumors, generally has a favorable prognosis but remains a significant medical and societal concern due to its high incidence. Early diagnosis and treatment of differentiated thyroid cancer (DTC) significantly affect long-term outcomes, requiring the selection and application of appropriate initial treatments to improve prognosis and quality of life. Recent advances in technology and health information systems have enhanced our understanding of the molecular genetics of thyroid cancer, facilitating the identification of aggressive subgroups and enabling the accumulation of research on risk factors through big data. The Korean Thyroid Association (KTA) has revised the "KTA Guidelines on the Management of Differentiated Thyroid Cancers 2024" to incorporate these advances, which were developed by a multidisciplinary team and underwent extensive review and approval processes by various academic societies. This article summarizes the 2024 KTA guidelines for nuclear medicine imaging in patients with DTC, written by the Nuclear Medicine members of the KTA Guideline Committee, and covers 18F-FDG PET/CT and radioiodine imaging with SPECT/CT in the management of DTC.
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Affiliation(s)
- So Won Oh
- Department of Nuclear Medicine, Seoul National University Boramae Medical Center , Seoul, Republic of Korea
| | - Sohyun Park
- Department of Nuclear Medicine, National Cancer Center, Goyang, Republic of Korea
| | - Ari Chong
- Department of Nuclear Medicine, Chosun University Hospital, Gwangju, Republic of Korea
| | - Keunyoung Kim
- Department of Nuclear Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Ji-In Bang
- Department of Nuclear Medicine, CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - Youngduk Seo
- Department of Nuclear Medicine, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Chae Moon Hong
- Department of Nuclear Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Sang-Woo Lee
- Department of Nuclear Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
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He Z, Sa R, Zhang K, Wang J, Qiu X, Chen L. Optimizing the indication of initial radioiodine oncolytic treatment for metastatic differentiated thyroid cancer by diagnostic 131I scan. Clin Radiol 2024; 79:e949-e956. [PMID: 38641445 DOI: 10.1016/j.crad.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/27/2024] [Accepted: 03/25/2024] [Indexed: 04/21/2024]
Abstract
AIM As a classic theranostic radiopharmaceutical, radioiodine (131I) has been utilized in the management of differentiated thyroid cancer (DTC) for more than 8 decades, and the refinement of its clinical practice has been raised recently. This study was conducted to evaluate the efficiency of a diagnostic (Dx) 131I scan in optimizing the indication of initial radioiodine oncolytic treatment (ROT) for metastatic DTC by predicting therapeutic outcomes. RESULTS A total of 100 patients (Dx positive, n=29; Dx negative, n=71) were eligible for patient-based analysis. The matching rate was 83.0% between the Dx and the post-therapeutic scans (kappa = 0.648, P<0.001). The biochemical remission rate and structural shrinkage rate induced by the initial ROT in the Dx-positive group were, respectively, greater than those in the Dx-negative group (83.3% vs. 17.4%, P<0.001; 37.9% vs. 4.2%, P<0.001). Notably, the predictive values of positive Dx scans for ROT responsiveness and negative Dx scans for ROT nonresponsiveness reached up to 89.7% and 84.5%, respectively. CONCLUSION This Dx scan approach seems viable in characterizing the 131I-avidity of metastatic DTC and plays a pivotal role in optimizing the indication of initial ROT for metastatic DTC.
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Affiliation(s)
- Z He
- Department of Nuclear Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600(#) Yishan Rd, Shanghai 200233, People's Republic of China.
| | - R Sa
- Department of Nuclear Medicine, The First Hospital of Jilin University, 1(#) Xinmin St, Changchun 130021, People's Republic of China.
| | - K Zhang
- Department of Nuclear Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600(#) Yishan Rd, Shanghai 200233, People's Republic of China.
| | - J Wang
- Department of Nuclear Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600(#) Yishan Rd, Shanghai 200233, People's Republic of China.
| | - X Qiu
- Department of Nuclear Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600(#) Yishan Rd, Shanghai 200233, People's Republic of China.
| | - L Chen
- Department of Nuclear Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600(#) Yishan Rd, Shanghai 200233, People's Republic of China.
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Edamadaka Y, Parghane RV, Basu S. Unusual Metastatic Sites and Radioiodine Uptake in Patients of Differentiated Thyroid Carcinoma with Atypical Clinical Presentations: Utilization of 131 I-Whole-Body Scintigraphy with Regional SPECT/CT. World J Nucl Med 2024; 23:130-134. [PMID: 38933072 PMCID: PMC11199032 DOI: 10.1055/s-0044-1779750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024] Open
Abstract
Differentiated thyroid carcinoma (DTC) usually is slow growing and carries a good prognosis. It most commonly tends to spread locally to regional lymph nodes in 20 to 60% of patients. The presence of distant metastasis impacts overall survival and prognosis. The lungs, bones, and the brain are typically involved in distant sites with less common metastatic sites that include the liver, kidney, skeletal muscle, adrenal glands, bladder, and skin. These unusual sites are rare and pose a diagnostic challenge and impact clinical decision-making to a great extent. The radioiodine 131 I whole-body scintigraphy with single-photon emission computed tomography/computed tomography can provide a thorough investigation of unusual sites of uptake leading to diagnosis of these metastases. We present a case series of DTC showing unusual sites of metastasis and/or radioiodine uptake in urinary bladder, in the third metacarpal bone of left hand and lastly in the forearm at postoperative hypertrophic scar area.
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Affiliation(s)
- Yeshwanth Edamadaka
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Jerbai Wadia Road, Parel, Mumbai, Maharashtra, India
- Radiation medicine center (BARC), Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Rahul V. Parghane
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Jerbai Wadia Road, Parel, Mumbai, Maharashtra, India
- Radiation medicine center (BARC), Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sandip Basu
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Jerbai Wadia Road, Parel, Mumbai, Maharashtra, India
- Radiation medicine center (BARC), Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Chong A, Seo Y, Bang JI, Park S, Kim K, Hong CM, Choi M, Oh SW, Lee SW. Clinical Implications of Adding SPECT/CT to Radioiodine Whole-Body Scan in Patients With Differentiated Thyroid Cancer: A Systematic Review and Meta-analysis. Clin Nucl Med 2024; 49:215-225. [PMID: 38048517 DOI: 10.1097/rlu.0000000000004953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
PURPOSE This study aimed to determine the usefulness of adding SPECT/CT to radioiodine whole-body scans (WBSs) for the treatment of differentiated thyroid cancer (DTC). PATIENTS AND METHODS A systematic review and meta-analysis were performed following the PRISMA guidelines (PROSPERO registration: CRD42022341732) to compare the feasibility of conclusive readings and the frequency of changes in treatment plans in patients with DTC undergoing WBS + SPECT/CT versus WBS. MEDLINE, EMBASE, and Cochrane databases were searched to identify relevant articles concerning thyroid cancer, radioactive iodine, and SPECT/CT or SPECT, published before August 16, 2023. Studies not comparing WBS + SPECT/CT with WBS, those lacking target outcomes, and those not involving human subjects were excluded. The risk of bias was assessed using the RoBANS 2.0 (Risk of Bias Assessment Tool for Nonrandomized Studies) tool. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system was used to evaluate the quality of evidence and strength of recommendations. RESULTS A total of 30 studies (prospective n = 9, retrospective n = 21) were included in the meta-analyses. Adding SPECT/CT to WBS was shown to increase conclusive readings for cervical lesions, extracervical lesions, and all regions. Lesion-based analyses showed improvements of 14%, 20%, and 18%, respectively, whereas scan-based analyses showed improvements of 27%, 9%, and 34%. The addition of SPECT/CT to WBS led to changes in 30% of treatment plans after diagnostic scans and 9% of treatment plans after posttherapeutic scans. The quality of evidence and strength of recommendations were low. CONCLUSIONS Compelling evidence demonstrates that the addition of SPECT/CT to WBS improves lesion localization, diagnostic performance, and therapy plan for patients with DTC.
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Affiliation(s)
- Ari Chong
- From the Department of Nuclear Medicine, Chosun University, College of Medicine and Chosun University Hospital, Gwangju
| | - Youngduk Seo
- Department of Nuclear Medicine, Chungnam National University Sejong Hospital, Sejong
| | - Ji-In Bang
- Department of Nuclear Medicine, CHA Bundang Medical Center, CHA University, Pocheon
| | - Sohyun Park
- Department of Nuclear Medicine, Hospital, National Cancer Center, Goyang
| | - Keunyoung Kim
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital and School of Medicine, Pusan National University, Busan
| | - Chae Moon Hong
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu
| | - Miyoung Choi
- Division of Health Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency
| | - So Won Oh
- Department of Nuclear Medicine, Seoul National University Boramae Medical Center, Seoul
| | - Sang-Woo Lee
- Department of Nuclear Medicine, Kyungpook National University, School of Medicine and Chilgok Hospital, Daegu, South Korea
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Chen Y, Sa R, Qiu X, Chen L. Second radioiodine treatment hardly benefits TT-DTC patients with radioiodine-negative metastases on initial post-therapeutic whole-body scans. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2023; 67:294-303. [PMID: 37526527 DOI: 10.23736/s1824-4785.23.03518-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
BACKGROUND The effect of second 131I treatment (RT) in totally thyroidectomized differentiated thyroid cancer (TT-DTC) patients with true-positive thyroid beds and false-negative metastasis (TB+/M-) on initial post-therapeutic whole-body scan (Rx-WBS) remains unknown. METHODS TT-DTC patients with TB+/M- on initial Rx-WBS receiving and not receiving second RT were categorized into group A and group B, respectively, while patients with 131I-avid metastasis receiving second RT were referred to as group C. Biochemical remission (BR) was defined as a decrease of ≥25.0% in thyrotropin-suppressed thyroglobulin (Tgon) level, while the structural response (SR) was determined by the change in the size of the largest lesion. RESULTS In total, 145 patients were eligible. In group A, the median Tgon measured 3.3 ng/mL before and 3.0 ng/mL at 4 months after second RT (P=0.307), yielding a decrease in the median Tgon (∆Tgon%) of 13.3%, a BR rate of 36%, and an insignificant SR, which were comparable to those in group B. In group C, however, a median ∆Tgon% of 37.8% and a BR rate of 64% were obtained, which were significantly higher than those in group A (P=0.038 and 0.022, respectively), with SR distributions similar to those in group A. In addition, 131I uptake in the neck was not statistically associated with the detection of metastasis on initial Rx-WBS. CONCLUSIONS This controlled study demonstrated a subtle response to second RT in TT-DTC patients with TB+/M- on initial Rx-WBS, representing a meaningful advancement in avoiding ineffective repeated RT.
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Affiliation(s)
- Yun Chen
- Department of Nuclear Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Ri Sa
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Department of Nuclear Medicine, The First Hospital of Jilin University, Changchun, China
| | - Xian Qiu
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Libo Chen
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China -
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Abdelhamed HM, Mohammed AE, Fattahalla MS, Askar H. Additive value of 18FDG-PET/CT to positive 131I whole body scan in recurrent differentiated thyroid cancer patients with potential influence on treatment strategy: single Egyptian center experience. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-021-00692-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Years ago the utility of of18F-fluorodeoxyglucose-positron emission tomography/computerized tomography (18FDG-PET/CT) in differentiated thyroid cancer was confined mainly to cases with elevated serum thyroglobulin and negative 131I whole body scan. In this study, we try to assess the diagnostic performance of 18FDG-PET/CT in recurrent differentiated thyroid cancer patients with positive 131I whole body scan and in addition to evaluate the impact of 18FDG-PET/CT on the treatment strategy.
Results
The 18FDG PET/CT detected tumor recurrence in 35 (81.3%) patients most of them (91.4%) were in stage IV, while the rest 8.5% was in stage III. No recurrence was detected among patients in stage II and III by 18FDG PET/CT.
Regarding lesion-based analysis, sensitivity of 18FDG-PET/CT was superior to that of 131I post-therapeutic whole body scan (TxWBS) (78.2% vs. 69.4%, respectively), while both modalities had the same specificity (50%). 18FDG-PET/CT changed the treatment plan in 18 (41.6%) patients.
Conclusion
18FDG-PET/CT may be complementary to 131ITxWBS in high-risk DTC with impact on treatment strategy.
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Qiu X, Wang P, Sa R, Cheng L, Jin Y, Song H, Chen L. Diagnosis and Treatment of Acute Pleural Effusion following Radioiodine Remnant Ablation Post Lobectomy for Thyroid Cancer. Diagnostics (Basel) 2022; 12:diagnostics12122982. [PMID: 36552989 PMCID: PMC9777309 DOI: 10.3390/diagnostics12122982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/15/2022] [Accepted: 11/21/2022] [Indexed: 11/30/2022] Open
Abstract
Radioiodine remnant ablation (RRA) was previously demonstrated to be a safe and effective alternative to completion thyroidectomy for patients with differentiated thyroid cancer (DTC). However, its side effects have not been fully investigated, particularly in patients with lobectomy. We reported a young euthyroidal female who underwent RRA post lobectomy and lymph node dissection for papillary thyroid cancer, whose post-ablation 131I-whole-body scan accidentally showed diffuse radioiodine distribution on chest-mimicking pulmonary metastases. Immediately-added single-photon emission computed tomography/computed tomography (SPECT/CT), nevertheless, revealed a 131I-accumulating swollen left thyroid lobe and emerging pleural effusion, which relieved after short-term treatment with prednisone. In summary, acute pleural effusion ascribed to RRA-induced thoracic duct compression was reported for the first time. 131I-lobectomy-induced pleural effusion could be precisely diagnosed by SPECT/CT and efficiently manipulated via treating radiation thyroiditis with the short-term administration of corticosteroid.
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Affiliation(s)
- Xian Qiu
- Department of Nuclear Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai 200233, China
| | - Pengwen Wang
- Department of Thyroid Surgery, Panshi Hospital, 1 Kangfu Road, Panshi 132300, China
| | - Ri Sa
- Department of Nuclear Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai 200233, China
- Department of Nuclear Medicine, The First Hospital of Jilin University, 71 Xinmin St., Changchun 130021, China
| | - Lin Cheng
- Department of Nuclear Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai 200233, China
| | - Yuchen Jin
- Department of Nuclear Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai 200233, China
| | - Hongjun Song
- Department of Nuclear Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai 200233, China
| | - Libo Chen
- Department of Nuclear Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai 200233, China
- Correspondence: ; Tel.: +86-21-24058871; Fax: +86-21-64941720
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Marongiu A, Nuvoli S, De Vito A, Rondini M, Spanu A, Madeddu G. A Comparative Follow-Up Study of Patients with Papillary Thyroid Carcinoma Associated or Not with Graves' Disease. Diagnostics (Basel) 2022; 12:diagnostics12112801. [PMID: 36428861 PMCID: PMC9689017 DOI: 10.3390/diagnostics12112801] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Abstract
Whether papillary carcinoma (PC) behavior is more aggressive in Graves’ disease (GD) patients than PC cases without GD is controversial. We retrospectively enrolled 33 thyroidectomized PC/GD patients during long-term follow-up, 23/33 without risk factors at surgery, and 18/33 microcarcinomas; 312 PC euthyroid-matched patients without risk factors served as controls. A total of 14/33 (42.4%) PC/GD patients, 4 with and 10 without risk factors at diagnosis, 6 with microcarcinoma, underwent metastases during follow-up. In controls, metastases in 21/312 (6.7%) were ascertained. Considering 10/23 PC/GD patients and 21/312 controls without risk factors who developed metastases, univariate analysis showed that there was an increased risk of metastasis appearance for PC/GD cases (p < 0.001). Disease-free survival (DFS) was significantly (p < 0.0001, log-rank test) shorter in PC/GD patients than in controls. Significantly more elevated aggressiveness in 6/18 PC/GD patients with microcarcinoma than in controls was also ascertained with shorter DFS. Thus, in the present study, PC/GD had aggressive behavior during follow-up also when carcinoma characteristics were favorable and some cases were microcarcinomas. GD and non-GD patient comparison in the cases without risk factors at diagnosis showed an increased risk to develop metastases in GD during follow-up, suggesting that GD alone might be a tumor aggressiveness predictive factor in these cases.
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Affiliation(s)
- Andrea Marongiu
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Susanna Nuvoli
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Andrea De Vito
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Maria Rondini
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Angela Spanu
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
- Correspondence:
| | - Giuseppe Madeddu
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
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Sun P, Zhan J, Chong TH, Li J, Wang C. Endoscopic central lymph node dissection of thyroid cancer via chest-breast approach: results, indications, and strategies. Surg Endosc 2022; 36:4239-4247. [PMID: 35169879 DOI: 10.1007/s00464-021-08758-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/27/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Surgery for thyroid cancer via endoscopic approach was still controversial. Herein, we report the indications, strategies for operative techniques, as well as results for endoscopic central lymph node dissection of thyroid cancer via chest-breast approach (ETCB-CLND). METHODS A retrospective analysis was conducted on the cases of DTC, whom underwent ETCB-CLND from January 2013 to June 2020. Three hundred and twenty-three cases underwent ETCB-CLND (endoscopic group) and 267 cases underwent open surgery (open group). General characteristic, surgical results, thyroglobulin (Tg), radioactive iodine uptake (RAIU), radioactive technetium uptake (RATU), radionuclide imaging of the thyroid residual area (RITRA), and radionuclide imaging of suspicious lymph nodes metastasis (RISLNM) were analyzed and compared between the two groups. RESULTS The age of the endoscopic group were lower than that of the open group. The operation time of lobectomy in endoscopic group were longer than that in open group. The gender distribution (P = 0.831), operation time of total thyroidectomy (P = 0.311), intraoperative blood loss (P = 0.672), postoperative hospital stay (P = 0.852), tumor size (P = 0.259), number of cases of lymph node metastasis (P = 0.618), number of dissected lymph nodes (P = 0.681), number of metastatic lymph nodes (P = 0.723), and complications (P = 0.749) did not differ significantly between groups, nor did the surgical range (P = 0.661), Tg at 1 month (P = 0.61) and 1 year (P = 0.67) after surgery, before (P = 0.589) and after (P = 0.593) radioiodine therapy, RAIU-2 h/24 h (P = 0.906/0.582), RATU (P = 0.532), (99mTc 15 min:P = 0.503; 131I 24 h:P = 0.377; 131I 3d:P = 0.919), RISLNM (none: P = 0.887; central: P = 0.630; lateral: P = 0.659). CONCLUSION The rational and normative application of the endoscopic technique in central lymph node dissection of DTC is safe, feasible, and consistent with the principle of radical tumor cure for selected cases by well-trained surgeons.
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Affiliation(s)
- Peng Sun
- Department of Thyroid Surgery, Jinan University First Affiliated Hospital, No. 613 Huangpu Road West, Guangzhou, Guangdong, People's Republic of China.
| | - Jialin Zhan
- Department of Dermatology and STD, Jinan University First Affiliated Hospital, Guangzhou, China
| | - Tsz Hong Chong
- Department of Thyroid Surgery, Jinan University First Affiliated Hospital, No. 613 Huangpu Road West, Guangzhou, Guangdong, People's Republic of China
| | - Jinyi Li
- Department of Thyroid Surgery, Jinan University First Affiliated Hospital, No. 613 Huangpu Road West, Guangzhou, Guangdong, People's Republic of China.
| | - Cunchuan Wang
- Department of General Surgery, Jinan University First Affiliated Hospital, Guangzhou, China
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Elisei R, Agate L, Mazzarri S, Bottici V, Guidoccio F, Molinaro E, Boni G, Ferdeghini M, Mariani G. Radionuclide Therapy of Thyroid Tumors. NUCLEAR ONCOLOGY 2022:1381-1429. [DOI: 10.1007/978-3-031-05494-5_49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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Gamma camera imaging in differentiated thyroid cancer. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00195-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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A progress review on methods for in vivo measurement of 131I in thyroids by using portable gamma spectrometers. RADIATION MEDICINE AND PROTECTION 2021. [DOI: 10.1016/j.radmp.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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Alkhybari EM, Albeshan SM, Alanazi BM, Alqahtani DM, Abokhater HK, Albakhiti SH, Ghanem IE. The diagnostic incremental value of 131I SPECT-CT scan compared to planar 131I WBS for differentiated thyroid carcinoma: A single institutional experience. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2021. [DOI: 10.1080/16878507.2021.1994241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Essam M. Alkhybari
- Faculty of Applied Medical Sciences, Department of Radiology and Medical Imaging, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Salman M. Albeshan
- Department of Radiological Sciences, King Saud University, College of Applied Medica Sciences, Saudi Arabia
| | - Bander M. Alanazi
- Ministry of health, King Khalid Hospital, Radiology department, Hail Health Cluster, Saudi Arabia
| | - Dalal M. Alqahtani
- Ministry of health, Ad Diriah Hospital, Radiology Department, Riyadh, Saudi Arabia
| | - Hala K. Abokhater
- Ministry of health, King Fahad Medical City, Nuclear Medicine Department, Riyadh, Saudi Arabia
| | - Sundus H. Albakhiti
- Nuclear Medicine department, Dallah Private Hospital, Radiology Department, Riyadh, Saudi Arabia
| | - Intidhar E. Ghanem
- Ministry of health, King Fahad Medical City, Nuclear Medicine Department, Riyadh, Saudi Arabia
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Wang C, Zhang R, Wang R, Meng Z, Zhang G, Dong F, He Y, Tan J. Predictive Value of Thyroglobulin Changes for the Curative Effect of Radioiodine Therapy in Patients With Metastatic Differentiated Thyroid Carcinoma. Front Endocrinol (Lausanne) 2021; 12:667544. [PMID: 34040584 PMCID: PMC8142149 DOI: 10.3389/fendo.2021.667544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/14/2021] [Indexed: 02/03/2023] Open
Abstract
Background Serum thyroglobulin (Tg) serves as a sensitive and easily available tumor marker for patients with metastatic differentiated thyroid carcinoma (m-DTC). The aim of the present study was to evaluate the predictive value of suppressed Tg changes (Δsup-Tg) and/or stimulated Tg changes (Δsti-Tg) to evaluate the efficacy of radioiodine therapy (RT). Methods We studied 117 patients with m-DTC who received RT. Δsup-Tg and Δsti-Tg were compared after the first RT in different therapeutic response groups and a receiver-operating characteristic (ROC) curve was used to determine the cut-off values to predict non-remission. Univariate and multivariate analyses were used to investigate the effects of 17 observed factors on the efficacy of RT. Results A total of 218 RT events in 117 patients with m-DTC were analyzed. After the last RT, the remission rate was 70.94% (83/117), and the proportion of remission events accounted for 74.77% (163/218). ROC curve analysis showed that the cut-off values for Δsup-Tg and Δsti-Tg after the first RT to predict the non-remission of RT were 21.54% and 27.63%, respectively. Age, the size of the metastasis, the maximum count of target metastatic lesions and the average count of contralateral non-target tissue on tomographic imaging (Tmax/NTmean) of the first RT, and Δsup-Tg after the first RT were identified as independent factors associated with RT efficacy. Conclusions Tg response was valuable to predict RT efficacy for patients with m-DTC. Age, the size of the metastasis, Tmax/NTmean, and Δsup-Tg after the first RT were verified as independent predictive factors of RT efficacy.
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Affiliation(s)
| | | | - Renfei Wang
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
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15
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Lu YL, Chen ST, Ho TY, Chan WH, Wong RJ, Hsueh C, Lin SF. Primary lung cancer with radioiodine avidity: A thyroid cancer cohort study. World J Clin Cases 2021; 9:71-80. [PMID: 33511173 PMCID: PMC7809679 DOI: 10.12998/wjcc.v9.i1.71] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/30/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A proportion of lung cancers show sodium/iodide symporter (NIS) expression. Lung cancers with NIS expression may uptake radioiodine (RAI) and show RAI-avid lesions on RAI scan for differentiated thyroid cancer (DTC) surveillance.
AIM To investigate the possibility of RAI uptake by lung cancer in a cohort with thyroid cancer.
METHODS RAI-avid lung cancers were analyzed using a prospectively maintained database of patients with thyroid cancer who were registered at a medical center between December 1, 1976 and May 28, 2018. NIS expression in lung cancer was assessed using immunohistochemical staining.
RESULTS Of the 5000 patients with thyroid cancer from the studied dataset, 4602 had DTC. During follow-up, 33 patients developed primary lung cancer. Of these patients, nine received an iodine-131 (131I) scan within 1 year before the diagnosis of lung cancer. One of these nine lung cancers was RAI-avid. NIS expression was evaluated, and three of the eight available lung cancers revealed NIS expression. The proportions of lung cancer cells with NIS expression were 60%, 15%, and 10%. The RAI-avid lung cancer had the highest level of expression (60%). The RAI-avid lung cancer had a spiculated border upon single-photon emission computed tomography/computed tomography, which led to an accurate diagnosis.
CONCLUSION A proportion of lung cancer demonstrates NIS expression and is RAI-avid. Clinicians should be aware of this possibility in the interpretation of RAI scintigraphy.
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Affiliation(s)
- Yu-Ling Lu
- Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City 236, Taiwan
- Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Szu-Tah Chen
- Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Tsung-Ying Ho
- Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Wen-Hui Chan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- Institute for Radiological Research, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Richard J Wong
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, United States
| | - Chuen Hsueh
- Department of Pathology, Chang-Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Shu-Fu Lin
- Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City 236, Taiwan
- Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
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16
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Donohoe KJ, Aloff J, Avram AM, Bennet KG, Giovanella L, Greenspan B, Gulec S, Hassan A, Kloos RT, Solórzano CC, Stack BC, Tulchinsky M, Tuttle RM, Van Nostrand D, Wexler JA. Appropriate Use Criteria for Nuclear Medicine in the Evaluation and Treatment of Differentiated Thyroid Cancer. J Nucl Med 2020; 61:375-396. [PMID: 32123131 DOI: 10.2967/jnumed.119.240945] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 12/12/2019] [Indexed: 12/22/2022] Open
Affiliation(s)
- Kevin J Donohoe
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | | | - Anca M Avram
- American College of Nuclear Medicine, Reston, Virginia
| | - K G Bennet
- American College of Nuclear Medicine, Reston, Virginia
| | | | | | - Seza Gulec
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | - Aamna Hassan
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | | | | | | | - Mark Tulchinsky
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
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17
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Cheng L, Sa R, Luo Q, Fu H, Jin Y, Tang L, Yang Y, Yu C, Chen L. Unexplained Hyperthyroglobulinemia in Differentiated Thyroid Cancer Patients as an Indication for Radioiodine Adjuvant Therapy: A Prospective Multicenter Study. J Nucl Med 2020; 62:62-68. [PMID: 32358095 DOI: 10.2967/jnumed.120.243642] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/09/2020] [Indexed: 11/16/2022] Open
Abstract
The management for totally thyroidectomized differentiated thyroid cancer (TT-DTC) patients with unexplained hyperthyroglobulinemia remains indeterminate because of evidence scarcity. This multicenter study aimed at prospectively evaluating the response to radioiodine (131I) adjuvant therapy (RAT) and its potential role in risk stratification and causal clarification. Methods: TT-DTC patients with stimulated serum thyroglobulin levels greater than 10 ng/mL but no structurally evident disease were consecutively enrolled in 5 tertiary-care institutions. After the administration of 5.55 GBq of 131I, the risk of persistent, recurrent, or metastatic differentiated thyroid cancer (prmDTC) was compared with that before RAT. The causes of hyperthyroglobulinemia were explored-and the response to RAT assessed-6-12 mo after RAT. The change in suppressed thyroglobulin level was reported. Results: A cohort of 254 subjects with a median stimulated thyroglobulin level of 27.1 ng/mL was enrolled for the analyses. Immediately after RAT, low, intermediate, and high risk were identified in 5.9%, 88.6%, and 5.5% patients, respectively, with no significant difference in risk stratification compared with that before RAT (P = 0.952). During the follow-up (median, 10.6 mo), hyperthyroglobulinemia was ultimately attributed to a thyroid remnant, biochemical disease, and structural or functional disease in 17.3%, 54.3%, and 28.4% of subjects, respectively. In addition, responses that were excellent, indeterminate, biochemically incomplete, and structurally or functionally incomplete were achieved in 18.1%, 27.2%, 36.2%, and 18.5% of patients, respectively. Notably, the distribution for either cause of hyperthyroglobulinemia or response to RAT was comparable among the 3 postoperative risk groups. Suppressed thyroglobulin levels in patients who merely received RAT declined significantly over time. Conclusion: Our study demonstrated that over 90% of TT-DTC patients with unexplained hyperthyroglobulinemia are stratified as being at intermediate to high risk, and RAT using 5.55 GBq of 131I reveals biochemical, functional, or structural disease and yields a non-structurally or -functionally incomplete response in more than 80% patients, suggesting that TT-DTC patients with unexplained hyperthyroglobulinemia are explicit candidates for RAT.
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Affiliation(s)
- Lin Cheng
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Ri Sa
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Qiong Luo
- Department of Nuclear Medicine, Tenth People's Hospital of Tongji University, Shanghai, China
| | - Hao Fu
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yuchen Jin
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Linglin Tang
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yi Yang
- Department of Nuclear Medicine, Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, China; and
| | - Chunjing Yu
- Department of Nuclear Medicine, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Libo Chen
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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18
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Neck lymph node metastasis detection in patients with differentiated thyroid carcinoma (DTC) in long-term follow-up: a 131I-SPECT/CT study. BMC Cancer 2020; 20:239. [PMID: 32197595 PMCID: PMC7083046 DOI: 10.1186/s12885-020-06744-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 03/12/2020] [Indexed: 11/30/2022] Open
Abstract
Background The identification of neck lymph node (LN) metastases represents a very important issue in the management of patients with differentiated thyroid carcinoma (DTC). To this purpose, in the present study, we used 131I-SPECT/CT as a diagnostic imaging procedure. Methods A consecutive series of 224 DTC patients with ascertained neck radioiodine-avid foci at 131I-SPECT/CT during long-term follow-up was evaluated. All patients had already undergone total thyroidectomy and radioiodine therapy and had been classified as follows: 62 at high risk (H), 64 at low risk (L) and 98 at very low risk (VL). 131I-Whole body scan (WBS) followed by SPECT/CT was performed in all cases. Results In the 224 patients, 449 neck iodine avid foci were ascertained at SPECT/CT, while 322 were evidenced at WBS in 165/224 patients. WBS classified as residues 263/322 foci and as unclear 59/322 foci; among the former foci SPECT/CT correctly characterized 8 LN metastases and 3 physiologic uptakes and among the latter, it pinpointed 26 LN metastases, 18 residues, and 15 physiologic uptakes. SPECT/CT also classified 127 foci occult at WBS as 59 LN metastases and 68 residues. Globally, SPECT/CT identified 93 LN metastases in 59 patients (26 H, 20 L, 13 VL), while WBS evidenced 34 in 25 cases. All 13 VL patients, T1aN0M0, 5 of whom with LN near sub-mandibular glands, had thyroglobulin undetectable or < 2.5 ng/ml. Globally, SPECT/CT obtained an incremental value than WBS in 45.5% of patients, a more correct patient classification changing therapeutic approach in 30.3% of cases and identified WBS false-positive findings in 8% of cases. Conclusions 131I-SPECT/CT proved to correctly detect and characterize neck LN metastases in DTC patients in long-term follow-up, improving the performance of planar WBS. SPECT/CT routine use is thus suggested; its role is particularly relevant in patients with WBS inconclusive, VL, T1aN0M0 and with undetectable or very low thyroglobulin levels.
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Sa R, Cheng L, Jin Y, Fu H, Shen Y, Chen L. Distinguishing Patients With Distant Metastatic Differentiated Thyroid Cancer Who Biochemically Benefit From Next Radioiodine Treatment. Front Endocrinol (Lausanne) 2020; 11:587315. [PMID: 33304320 PMCID: PMC7701118 DOI: 10.3389/fendo.2020.587315] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 10/21/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Repeated radioiodine (131I) treatment (RT) are commonly performed in patients with 131I-avid distant metastatic differentiated thyroid cancer (DM-DTC), but more precise indications remain indeterminate. This prospective study was conducted to explore predictors for biochemical response (BR) to next RT. METHODS Totally thyroidectomized patients with 131I-avid DM-DTC demonstrated by initial post-therapeutic whole body scan (Rx-WBS) were consecutively recruited. Repeated RTs were performed at a fixed dose and a fixed interval, which was terminated once a decline in thyroid stimulating hormone-suppressed thyroglobulin (Tgon) could not be achieved or Rx-WBS was negative. BR was evaluated by change rate of Tgon level (ΔTgon%). RESULTS After exclusion of 27 ineligible courses, a total of 166 neighboring course pairs from 77 patients were established and utilized. Univariate and multivariate analyses showed that the maximum target/background ratio (T/Bmax) on the whole body scan and ΔTgon% derived from the former RT were independently associated to the latter one. In predicting biochemical remission, the positive predictive value (PPV) and negative predictive value (NPV) of T/Bmax at the cut-off value of 8.1 were 79.1% and 84.0%, respectively; whereas the PPV and NPV of ΔTgon% at the cut-off value of 25.3% were 70.8% and 77.1%, respectively. Notably, the PPV of combined T/Bmax ≥ 8.1 and ΔTgon% ≥ 25.3% increased to 87.7%; while the NPV of T/Bmax ≥ 8.1 or ΔTgon% ≥ 25.3% reached as high as 97.7%. CONCLUSIONS This study revealed that combined use of the latest RT-derived T/Bmax and ΔTgon% may efficiently identify biochemical responders/non-responders to next RT, warranting management optimization of patients with 131I-avid DM-DTC.
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Affiliation(s)
- Ri Sa
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- Department of Nuclear Medicine, The First Hospital of Jilin University, Changchun, China
| | - Lin Cheng
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Yuchen Jin
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Hao Fu
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Yan Shen
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Yan Shen, ; Libo Chen,
| | - Libo Chen
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- *Correspondence: Yan Shen, ; Libo Chen,
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20
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Xiao T, Li D, Shi X, Shen M. PAMAM Dendrimer‐Based Nanodevices for Nuclear Medicine Applications. Macromol Biosci 2019; 20:e1900282. [DOI: 10.1002/mabi.201900282] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/03/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Tingting Xiao
- Key Laboratory of Science & Technology of Eco‐TextileMinistry of EducationCollege of ChemistryChemical Engineering and BiotechnologyDonghua University Shanghai 201620 P. R. China
| | - Du Li
- Key Laboratory of Science & Technology of Eco‐TextileMinistry of EducationCollege of ChemistryChemical Engineering and BiotechnologyDonghua University Shanghai 201620 P. R. China
| | - Xiangyang Shi
- Key Laboratory of Science & Technology of Eco‐TextileMinistry of EducationCollege of ChemistryChemical Engineering and BiotechnologyDonghua University Shanghai 201620 P. R. China
| | - Mingwu Shen
- Key Laboratory of Science & Technology of Eco‐TextileMinistry of EducationCollege of ChemistryChemical Engineering and BiotechnologyDonghua University Shanghai 201620 P. R. China
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21
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Israel O, Pellet O, Biassoni L, De Palma D, Estrada-Lobato E, Gnanasegaran G, Kuwert T, la Fougère C, Mariani G, Massalha S, Paez D, Giammarile F. Two decades of SPECT/CT - the coming of age of a technology: An updated review of literature evidence. Eur J Nucl Med Mol Imaging 2019; 46:1990-2012. [PMID: 31273437 PMCID: PMC6667427 DOI: 10.1007/s00259-019-04404-6] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/14/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE Single-photon emission computed tomography (SPECT) combined with computed tomography (CT) was introduced as a hybrid SPECT/CT imaging modality two decades ago. The main advantage of SPECT/CT is the increased specificity achieved through a more precise localization and characterization of functional findings. The improved diagnostic accuracy is also associated with greater diagnostic confidence and better inter-specialty communication. METHODS This review presents a critical assessment of the relevant literature published so far on the role of SPECT/CT in a variety of clinical conditions. It also includes an update on the established evidence demonstrating both the advantages and limitations of this modality. CONCLUSIONS For the majority of applications, SPECT/CT should be a routine imaging technique, fully integrated into the clinical decision-making process, including oncology, endocrinology, orthopaedics, paediatrics, and cardiology. Large-scale prospective studies are lacking, however, on the use of SPECT/CT in certain clinical domains such as neurology and lung disorders. The review also presents data on the complementary role of SPECT/CT with other imaging modalities and a comparative analysis, where available.
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Affiliation(s)
- Ora Israel
- Rappaport School of Medicine, Israel Institute of Technology, Haifa, Israel.
| | - O Pellet
- Nuclear Medicine and Diagnostic Imaging Section International Atomic Energy Agency, Vienna, Austria
| | - L Biassoni
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - D De Palma
- Nuclear Medicine Unit, Circolo Hospital, ASST-Settelaghi, Varese, Italy
| | - E Estrada-Lobato
- Nuclear Medicine and Diagnostic Imaging Section International Atomic Energy Agency, Vienna, Austria
| | - G Gnanasegaran
- Department of Nuclear Medicine, Royal Free NHS Foundation Trust, London, UK
| | - T Kuwert
- Clinic of Nuclear Medicine, University Hospital, Erlangen, Germany
| | - C la Fougère
- Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University Hospital, Tubingen, Germany
| | - G Mariani
- Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy
| | - S Massalha
- Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada
- Department of Nuclear Medicine, Rambam Healthcare Campus, Haifa, Israel
| | - D Paez
- Nuclear Medicine and Diagnostic Imaging Section International Atomic Energy Agency, Vienna, Austria
| | - F Giammarile
- Nuclear Medicine and Diagnostic Imaging Section International Atomic Energy Agency, Vienna, Austria
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22
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Liu H, Wang X, Yang R, Zeng W, Peng D, Li J, Wang H. Recent Development of Nuclear Molecular Imaging in Thyroid Cancer. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2149532. [PMID: 29951528 PMCID: PMC5987314 DOI: 10.1155/2018/2149532] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 03/25/2018] [Accepted: 04/02/2018] [Indexed: 12/21/2022]
Abstract
Therapies targeting specific tumor pathways are easy to enter the clinic. To monitor molecular changes, cellular processes, and tumor microenvironment, molecular imaging is becoming the key technology for personalized medicine because of its high efficacy and low side effects. Thyroid cancer is the most common endocrine malignancy, and its theranostic radioiodine has been widely used to diagnose or treat differentiated thyroid cancer. This article summarizes recent development of molecular imaging in thyroid cancer, which may accelerate the development of personalized thyroid cancer therapy.
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Affiliation(s)
- Huiting Liu
- Department of Nuclear Medicine, Chongqing Three Gorges Central Hospital, Wanzhou 404000, China
| | - Xiaoqin Wang
- Clinical Test Center, Chongqing Three Gorges Central Hospital, Wanzhou 404000, China
| | - Ran Yang
- Department of Radiology, Chongqing Three Gorges Central Hospital, Wanzhou 404000, China
| | - Wenbing Zeng
- Department of Radiology, Chongqing Three Gorges Central Hospital, Wanzhou 404000, China
| | - Dong Peng
- Department of Nuclear Medicine, Chongqing Three Gorges Central Hospital, Wanzhou 404000, China
| | - Jason Li
- Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Hu Wang
- Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Medical School, China Three Gorges University, Yichang 443002, China
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23
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Miller JE, Al-Attar NC, Brown OH, Shaughness GG, Rosculet NP, Avram AM, Hughes DT. Location and Causation of Residual Lymph Node Metastasis After Surgical Treatment of Regionally Advanced Differentiated Thyroid Cancer. Thyroid 2018; 28:593-600. [PMID: 29562827 DOI: 10.1089/thy.2017.0434] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND After initial surgical treatment of differentiated thyroid cancer (DTC) residual lymph node metastases are often found at the time of radioactive iodine (131I) therapy. Recurrence of DTC is due to persistent disease not removed at initial surgery which also did not respond to 131I treatment. This study aimed at determining locations of, and reasons for, residual nodal metastases detected by 131I scans with single-photon emission computed tomography (SPECT/CT) obtained prior to radioiodine therapy following surgical treatment of DTC. METHODS This is a retrospective study of 352 patients with intermediate and high-risk DTC treated with 131I therapy at the University of Michigan from 2007 to 2014. All patients underwent total thyroidectomy with or without lymph node dissection followed by radioiodine therapy. Pre-ablation diagnostic 131I scans with SPECT/CT were used postoperatively to localize nodal metastases, which were then compared with the cervical lymph node basins dissected at the time of surgery to determine the reason for residual nodal metastases: incomplete nodal dissection versus preoperative unrecognized nodal metastases. RESULTS Of the 352 patients in the study, 146 (41.5%) had residual nodal metastases detected on 131I scans with SPECT/CT following initial surgery but prior to 131I therapy. Among the 146 patients with residual disease, there were a total of 218 distinct nodal metastases. Relative to the primary tumor, 71.6% (n = 156) of metastases were ipsilateral, 22.0% (n = 48) were contralateral, and 6.4% (n = 14) were non-sided in the central neck (level VI/VII). Cervical lymph node levels VI, III, and II had the greatest frequencies of residual metastases (33.9%, 22.9%, 18.8%, respectively). Residual metastases occurred because of incomplete nodal dissection (49.3%), lack of preoperative identification (37.7%), or a combination of both (13%). CONCLUSION Residual nodal metastasis following initial surgical treatment for regionally advanced differentiated thyroid cancer is rather common on highly sensitive 131I scans with SPECT/CT and is due to both unrecognized nodal involvement preoperatively and incomplete removal of metastatic lymph nodes during compartment-orientated nodal dissection. The surgical management of high-risk DTC should include preoperative imaging to evaluate for nodal metastases in the central and lateral neck and compartment-orientated nodal dissection of involved compartments. Attention should be given to complete dissection in levels VI, III, and II, particularly when dissecting compartments ipsilateral to the primary tumor.
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Affiliation(s)
- Jessa E Miller
- 1 University of Michigan Medical School, University of Michigan Health System , Ann Arbor, Michigan
| | - Neal C Al-Attar
- 1 University of Michigan Medical School, University of Michigan Health System , Ann Arbor, Michigan
| | - Owen H Brown
- 1 University of Michigan Medical School, University of Michigan Health System , Ann Arbor, Michigan
| | - Gabrielle G Shaughness
- 1 University of Michigan Medical School, University of Michigan Health System , Ann Arbor, Michigan
| | - Natalja P Rosculet
- 1 University of Michigan Medical School, University of Michigan Health System , Ann Arbor, Michigan
| | - Anca M Avram
- 1 University of Michigan Medical School, University of Michigan Health System , Ann Arbor, Michigan
- 2 Department of Nuclear Medicine, University of Michigan Health System , Ann Arbor, Michigan
| | - David T Hughes
- 1 University of Michigan Medical School, University of Michigan Health System , Ann Arbor, Michigan
- 3 Department of Surgery, University of Michigan Health System , Ann Arbor, Michigan
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Predicting 131I-avidity of metastases from differentiated thyroid cancer using 18F-FDG PET/CT in postoperative patients with elevated thyroglobulin. Sci Rep 2018. [PMID: 29531251 PMCID: PMC5847528 DOI: 10.1038/s41598-018-22656-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The quantitative relationship between iodine and glucose metabolism in metastases from differentiated thyroid cancer (DTC) remains unknown. Aim of the prospective study was to establish the value of 18F-FDG PET/CT in predicting 131I-avidity of metastases from DTC before the first radioiodine therapy. A total of 121 postoperative DTC patients with elevated stimulated serum thyroglobulin (ssTg) who underwent 131I adjuvant therapy or therapy after 18F-FDG PET/CT scan were enrolled. The Receiver operating characteristic curve was established to create an optimal cut-off point and evaluate the value of SUVmax for predicting 131I-avidity. In our study, the median SUVmax in 131I-nonavid metastatic target lesions was also significantly higher than that in 131I-avid metastatic target lesions (5.37 vs. 3.30; P = 0.000). At a cut-off value of 4.0 in SUVmax, the area under curve was 0.62 with the sensitivity, specificity, positive predictive value and negative predictive value of 75.3%, 56.7%, 76.1%, and 54.8%, respectively. These results suggest that 18F-FDG PET/CT may be of great value in identifying metastases in postoperative DTC patients with elevated ssTg before 131I administration, leading to an improved management of disease. 18F-FDG positive metastatic DTC with SUVmax of greater than 4.0 possesses higher probability of non-avidity to radioiodine.
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25
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Doğan M, Durmuş K, Hasbek Z, Altuntaş EE. Does the use of recombinant TSH in preparation for I-131 scintigraphy scan affect hearing function? J Otol 2018; 13:20-24. [PMID: 29937862 PMCID: PMC6002631 DOI: 10.1016/j.joto.2017.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 10/09/2017] [Accepted: 10/09/2017] [Indexed: 11/28/2022] Open
Abstract
Objective The objective of this study was to examine the effect of hypothyroidism on hearing function in patients surgically treated for differentiated thyroid cancer and subsequently experienced hypothyroidism during preparation for follow up I-131 scintigraphy scan by either recombinant human thyroid stimulating hormone (rhTSH) treatment or thyroid hormone withdrawal (THW). Methods A total of 55 patients undergoing I-131 scintigraphy scan following surgeries for differentiated thyroid cancer were included in the study, including 25 patients prepared by administration of recombinant TSH (rhTSH Group) and 30 patients by thyroid hormone withdrawal (THW Group). Results Air conduction thresholds at 1, 2 and 4 kHz for both ears were higher during hypothyroid period than during euthyroid period for patients in the THW group (p < 0.05) but not for patients in the rhTSH group. Conclusion Sensorineural hearing loss was detected, especially at low frequencies, in patients with DTC after surgical treatment whose hormone replacement therapy was withdrawn but not in those receiving rhTSH. It is therefore preferred to use rhTSH when preparing for I-131 scintigraphy scan in patients at risk for hearing loss.
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Affiliation(s)
- Mehtap Doğan
- Department of Otolaryngology, Faculty of Medicine Cumhuriyet University 58140, Sivas, Turkey
| | - Kasım Durmuş
- Department of Otolaryngology, Faculty of Medicine Cumhuriyet University 58140, Sivas, Turkey
- Corresponding author. Fax: +90 346 2191155.
| | - Zekiye Hasbek
- Cumhuriyet Univ. School of Medicine, Dept. of Nuclear Medicine, Campus, 58140, Sivas, Turkey
| | - Emine Elif Altuntaş
- Department of Otolaryngology, Faculty of Medicine Cumhuriyet University 58140, Sivas, Turkey
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Ahmed N, Niyaz K, Borakati A, Marafi F, Birk R, Usmani S. Hybrid SPECT/CT Imaging in the Management of Differentiated
Thyroid Carcinoma. Asian Pac J Cancer Prev 2018; 19:303-308. [PMID: 29479949 PMCID: PMC5980912 DOI: 10.22034/apjcp.2018.19.2.303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Differentiated thyroid cancer (DTC) has a good prognosis overall; however, lifelong follow-up is required for
many cases. Radioiodine planar imaging with iodine-123 (I-123) or radioiodine-131 (I-131) remains the standard in
the follow-up after initial surgery and ablation of residual thyroid tissue using I-131 therapy. Radioiodine imaging
is also used in risk-stratifying and for staging of thyroid cancer, and in long-term follow-up. Unfortunately, the lack
of anatomical detail on planar gamma camera imaging and superimposition of areas presenting with increased radioiodine
uptake can make accurate diagnosis and localization of radioiodine-avid metastatic disease challenging, leading to false
positive results and potentially to over-treatment of patients. Hybrid SPECT/CT allows precise anatomical localization
and superior characterization of foci of increased tracer uptake when compared to planar imaging. This, in turn, allows the
differentiation of pathological and physiological uptake, increasing the accuracy of image interpretation and ultimately
improving the accuracy of DTC staging and subsequent patient management. In this review, we look at the unique and
emerging role that SPECT/CT plays in the management of DTC, illustrated by examples from our own clinical practice.
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Affiliation(s)
- Najeeb Ahmed
- Department of Radiology and Nuclear Medicine, Hull and East Yorkshire Hospitals NHS Trust, Hull, United Kingdom.
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Liu M, Chai L, Luo Q, Ruan M, Cheng L, Lv Z, Chen L. 99mTc-pertechnetate-avid metastases from differentiated thyroid cancer are prone to benefit from 131I therapy: A prospective observational study. Medicine (Baltimore) 2017; 96:e7631. [PMID: 28816945 PMCID: PMC5571682 DOI: 10.1097/md.0000000000007631] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The aim of this study is to determine the contribution of neck and chest Tc-pertechnetate scan to the management of postoperative patients with suspicious metastatic differentiated thyroid cancer (DTC), particularly to the prediction of response to radioiodine (I) therapy. Just before I administration, a total of 184 postoperative DTC patients with stimulated serum thyroglobulin (ssTg) >10 ng/mL were enrolled to undergo neck and chest Tc-pertechnetate scan, which were directly compared with post-therapeutic I scan to determine the concordance of site and number of metastatic lesions. The percentage changes in ssTg between Tc-pertechnetate-avid group and Tc-pertechnetate-nonavid group were compared, and the response to I in both groups was analyzed according to the nature of Tc-pertechnetate avidity as well. The percentages of concordance between Tc-pertechnetate and I scan in detecting metastases were 65.7% and 26.0% in per-patient and per-site analyses with low unweighted kappa, respectively. Tc-pertechnetate scan led to a change in therapeutic decision making in 19/184 (10.3%) patients. In 72 patients with I-avid metastases, the ssTg in Tc-pertechnetate-avid group (n = 13) decreased significantly compared with that in Tc-pertechnetate-nonavid group (n = 59) (median: -81.56% vs -48.14%; Z = -4.276, P = .000). The difference of therapeutic response between Tc-pertechnetate-avid group and Tc-pertechnetate-nonavid group was statistically significant (χ = 8.4; P = .03). Although the consistency between Tc-pertechnetate scan before I administration and post-therapy I scan in detecting metastases is low, identifying metastases in postoperative DTC patients with elevated ssTg via Tc-pertechnetate scan prior to I therapy provides incremental value for therapeutic decision making. Notably, patients with Tc-pertechnetate-avid metastases may be more prone to benefit from I therapy than those with Tc-pertechnetate-nonavid metastases.
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Affiliation(s)
- Min Liu
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital
| | - Li Chai
- Department of Nuclear Medicine, Shanghai Tenth People's Hospital, Tongji University
| | - Qiong Luo
- Department of Nuclear Medicine, Shanghai Tenth People's Hospital, Tongji University
| | - Maomei Ruan
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Lingxiao Cheng
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital
| | - Zhongwei Lv
- Department of Nuclear Medicine, Shanghai Tenth People's Hospital, Tongji University
| | - Libo Chen
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital
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Szujo S, Sira L, Bajnok L, Bodis B, Gyory F, Nemes O, Rucz K, Kenyeres P, Valkusz Z, Sepp K, Schmidt E, Szabo Z, Szekeres S, Zambo K, Barna S, Nagy EV, Mezosi E. The impact of post-radioiodine therapy SPECT/CT on early risk stratification in differentiated thyroid cancer; a bi-institutional study. Oncotarget 2017; 8:79825-79834. [PMID: 29108364 PMCID: PMC5668097 DOI: 10.18632/oncotarget.19781] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 07/18/2017] [Indexed: 11/25/2022] Open
Abstract
Objective SPECT/CT has numerous advantages over planar and traditional SPECT images. The aim of this study was to evaluate the role of post-radioiodine therapy SPECT/CT of patients with differentiated thyroid cancer (DTC) in early risk classification and in prediction of late prognosis. Patients and methods 323 consecutive patients were investigated after their first radioiodine treatment (1100–3700 MBq). Both whole body scan and SPECT/CT images of the head, neck, chest and abdomen regions were taken 4–6 days after radioiodine therapy. Patients were re-evaluated 9–12 months later as well as at the end of follow up (median 37 months). Results Post-radioiodine therapy SPECT/CT showed metastases in 22% of patients. Lymph node, lung and bone metastases were detected in 61, 13 and 5 patients, respectively, resulting in early reclassification of 115 cases (36%). No evidence of disease was found in 251 cases at 9–12 months after radioiodine treatment and 269 patients at the end of follow-up. To predict residual disease at the end of follow-up, the sensitivities, specificities and diagnostic accuracies of the current risk classification systems and SPECT/CT were: ATA: 77%, 47% and 53%; ETA: 70%, 62% and 64%; SPECT/CT: 61%, 88% and 83%, respectively. There was no difference between cohorts of the two institutions when data were analyzed separately. Conclusions Based on our bi-institutional experience, the accuracy of post-radioiodine SPECT/CT outweighs that of the currently used ATA and ETA risk classification systems in the prediction of long-term outcome of DTC.
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Affiliation(s)
- Szabina Szujo
- Ist Department of Medicine, University of Pecs, H-7624 Pecs, Hungary
| | - Livia Sira
- Department of Medicine, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Hungary
| | - Laszlo Bajnok
- Ist Department of Medicine, University of Pecs, H-7624 Pecs, Hungary
| | - Beata Bodis
- Ist Department of Medicine, University of Pecs, H-7624 Pecs, Hungary
| | - Ferenc Gyory
- Department of Surgery, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary
| | - Orsolya Nemes
- Ist Department of Medicine, University of Pecs, H-7624 Pecs, Hungary
| | - Karoly Rucz
- Ist Department of Medicine, University of Pecs, H-7624 Pecs, Hungary
| | - Peter Kenyeres
- Ist Department of Medicine, University of Pecs, H-7624 Pecs, Hungary
| | - Zsuzsanna Valkusz
- Ist Department of Medicine, University of Szeged, H-6720 Szeged, Hungary
| | - Krisztian Sepp
- Ist Department of Medicine, University of Szeged, H-6720 Szeged, Hungary
| | - Erzsebet Schmidt
- Department of Nuclear Medicine, University of Pecs, H-7624 Pecs, Hungary
| | - Zsuszanna Szabo
- Department of Nuclear Medicine, University of Pecs, H-7624 Pecs, Hungary
| | - Sarolta Szekeres
- Department of Nuclear Medicine, University of Pecs, H-7624 Pecs, Hungary
| | - Katalin Zambo
- Department of Nuclear Medicine, University of Pecs, H-7624 Pecs, Hungary
| | - Sandor Barna
- Department of Nuclear Medicine, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Hungary
| | - Endre V Nagy
- Department of Medicine, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Hungary
| | - Emese Mezosi
- Ist Department of Medicine, University of Pecs, H-7624 Pecs, Hungary
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Zilioli V, Peli A, Panarotto MB, Magri G, Alkraisheh A, Wiefels C, Rodella C, Giubbini R. Differentiated thyroid carcinoma: Incremental diagnostic value of 131I SPECT/CT over planar whole body scan after radioiodine therapy. Endocrine 2017; 56:551-559. [PMID: 27709475 DOI: 10.1007/s12020-016-1086-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/10/2016] [Indexed: 12/13/2022]
Abstract
The purpose of this prospective study was to determine the incremental diagnostic value of single photon emission computed tomography/computed tomography with iodine-131 over planar whole body scan in the staging of patients with differentiated thyroid carcinoma. A total of 365 patients (270 female, 95 male) with differentiated thyroid carcinoma were treated with radioiodine therapy for thyroid remnant ablation with radical intent after thyroidectomy between January 2013 and November 2014. In addition to planar whole body scan, single photon emission computed tomography/computed tomography of neck and chest were performed. Each radioactive focus at whole body scan was classified as positive or equivocal with respect of specific territories: thyroid bed, cervical lymph nodes and distant metastases.Whole-body scan detected focal uptake in 353 patients and no uptake in 12. The location was considered equivocal in 100. Single photon emission computed tomography/computed tomography detected focal uptake in 356 patients and no uptake in nine. In three patients with negative wholebody scan, single photon emission computed tomography/computed tomography provided information about residual activity in the thyroid bed. By single photon emission computed tomography/computed tomography the location was equivocal in 18 patients only. Single photon emission computed tomography/computed tomography was helpful in 82 out of 100 patients with equivocal findings by whole body scan allowing a correct identification of the uptake sites. In a great number of equivocal whole body scan, due to high remnant activity, single photon emission computed tomography/computed tomography was able to differentiate between thyroid remnant and lymph nodes uptake. In 22 out of 100 patients with doubtful whole body scan, single photon emission computed tomography/computed tomography correctly identified nodal or distant metastases, and in 2/100 patients, focal uptake classified as metastatic by whole body scan was reclassified as para-physiological by single photon emission computed tomography/computed tomography. The TNM classification changed in 13 out of 22 patients. Single photon emission computed tomography/computed tomography improves detection and localization of the iodine-131 uptake after thyroidectomy in patients with differentiated thyroid carcinoma and it is more accurate than whole body scan to evaluate lymph nodes and to identify and characterize distant metastases. Single photon emission computed tomography/computed tomography aids assessment of lower/upper stage in a significant number of patients with differentiated thyroid carcinoma and it can affect therapy decision-making and patient management.
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MESH Headings
- Adenocarcinoma, Follicular/diagnostic imaging
- Adenocarcinoma, Follicular/pathology
- Adenocarcinoma, Follicular/radiotherapy
- Adenocarcinoma, Follicular/surgery
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Papillary/diagnostic imaging
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/radiotherapy
- Carcinoma, Papillary/surgery
- Carcinoma, Papillary, Follicular/diagnostic imaging
- Carcinoma, Papillary, Follicular/pathology
- Carcinoma, Papillary, Follicular/radiotherapy
- Carcinoma, Papillary, Follicular/surgery
- Female
- Humans
- Iodine Radioisotopes/therapeutic use
- Male
- Middle Aged
- Neoplasm Staging
- Radiotherapy Dosage
- Single Photon Emission Computed Tomography Computed Tomography/methods
- Thyroid Neoplasms/diagnostic imaging
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/radiotherapy
- Thyroid Neoplasms/surgery
- Thyroidectomy
- Whole Body Imaging/methods
- Young Adult
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Affiliation(s)
- Valentina Zilioli
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Spedali Civili and University of Brescia, Brescia, Italy
| | - Alessia Peli
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Spedali Civili and University of Brescia, Brescia, Italy
| | - Maria Beatrice Panarotto
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Spedali Civili and University of Brescia, Brescia, Italy
| | - Giancarlo Magri
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Spedali Civili and University of Brescia, Brescia, Italy
| | - Ahmed Alkraisheh
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Spedali Civili and University of Brescia, Brescia, Italy
| | - Christiane Wiefels
- Chair of Nuclear Medicine, Federal Fluminense University, Rio de Janeiro, Brazil
| | - Carlo Rodella
- Medical Physics Department, Spedali Civili di Brescia, Brescia, Italy
| | - Raffaele Giubbini
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Spedali Civili and University of Brescia, Brescia, Italy.
- Chair of Nuclear Medicine, Federal Fluminense University, Rio de Janeiro, Brazil.
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Lee SW. SPECT/CT in the Treatment of Differentiated Thyroid Cancer. Nucl Med Mol Imaging 2017; 51:297-303. [PMID: 29242723 DOI: 10.1007/s13139-017-0473-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/07/2016] [Accepted: 01/20/2017] [Indexed: 01/25/2023] Open
Abstract
Single-photon emission computed tomography with integrated computed tomography (SPECT/CT) systems has been applied in a wide range of clinical circumstances, and differentiated thyroid cancer (DTC) is one of the most important indications of SPECT/CT imaging. In the treatment of DTC, SPECT/CT images have been reported to have many advantages over conventional planar whole-body scintigraphy based on its precise localization and characterization of abnormal foci of radioactive iodine (RAI) accumulation, influencing the staging, risk stratification, and clinical management as well as reader confidence. On the other hand, SPECT/CT has limitations including additional radiation exposure from the CT component, additional imaging time, and cost-related issues. Each SPECT/CT image acquired at different time points throughout the management of DTC may have a different clinical meaning and significance. This review article addresses the clinical usefulness of RAI SPECT/CT images acquired during the pre-ablation period, post-therapy period, and long-term follow-up period, respectively.
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Affiliation(s)
- Sang-Woo Lee
- Department of Nuclear Medicine, Kyungpook National University Medical Center and School of Medicine, 807 Hoguk-ro, Buk-gu, Daegu, Republic of Korea 41404
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Elisei R, Agate L, Mazzarri S, Bottici V, Guidoccio F, Molinaro E, Boni G, Ferdeghini M, Mariani G. Radionuclide Therapy of Thyroid Tumors. NUCLEAR ONCOLOGY 2017:1197-1241. [DOI: 10.1007/978-3-319-26236-9_49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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Ilhan H, Mustafa M, Bartenstein P, Kuwert T, Schmidt D. Rate of elimination of radioiodine-avid lymph node metastases of differentiated thyroid carcinoma by postsurgical radioiodine ablation. A bicentric study. Nuklearmedizin 2016; 55:221-227. [PMID: 27588323 DOI: 10.3413/nukmed-0794-16-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 08/18/2016] [Indexed: 12/31/2022]
Abstract
SPECT/CT detects radioiodine-positive cervical lymph node metastases (LNMs) of differentiated thyroid carcinoma (DTC) at the time of postsurgical radioablation (RA). Preliminary evidence indicates that the majority of LNMs are successfully treated by RA. The aim of this study was to confirm this evidence in a bicentric setting and to evaluate whether size is a predictor for successful elimination. PATIENTS AND METHODS Since 01/2007 and 05/2008, respectively, SPECT/spiral-CT is performed routinely in all patients with DTC at RA in two University Clinics. The outcome of iodine-positive LNMs identified by SPECT/CT until 12/2012 was analyzed by follow-up diagnostic 131I scans and serum thyreoglobulin (Tg) values. LNM volume and short-axis diameter were evaluated as prognostic factors by a receiver-operating characteristic (ROC) analysis. RESULTS 79 patients with 97 iodine-positive LNMs were included. Surgery was carried out in 8 patients with 13 LNMs due to the presence of additional iodine-negative lesions. Of the remaining 84 LNMs, 74 (88%) were successfully treated as demonstrated by radioiodine scans at follow-up. 10 LNMs persisted. 67/70 LNMs smaller than 0.9 ml were treated successfully, whereas this was the case of only 6/14 exceeding this threshold. Using this cut-off level to predict treatment success, sensitivity, specificity, positive and negative predictive value were 92%, 73%, 96%, and 57%. Results for short-axis diameter (cut-off level < 1cm) were 90%, 69%, 94% and 56%. CONCLUSION RA is effective in the treatment of the majority of 131I-positive LNMs identified in SPECT/CT images. In this study, 88% of iodine-positive LNM in DTC were successfully treated by radioiodine given at RA. Both LNM volume and diameter are reliable predictors of treatment success.
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Affiliation(s)
- Harun Ilhan
- Harun Ilhan, M.D., Department of Nuclear Medicine, Klinikum Grosshadern, University of Munich, Marchioninistraße 15, 81377 München, Germany, E-Mail:
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Wong KK, Gandhi A, Viglianti BL, Fig LM, Rubello D, Gross MD. Endocrine radionuclide scintigraphy with fusion single photon emission computed tomography/computed tomography. World J Radiol 2016; 8:635-655. [PMID: 27358692 PMCID: PMC4919764 DOI: 10.4329/wjr.v8.i6.635] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/09/2015] [Accepted: 03/18/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To review the benefits of single photon emission computed tomography (SPECT)/computed tomography (CT) hybrid imaging for diagnosis of various endocrine disorders.
METHODS: We performed MEDLINE and PubMed searches using the terms: “SPECT/CT”; “functional anatomic mapping”; “transmission emission tomography”; “parathyroid adenoma”; “thyroid cancer”; “neuroendocrine tumor”; “adrenal”; “pheochromocytoma”; “paraganglioma”; in order to identify relevant articles published in English during the years 2003 to 2015. Reference lists from the articles were reviewed to identify additional pertinent articles. Retrieved manuscripts (case reports, reviews, meta-analyses and abstracts) concerning the application of SPECT/CT to endocrine imaging were analyzed to provide a descriptive synthesis of the utility of this technology.
RESULTS: The emergence of hybrid SPECT/CT camera technology now allows simultaneous acquisition of combined multi-modality imaging, with seamless fusion of three-dimensional volume datasets. The usefulness of combining functional information to depict the bio-distribution of radiotracers that map cellular processes of the endocrine system and tumors of endocrine origin, with anatomy derived from CT, has improved the diagnostic capability of scintigraphy for a range of disorders of endocrine gland function. The literature describes benefits of SPECT/CT for 99mTc-sestamibi parathyroid scintigraphy and 99mTc-pertechnetate thyroid scintigraphy, 123I- or 131I-radioiodine for staging of differentiated thyroid carcinoma, 111In- and 99mTc- labeled somatostatin receptor analogues for detection of neuroendocrine tumors, 131I-norcholesterol (NP-59) scans for assessment of adrenal cortical hyperfunction, and 123I- or 131I-metaiodobenzylguanidine imaging for evaluation of pheochromocytoma and paraganglioma.
CONCLUSION: SPECT/CT exploits the synergism between the functional information from radiopharmaceutical imaging and anatomy from CT, translating to improved diagnostic accuracy and meaningful impact on patient care.
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Yi KH, Lee EK, Kang HC, Koh Y, Kim SW, Kim IJ, Na DG, Nam KH, Park SY, Park JW, Bae SK, Baek SK, Baek JH, Lee BJ, Chung KW, Jung YS, Cheon GJ, Kim WB, Chung JH, Rho YS. 2016 Revised Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer. ACTA ACUST UNITED AC 2016. [DOI: 10.11106/ijt.2016.9.2.59] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Ka Hee Yi
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Korea
| | - Eun Kyung Lee
- Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Medical School, Korea
| | - Yunwoo Koh
- Department of Otorhinolaryngology, College of Medicine, Yonsei University, Korea
| | - Sun Wook Kim
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - In Joo Kim
- Department of Internal Medicine, College of Medicine, Pusan National University, Korea
| | - Dong Gyu Na
- Department of Radiology, Human Medical Imaging and Intervention Center, Korea
| | - Kee-Hyun Nam
- Department of Surgery, College of Medicine, Yonsei University, Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University College of Medicine, Korea
| | - Jin Woo Park
- Department of Surgery, College of Medicine, Chungbuk National University, Korea
| | - Sang Kyun Bae
- Department of Nuclear Medicine, Inje University College of Medicine, Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology, College of Medicine, Korea University, Korea
| | - Jung Hwan Baek
- Department of Radiology, University of Ulsan College of Medicine, Korea
| | - Byung-Joo Lee
- Department of Otorhinolaryngology, College of Medicine, Pusan National University, Korea
| | - Ki-Wook Chung
- Department of Surgery, University of Ulsan College of Medicine, Korea
| | - Yuh-Seog Jung
- Department of Otorhinolaryngology, Center for Thyroid Cancer, National Cancer Center, Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University College of Medicine, Korea
| | - Won Bae Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Korea
| | - Jae Hoon Chung
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Young-Soo Rho
- Department of Otorhinolaryngology, Hallym University College of Medicine, Korea
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Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26:1-133. [PMID: 26462967 PMCID: PMC4739132 DOI: 10.1089/thy.2015.0020] [Citation(s) in RCA: 9473] [Impact Index Per Article: 1052.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer. METHODS The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles on adults were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations for therapeutic interventions. We developed a similarly formatted system to appraise the quality of such studies and resultant recommendations. The guideline panel had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. RESULTS The revised guidelines for the management of thyroid nodules include recommendations regarding initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, use of molecular markers, and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to screening for thyroid cancer, staging and risk assessment, surgical management, radioiodine remnant ablation and therapy, and thyrotropin suppression therapy using levothyroxine. Recommendations related to long-term management of differentiated thyroid cancer include those related to surveillance for recurrent disease using imaging and serum thyroglobulin, thyroid hormone therapy, management of recurrent and metastatic disease, consideration for clinical trials and targeted therapy, as well as directions for future research. CONCLUSIONS We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid nodules and differentiated thyroid cancer. They represent, in our opinion, contemporary optimal care for patients with these disorders.
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Affiliation(s)
| | - Erik K. Alexander
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Susan J. Mandel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Gregory W. Randolph
- Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anna M. Sawka
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Julie Ann Sosa
- Duke University School of Medicine, Durham, North Carolina
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Rosario PW, Mourão GF, Siman TL, Calsolari MR. A low postoperative nonstimulated serum thyroglobulin level excludes the presence of persistent disease in low-risk papillary thyroid cancer patients: implication for radioiodine indication. Clin Endocrinol (Oxf) 2015; 83:957-61. [PMID: 25393656 DOI: 10.1111/cen.12668] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 09/30/2014] [Accepted: 11/08/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the presence of persistent disease, including on post-therapy whole-body scan (RxWBS), in low-risk patients with papillary thyroid carcinoma (PTC) >1 cm who have low nonstimulated thyroglobulin (Tg) (measured with a sensitive assay), negative anti-Tg antibodies (TgAb) and neck ultrasound (US) showing no metastases after total thyroidectomy. PATIENTS We studied 154 patients with PTC >1 cm classified as low risk, who had US without metastases, negative TgAb, nonstimulated Tg ≤ 0·25 ng/ml and TSH ≤ 2 mIU/l about 3 months after total thyroidectomy. RESULTS Tg measured immediately before (131) I was ≤ 1 ng/ml in 89·5% of the patients and >1 ng/ml in 10·5%. None of the patients showed ectopic uptake on RxWBS. Uptake in the thyroid bed was observed in 146 (94·8%) patients and was ≤ 2% in all of them. In the control assessment 9-12 months after ablation, stimulated Tg (sTg) ≤ 1 ng/ml was achieved in 150 patients (97·4%). Only one patient had sTg >2 ng/ml (2·5 ng/ml) and none of the patients had apparent disease detected by imaging methods. During further short-term follow-up after control assessment (median of 24 months), none of the patients had tumour recurrence. CONCLUSIONS The combination of nonstimulated Tg ≤0·25 ng/ml, negative TgAb and US without metastases after thyroidectomy rules out the presence of persistent disease (including on RxWBS) in low-risk patients with PTC >1 cm. This demonstration weakens the indication of ablation with (131) I in these cases.
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Affiliation(s)
- Pedro W Rosario
- Postgraduate Program, Santa Casa de Belo Horizonte, Minas Gerais, Brazil
- Endocrinology Service, Santa Casa de Belo Horizonte, Minas Gerais, Brazil
| | - Gabriela F Mourão
- Postgraduate Program, Santa Casa de Belo Horizonte, Minas Gerais, Brazil
- Endocrinology Service, Santa Casa de Belo Horizonte, Minas Gerais, Brazil
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Hassan FU, Mohan HK. Clinical Utility of SPECT/CT Imaging Post-Radioiodine Therapy: Does It Enhance Patient Management in Thyroid Cancer? Eur Thyroid J 2015; 4:239-45. [PMID: 26835427 PMCID: PMC4716421 DOI: 10.1159/000435836] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 06/08/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate post-therapy iodine-131 single-photon emission computed tomography/computed tomography ((131)I-SPECT/CT) imaging in comparison to conventional planar (131)I whole-body imaging, and to assess its clinical impact on the management of patients. METHODS We retrospectively reviewed planar (131)I whole-body and (131)I-SPECT/CT imaging findings in 67 patients who underwent (131)I therapy for thyroid cancer. Two nuclear medicine physicians reviewed the scans independently. The foci of increased tracer uptake were identified in the neck, thorax and elsewhere. Within the neck, the foci of (131)I-increased uptake were graded qualitatively as probable or definite uptake in thyroid remnants and probable or definite uptake in the lymph nodes. Serum thyroglobulin level, histopathology and other imaging findings served as the reference standard. RESULTS Of the 67 patients, 57 (85%) had radioiodine avid disease and 10 (15%) demonstrated non-radioiodine avid disease. Overall, post-therapy (131)I-SPECT/CT downstaged lymph node staging in 10 patients and upstaged it in 4 patients. This translated into a change of management for 9/57 (16%) patients with radioiodine avid disease. A change of management was observed in 5/10 patients with non-radioiodine avid disease confirmed in the post-(131)I-SPECT/CT study. Additionally, clinically significant findings such as incidental lung cancer, symptomatic pleural effusion and consolidation were also diagnosed in both groups of patients. CONCLUSION In patients with thyroid cancer, (131)I-SPECT/CT is a valuable addition to standard post-therapy planar imaging. SPECT/CT also improved diagnostic confidence and provided crucial clinical information leading to change of management for a significant number of these patients.
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Affiliation(s)
- Fahim U. Hassan
- *Fahim-Ul-Hassan, Nuclear Medicine Department, Borough Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT (UK), E-Mail
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Zhao L, Zhu J, Cheng Y, Xiong Z, Tang Y, Guo L, Shi X, Zhao J. Chlorotoxin-Conjugated Multifunctional Dendrimers Labeled with Radionuclide 131I for Single Photon Emission Computed Tomography Imaging and Radiotherapy of Gliomas. ACS APPLIED MATERIALS & INTERFACES 2015; 7:19798-19808. [PMID: 26291070 DOI: 10.1021/acsami.5b05836] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Chlorotoxin-conjugated multifunctional dendrimers labeled with radionuclide 131I were synthesized and utilized for targeted single photon emission computed tomography (SPECT) imaging and radiotherapy of cancer. In this study, generation five amine-terminated poly(amidoamine) dendrimers were used as a platform to be sequentially conjugated with polyethylene glycol (PEG), targeting agent chlorotoxin (CTX), and 3-(4'-hydroxyphenyl)propionic acid-OSu (HPAO). This was followed by acetylation of the remaining dendrimer terminal amines and radiolabeling with 131I to form the targeted theranostic dendrimeric nanoplatform. We show that the dendrimer platform possessing approximately 7.7 CTX and 21.1 HPAO moieties on each dendrimer displays excellent cytocompatibility in a given concentration range (0-20 μM) and can specifically target cancer cells overexpressing matrix metallopeptidase 2 (MMP2) due to the attached CTX. With the attached HPAO moiety having the phenol group, the dendrimer platform can be effectively labeled with radioactive 131I with good stability and high radiochemical purity. Importantly, the 131I labeling renders the dendrimer platform with an ability to be used for targeted SPECT imaging and radiotherapy of an MMP2-overexpressing glioma model in vivo. The developed radiolabeled multifunctional dendrimeric nanoplatform may hold great promise to be used for targeted theranostics of human gliomas.
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Affiliation(s)
- Lingzhou Zhao
- Department of Nuclear Medicine, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai 200080, People's Republic of China
| | - Jingyi Zhu
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Materials Science and Engineering, Donghua University , Shanghai 201620, People's Republic of China
| | - Yongjun Cheng
- Department of Nuclear Medicine, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai 200080, People's Republic of China
| | - Zhijuan Xiong
- College of Chemistry, Chemical Engineering and Biotechnology, Donghua University , Shanghai 201620, People's Republic of China
| | - Yueqin Tang
- Experiment Center, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai 200080, People's Republic of China
| | - Lilei Guo
- Department of Nuclear Medicine, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai 200080, People's Republic of China
| | - Xiangyang Shi
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Materials Science and Engineering, Donghua University , Shanghai 201620, People's Republic of China
- College of Chemistry, Chemical Engineering and Biotechnology, Donghua University , Shanghai 201620, People's Republic of China
| | - Jinhua Zhao
- Department of Nuclear Medicine, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai 200080, People's Republic of China
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Agrawal K, Bhattacharya A, Mittal BR. Role of single photon emission computed tomography/computed tomography in diagnostic iodine-131 scintigraphy before initial radioiodine ablation in differentiated thyroid cancer. Indian J Nucl Med 2015; 30:221-6. [PMID: 26170564 PMCID: PMC4479910 DOI: 10.4103/0972-3919.151650] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objectives: The study was performed to evaluate the incremental value of single photon emission computed tomography/computed tomography (SPECT/CT) over planar radioiodine imaging before radioiodine ablation in the staging, management and stratification of risk of recurrence (ROR) in differentiated thyroid cancer (DTC) patients. Materials and Methods: Totally, 83 patients (21 male, 62 female) aged 17–75 (mean 39.9) years with DTC were included consecutively in this prospective study. They underwent postthyroidectomy planar and SPECT/CT scans after oral administration of 37–114 MBq iodine-131 (I-131). The scans were interpreted as positive, negative or suspicious for tracer uptake in the thyroid bed, cervical lymph nodes and sites outside the neck. In each case, the findings on planar images were recorded first, without knowledge of SPECT/CT findings. Operative and pathological findings were used for postsurgical tumor–node–metastasis staging. The tumor staging was reassessed after each of these two scans. Results: Single photon emission computed tomography/computed tomography localized radioiodine uptake in the thyroid bed in 9/83 (10.8%) patients, neck nodes in 24/83 (28.9%) patients and distant metastases in 8/83 (9.6%) patients in addition to the planar study. Staging was changed in 8/83 (9.6%), ROR in 11/83 (13.2%) and management in 26/83 (31.3%) patients by the pretherapy SPECT/CT in comparison to planar imaging. SPECT/CT had incremental value in 32/83 patients (38.5%) over the planar scan. Conclusion: Single photon emission computed tomography/computed tomography is feasible during a diagnostic I-131 scan with a low amount of radiotracer. It improved the interpretation of pretherapy I-131 scintigraphy and changed the staging and subsequent patient management.
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Affiliation(s)
- Kanhaiyalal Agrawal
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anish Bhattacharya
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Should all patients with differentiated thyroid carcinoma undergo 131I SPECT-CT scanning rather than 131I whole-body scanning? Nucl Med Commun 2015; 36:549-52. [PMID: 25906202 DOI: 10.1097/mnm.0000000000000277] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Zeuren R, Biagini A, Grewal RK, Randolph GW, Kamani D, Sabra MM, Shaha AR, Tuttle RM. RAI thyroid bed uptake after total thyroidectomy: A novel SPECT-CT anatomic classification system. Laryngoscope 2015; 125:2417-24. [PMID: 25891354 DOI: 10.1002/lary.25295] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/25/2015] [Accepted: 03/02/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Recent, more selective use of radioactive iodine (RAI) has led to reevaluation of the clinical importance of achieving complete total thyroidectomy with minimal residual normal thyroid tissue. We utilize the improved localization by post-RAI remnant ablation, single photon emission computerized tomography-computed tomography (SPECT-CT) to define specific anatomic sites of residual RAI-uptake foci after total thyroidectomy for differentiated thyroid cancer (DTC) and to provide a novel classification system relating uptake to thyroid anatomy and preservation of adjacent neural structures. STUDY DESIGN Retrospective. METHOD Radioactive iodine-uptake foci in thyroid bed were localized by SPECT/CT imaging at the time of RAI remnant ablation in 141 DTC patients undergoing total thyroidectomy. RESULTS Minimal residual RAI uptake (median 0.32% at 24 hours) in the thyroid bed was detected by diagnostic planar whole body scans in 93% and by posttherapy SPECT/CT imaging in 99% of subjects. Discrete RAI uptake foci were identified on the SPECT/CT imaging at Berry's ligament (87%), at superior thyroid poles (79%), in paratracheal-lobar regions (67%), in isthmus-region (54%), and in pyramidal lobe (46%). Despite the residual foci, the nonstimulated thyroglobulin (Tg) prior to remnant ablation (with a median thyroid-stimulating hormone of 0.36 m IU/L) was < 0.6 ng/mL in 53% and < 1 ng/mL in 73% of cases. CONCLUSION After extracapsular total thyroidectomy, highly sensitive detection tools identify microscopic residual RAI avid foci in thyroid bed in the majority of patients. These foci can be classified as 1) neural-related and 2) capsule-related. These common residual foci have no relationship to postoperative Tg, suggesting that attempts at radical removal of thyroid tissue in these locations may not be warranted. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Rebecca Zeuren
- Department of Endocrinology Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Agnese Biagini
- Department of Endocrinology Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Ravinder K Grewal
- Department of Nuclear Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Surgery, Otolaryngology, Massachusetts Eye and Ear Infirmary.,Department of Surgical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Dipti Kamani
- Division of Thyroid and Parathyroid Surgery, Otolaryngology, Massachusetts Eye and Ear Infirmary
| | - Mona M Sabra
- Department of Endocrinology Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Ashok R Shaha
- Department of Endocrinology Service, Memorial Sloan-Kettering Cancer Center, New York, New York.,Department of Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - R Michael Tuttle
- Department of Endocrinology Service, Memorial Sloan-Kettering Cancer Center, New York, New York
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Wong KK, Fig LM, Youssef E, Ferretti A, Rubello D, Gross MD. Endocrine scintigraphy with hybrid SPECT/CT. Endocr Rev 2014; 35:717-46. [PMID: 24977318 DOI: 10.1210/er.2013-1030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Nuclear medicine imaging of endocrine disorders takes advantage of unique cellular properties of endocrine organs and tissues that can be depicted by targeted radiopharmaceuticals. Detailed functional maps of biodistributions of radiopharmaceutical uptake can be displayed in three-dimensional tomographic formats, using single photon emission computed tomography (CT) that can now be directly combined with simultaneously acquired cross-sectional anatomic maps derived from CT. The integration of function depicted by scintigraphy and anatomy with CT has synergistically improved the efficacy of nuclear medicine imaging across a broad spectrum of clinical applications, which include some of the oldest imaging studies of endocrine dysfunction.
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Affiliation(s)
- Ka Kit Wong
- Nuclear Medicine/Radiology Department (K.K.W., E.Y., M.D.G.), University of Michigan Hospital, Ann Arbor, Michigan 48109; Nuclear Medicine Service (K.K.W., L.M.F., M.D.G.), Department of Veterans Affairs Health System, Ann Arbor, Michigan 48105; and Department of Nuclear Medicine (A.F., D.R.), Radiology, Medical Physics, Santa Maria della Misericordia Hospital, 45100 Rovigo, Italy
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Jeong SY, Lee SW, Kim HW, Song BI, Ahn BC, Lee J. Clinical applications of SPECT/CT after first I-131 ablation in patients with differentiated thyroid cancer. Clin Endocrinol (Oxf) 2014; 81:445-51. [PMID: 24716874 DOI: 10.1111/cen.12460] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 01/06/2014] [Accepted: 03/23/2014] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This study aimed to determine which thyroid cancer patients would benefit from SPECT/CT in addition to whole-body planar scintigraphy (RxWBS) for the detection and characterization of I-131 focal uptake after first ablation. DESIGN AND PATIENTS Neck and thoracic SPECT/CT was performed in 187 patients with I-131 focal uptake suggestive of remnant thyroid tissue (Rem group, n = 152) or presumed lymph node (LN) metastases (mLN group, n = 35) on RxWBS. Clinical and pathologic parameters were analysed and compared in patients with and without additional SPECT/CT findings. RESULTS wIn the Rem group, SPECT/CT revealed additional occult findings on RxWBS in 13 patients (8·6%). The serum thyroglobulin levels at the time of ablation were significantly higher in patients with additional SPECT/CT findings than in patients without additional findings (4·3 ± 3·4 ng/ml vs 1·6 ± 2·7 ng/ml, P = 0·001). In the mLN group, SPECT/CT demonstrated only remnant thyroid tissues without evidence of lymph node metastasis in 14 (40·0%) patients, whereas in the remaining 21 (60·0%) patients, I-131 uptake was confirmed in the corresponding neck and mediastinal lymph nodes on SPECT/CT. CONCLUSIONS Even in the Rem group, additional SPECT/CT could provide useful information for detecting hidden metastasis, especially in patients with high serum thyroglobulin levels. SPECT/CT should be recommended for patients with focal uptake lymph node metastasis on RxWBS.
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Affiliation(s)
- Shin Young Jeong
- Department of Nuclear Medicine, Kyungpook National University Medical Center and School of Medicine, Daegu, Korea
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Patel HH, Goyal N, Goldenberg D. Imaging, genetic testing, and biomarker assessment of follicular cell-derived thyroid cancer. Ann Med 2014; 46:409-16. [PMID: 24987865 DOI: 10.3109/07853890.2014.923739] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Thyroid carcinoma is the most common endocrine malignancy worldwide, and its incidence continues to increase. As such the approach to a recently identified thyroid nodule is important to understand. The relevant imaging, examination, and need for fine-needle aspiration biopsy (FNA) are discussed. In approximately 25% of nodules, the diagnosis cannot be established with FNA-based cytology, and surgical excision is necessary for definitive diagnosis. Recent advances in genetic and molecular testing may increase the diagnostic accuracy of FNA in managing thyroid nodules.
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Affiliation(s)
- Hetal H Patel
- Penn State Milton S. Hershey Medical Center, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery , Hershey, Pennsylvania , USA
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Barber TW, Cherk MH, Topliss DJ, Serpell JW, Yap KSK, Bailey M, Kalff V. The prevalence of thyroglossal tract thyroid tissue on SPECT/CT following (131) I ablation therapy after total thyroidectomy for thyroid cancer. Clin Endocrinol (Oxf) 2014; 81:266-70. [PMID: 24483626 DOI: 10.1111/cen.12419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 11/27/2013] [Accepted: 01/26/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the prevalence of thyroglossal tract thyroid tissue on SPECT/CT and to assess the contribution of this tissue to total neck radioactive iodine (RAI) activity in patients given (131) I ablation therapy after total thyroidectomy for thyroid cancer. PATIENTS AND METHODS Eighty-three consecutive patients with thyroid cancer treated with total thyroidectomy underwent whole-body planar and SPECT/CT imaging of the neck following initial RAI ablation. On SPECT/CT, thyroglossal tract thyroid tissue was defined as RAI in the anterior neck, superior to the thyroid bed in close proximity to the midline without evidence of localization to lymph nodes. Quantification was performed using region of interest analysis on planar imaging following localization on SPECT/CT. SPECT/CT, and planar images were classified by two reviewers as positive, negative or equivocal with interobserver agreement quantified using a Kappa score. Disagreement was resolved using a third reviewer. RESULTS Thyroglossal tract thyroid tissue was present in 39/83 (47%; 95%CI: 36-58%) patients on SPECT/CT. In these 39 patients, this tissue contributed to a significant amount of total neck activity (median = 50%; IQR 19-74%). Interobserver agreement for the presence of thyroglossal tract thyroid tissue was substantial on SPECT/CT (Kappa = 0.73) and fair on planar imaging (Kappa = 0.31). CONCLUSION Thyroglossal tract thyroid tissue was present in one half of our study population and contributed to a significant amount of total neck RAI activity. Given the high prevalence of this tissue, our results suggest that total neck RAI activity on planar imaging may not be suitable to assess the completeness of thyroid bed surgery.
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Affiliation(s)
- Thomas W Barber
- Department of Nuclear Medicine and PET Centre, Melbourne, Vic., Australia
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Esposito G. Initial radioiodine administration: when to use it and how to select the dose. Endocrinol Metab Clin North Am 2014; 43:385-400. [PMID: 24891168 DOI: 10.1016/j.ecl.2014.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
All published guidelines on the use of radioactive iodine for the treatment of well-differentiated thyroid cancer agree that an individualized assessment of the risk of cancer-related mortality and of disease recurrence should direct the decision of whether radioiodine treatment is needed and how much to administer. At the author's institution, they mostly follow the American Thyroid Association's risk stratification system, with the addition of a category of very-low-risk patients that do not receive radioactive iodine.
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Affiliation(s)
- Giuseppe Esposito
- Department of Radiology, Medstar Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC 20007, USA.
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Lepoutre-Lussey C, Maddah D, Golmard JL, Russ G, Tissier F, Trésallet C, Menegaux F, Aurengo A, Leenhardt L. Post-operative neck ultrasound and risk stratification in differentiated thyroid cancer patients with initial lymph node involvement. Eur J Endocrinol 2014; 170:837-46. [PMID: 24659355 DOI: 10.1530/eje-13-0888] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Cervical ultrasound (US) scan is a key tool for detecting metastatic lymph nodes (N1) in patients with papillary thyroid cancer (PTC). N1-PTC patients are stratified as intermediate-risk and high-risk (HR) patients, according to the American Thyroid Association (ATA) and European Thyroid Association (ETA) respectively. The aim of this study was to assess the value of post-operative cervical US (POCUS) in local persistent disease (PD) diagnosis and in the reassessment of risk stratification in N1-PTC patients. DESIGN Retrospective cohort study. METHODS Between 1997 and 2010, 638 N1-PTC consecutive patients underwent a systematic POCUS. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of POCUS for the detection of PD were evaluated and a risk reassessment using cumulative incidence functions was carried out. RESULTS After a median follow-up of 41.6 months, local recurrence occurred in 138 patients (21.6%), of which 121 were considered to have PD. Sensitivity, specificity, NPV, and PPV of POCUS for the detection of the 121 PD were 82.6, 87.4 95.6, and 60.6% respectively. Cumulative incidence of recurrence at 5 years was estimated at 26% in ETA HR patients, 17% in ATA intermediate-risk patients, and 35% in ATA HR patients respectively. This risk fell to 9, 8, and 11% in the above three groups when the POCUS result was normal and to <6% when it was combined with thyroglobulin results at ablation. CONCLUSION POCUS is useful for detecting PD in N1-PTC patients and for stratifying individual recurrence risk. Its high NPV could allow clinicians to tailor follow-up recommendations to individual needs.
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Affiliation(s)
- Charlotte Lepoutre-Lussey
- Departments of Nuclear MedicineBiostatisticsPathologyEndocrine SurgeryInstitute of Cancer, Pitie-Salpetriere Hospital, Pierre et Marie Curie University, 47-83 Bd de l'hôpital, 75013 Paris, France
| | - Dina Maddah
- Departments of Nuclear MedicineBiostatisticsPathologyEndocrine SurgeryInstitute of Cancer, Pitie-Salpetriere Hospital, Pierre et Marie Curie University, 47-83 Bd de l'hôpital, 75013 Paris, France
| | - Jean-Louis Golmard
- Departments of Nuclear MedicineBiostatisticsPathologyEndocrine SurgeryInstitute of Cancer, Pitie-Salpetriere Hospital, Pierre et Marie Curie University, 47-83 Bd de l'hôpital, 75013 Paris, France
| | - Gilles Russ
- Departments of Nuclear MedicineBiostatisticsPathologyEndocrine SurgeryInstitute of Cancer, Pitie-Salpetriere Hospital, Pierre et Marie Curie University, 47-83 Bd de l'hôpital, 75013 Paris, France
| | - Frédérique Tissier
- Departments of Nuclear MedicineBiostatisticsPathologyEndocrine SurgeryInstitute of Cancer, Pitie-Salpetriere Hospital, Pierre et Marie Curie University, 47-83 Bd de l'hôpital, 75013 Paris, France
| | - Christophe Trésallet
- Departments of Nuclear MedicineBiostatisticsPathologyEndocrine SurgeryInstitute of Cancer, Pitie-Salpetriere Hospital, Pierre et Marie Curie University, 47-83 Bd de l'hôpital, 75013 Paris, France
| | - Fabrice Menegaux
- Departments of Nuclear MedicineBiostatisticsPathologyEndocrine SurgeryInstitute of Cancer, Pitie-Salpetriere Hospital, Pierre et Marie Curie University, 47-83 Bd de l'hôpital, 75013 Paris, France
| | - André Aurengo
- Departments of Nuclear MedicineBiostatisticsPathologyEndocrine SurgeryInstitute of Cancer, Pitie-Salpetriere Hospital, Pierre et Marie Curie University, 47-83 Bd de l'hôpital, 75013 Paris, France
| | - Laurence Leenhardt
- Departments of Nuclear MedicineBiostatisticsPathologyEndocrine SurgeryInstitute of Cancer, Pitie-Salpetriere Hospital, Pierre et Marie Curie University, 47-83 Bd de l'hôpital, 75013 Paris, France
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Kobayashi M, Wakabayashi H, Kayano D, Konishi T, Kojima H, Yoneyama H, Okuda K, Tsushima H, Onoguchi M, Kawai K, Kinuya S. Application of a medium-energy collimator for I-131 imaging after ablation treatment of differentiated thyroid cancer. Ann Nucl Med 2014; 28:551-8. [PMID: 24710758 DOI: 10.1007/s12149-014-0845-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 03/19/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE High-energy (HE) collimators are usually applied for I-131 imaging after ablation treatment of differentiated thyroid cancer (DTC). However, purchase of HE collimators has been avoided in many nuclear medicine departments because the HE collimators are more expensive than other collimators. In this study, we compared the I-131 imaging using HE- and medium-energy (ME) collimators, which is more versatile than HE collimators. MATERIALS AND METHODS To simulate DTC patients with extra-thyroid beds, a phantom of acrylic containers containing I-131 was used. To simulate patients with thyroid beds, four phantoms representing extra-thyroid beds were arranged around the phantom representing normal thyroid tissues. Patients administered 1.11 or 3.70 GBq NaI-131 were also evaluated. Whole-body imaging and SPECT imaging of the phantoms and patients performed using HE-general-purpose (HEGP) and ME-low-penetration (MELP) collimators, and full-width at half maximum (FWHM) and percent coefficient of variation (%CV) were measured. RESULTS In the extra-thyroid beds, FWHM and %CV with MELP were negligibly different from those with HEGP in whole-body imaging. Although FWHM with MELP was a little different from that with HEGP in SPECT imaging, %CV with MELP was significantly higher than that with HEGP. In the thyroid beds, only an extra-thyroid bed including higher radioactivity was identified in whole-body imaging with both collimators. Although SPECT images with MELP could not clarify extra-thyroid beds with low radioactivity, HEGP could identify them. In patients, although some whole-body images with MELP could not detect extra-thyroid beds, whole-body imaging with HEGP and SPECT imaging with both collimators could detect them. CONCLUSIONS Although HEGP is the best collimator for I-131 imaging, MELP is applicable for not only whole-body imaging but also SPECT imaging.
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Affiliation(s)
- Masato Kobayashi
- School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, 920-0942, Japan,
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Spinapolice EG, Chytiris S, Fuccio C, Leporati P, Volpato G, Villani L, Trifirò G, Chiovato L. Pulmonary sequestration: a 131I whole body scintigraphy false-positive result. Ann Nucl Med 2014; 28:683-7. [DOI: 10.1007/s12149-014-0838-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 03/07/2014] [Indexed: 01/21/2023]
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