This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wang, W. Articles by Robbins, R. J. Search for Related Content PubMed PubMed Citation Articles by Wang, W. Articles by Robbins, R. J.

[¹⁸F]-2-Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography Localizes Residual Thyroid Cancer in Patients with Negative Diagnostic ¹³¹I Whole Body Scans and Elevated Serum Thyroglobulin Levels

Nuclear Medicine and Endocrinology Services, Departments of Radiology, Pathology, and Medicine, The Laurent and Alberta Gerschel Positron Emission Tomography Center, Memorial Sloan-Kettering Cancer Center, New York, New York 10021

Address all correspondence and requests for reprints to: Richard J. Robbins, M.D., Endocrinology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021. E-mail: robbinsr{at}mskcc.org

Progressive dedifferentiation of thyroid cancer cells leads to a loss of iodine-concentrating ability, with resultant false negative, whole body radioactive iodine scans in approximately 20% of all differentiated metastatic thyroid cancer lesions. We tested the hypothesis that all metastatic thyroid cancer lesions that did not concentrate iodine, but did produce thyroglobulin (Tg), could be localized by [¹⁸F]2-fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET). We performed FDG-PET on 37 patients with differentiated thyroid cancer after surgery and radioiodine ablation who had negative diagnostic ¹³¹I whole body scans during routine follow-up. Serum Tg, Tg autoantibodies, neck ultrasounds, and other clinically indicated imaging procedures were performed to detect residual disease. In those with elevated Tg levels, FDG-PET localized occult disease in 71%, was false positive in one, and was false negative in five patients. The majority of false negative FDG-PET occurred in patients with minimal cervical adenopathy. Surgical resections, biopsies, ¹³¹I therapy, and differentiation therapy were performed based on the PET results. The FDG-PET result changed the clinical management in 19 of the 37 patients. In patients with elevated Tg levels, FDG-PET had a positive predictive value of 92%. In patients with low Tg levels, FDG-PET had a negative predictive value of 93%. No FDG-PET scans were positive in stage I patients; however, they were always positive in stage IV patients with elevated Tg levels. An elevated TSH level (i.e. hypothyroidism) did not increase the ability to detect lesions. FDG-PET is able to localize residual thyroid cancer lesions in patients who have negative diagnostic ¹³¹I whole body scans and elevated Tg levels, although it was not sensitive enough to detect minimal residual disease in cervical nodes.

This article has been cited by other articles:

				S. E. Finkelstein, P. W. Grigsby, B. A. Siegel, F. Dehdashti, J. F. Moley, and B. L. Hall Combined [18F]Fluorodeoxyglucose Positron Emission Tomography and Computed Tomography (FDG-PET/CT) for Detection of Recurrent, 131I-Negative Thyroid Cancer Ann. Surg. Oncol., January 1, 2008; 15(1): 286 - 292. [Abstract] [Full Text] [PDF]

				T. M. Blodgett, C. C. Meltzer, and D. W. Townsend PET/CT: Form and Function Radiology, February 1, 2007; 242(2): 360 - 385. [Abstract] [Full Text] [PDF]

				M. Ahmed, M. Aslam, J. Ahmed, H. A. Faraz, A. Almahfouz, A. A. Arifi, H. Raef, and F. A. Dayel Renal metastases from thyroid cancer masquerading as renal angiomyolipoma on ultrasonography. J. Ultrasound Med., November 1, 2006; 25(11): 1459 - 1464. [Full Text] [PDF]

				D. Blaser, S. Maschauer, T. Kuwert, and O. Prante In Vitro Studies on the Signal Transduction of Thyroidal Uptake of 18F-FDG and 131I-Iodide J. Nucl. Med., August 1, 2006; 47(8): 1382 - 1388. [Abstract] [Full Text] [PDF]

				F. Pacini, M. Schlumberger, H. Dralle, R. Elisei, J. W A Smit, W. Wiersinga, and the European Thyroid Cancer Taskforce European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur. J. Endocrinol., June 1, 2006; 154(6): 787 - 803. [Full Text] [PDF]

				H. Palmedo, J. Bucerius, A. Joe, H. Strunk, N. Hortling, S. Meyka, R. Roedel, M. Wolff, E. Wardelmann, H.-J. Biersack, et al. Integrated PET/CT in Differentiated Thyroid Cancer: Diagnostic Accuracy and Impact on Patient Management J. Nucl. Med., April 1, 2006; 47(4): 616 - 624. [Abstract] [Full Text] [PDF]

				M. E. Juweid and B. D. Cheson Positron-Emission Tomography and Assessment of Cancer Therapy N. Engl. J. Med., February 2, 2006; 354(5): 496 - 507. [Full Text] [PDF]

				R. J. Robbins, Q. Wan, R. K. Grewal, R. Reibke, M. Gonen, H. W. Strauss, R. M. Tuttle, W. Drucker, and S. M. Larson Real-Time Prognosis for Metastatic Thyroid Carcinoma Based on 2-[18F]Fluoro-2-Deoxy-D-Glucose-Positron Emission Tomography Scanning J. Clin. Endocrinol. Metab., February 1, 2006; 91(2): 498 - 505. [Abstract] [Full Text] [PDF]

				E. L. Mazzaferri Empirically Treating High Serum Thyroglobulin Levels J. Nucl. Med., July 1, 2005; 46(7): 1079 - 1088. [Full Text] [PDF]

				T. Y. Kim, W. B. Kim, E. S. Kim, J. S. Ryu, J. S. Yeo, S. C. Kim, S. J. Hong, and Y. K. Shong Serum Thyroglobulin Levels at the Time of 131I Remnant Ablation Just after Thyroidectomy Are Useful for Early Prediction of Clinical Recurrence in Low-Risk Patients with Differentiated Thyroid Carcinoma J. Clin. Endocrinol. Metab., March 1, 2005; 90(3): 1440 - 1445. [Abstract] [Full Text] [PDF]

				R. J. Robbins and M. J. Schlumberger The Evolving Role of 131I for the Treatment of Differentiated Thyroid Carcinoma J. Nucl. Med., January 1, 2005; 46(1_suppl): 28S - 37S. [Abstract] [Full Text] [PDF]

				K. Pacak, G. Eisenhofer, and D. S. Goldstein Functional Imaging of Endocrine Tumors: Role of Positron Emission Tomography Endocr. Rev., August 1, 2004; 25(4): 568 - 580. [Abstract] [Full Text] [PDF]

				E. M. Rohren, T. G. Turkington, and R. E. Coleman Clinical Applications of PET in Oncology Radiology, May 1, 2004; 231(2): 305 - 332. [Abstract] [Full Text] [PDF]

				N Khan, N Oriuchi, T Higuchi, H Zhang, and K Endo PET in the follow-up of differentiated thyroid cancer Br. J. Radiol., October 1, 2003; 76(910): 690 - 695. [Abstract] [Full Text] [PDF]

				R. J. Robbins and A. K. Robbins Recombinant Human Thyrotropin and Thyroid Cancer Management J. Clin. Endocrinol. Metab., May 1, 2003; 88(5): 1933 - 1938. [Full Text] [PDF]

				M N Maisey Overview of clinical PET Br. J. Radiol., November 1, 2002; 75(90009): S1 - 5. [Full Text] [PDF]

				R. J. Robbins, J. T. Chon, M. Fleisher, S. M. Larson, and R. M. Tuttle Is the Serum Thyroglobulin Response to Recombinant Human Thyrotropin Sufficient, by Itself, to Monitor for Residual Thyroid Carcinoma? J. Clin. Endocrinol. Metab., July 1, 2002; 87(7): 3242 - 3247. [Abstract] [Full Text] [PDF]

				S E M Clarke and S C Rankin The thyroid gland Imaging, April 1, 2002; 14(2): 103 - 114. [Abstract] [Full Text] [PDF]

				B. O. Helal, P. Merlet, M.-E. Toubert, B. Franc, C. Schvartz, H. Gauthier-Koelesnikov, A. Prigent, and A. Syrota Clinical Impact of 18F-FDG PET in Thyroid Carcinoma Patients with Elevated Thyroglobulin Levels and Negative 131I Scanning Results After Therapy J. Nucl. Med., October 1, 2001; 42(10): 1464 - 1469. [Abstract] [Full Text] [PDF]

				S E M Clarke Advances in radionuclide imaging: radionuclide imaging as a guide to therapy Imaging, September 1, 2001; 13(3): 171 - 184. [Abstract] [Full Text] [PDF]

				L. Hooft, O. S. Hoekstra, W. Deville, P. Lips, G. J. J. Teule, M. Boers, and M. W. van Tulder Diagnostic Accuracy of 18F-Fluorodeoxyglucose Positron Emission Tomography in the Follow-Up of Papillary or Follicular Thyroid Cancer J. Clin. Endocrinol. Metab., August 1, 2001; 86(8): 3779 - 3786. [Abstract] [Full Text] [PDF]

				S. S. Gambhir, J. Czernin, J. Schwimmer, D. H. S. Silverman, R. E. Coleman, and M. E. Phelps A Tabulated Summary of the FDG PET Literature J. Nucl. Med., May 1, 2001; 42(90050): 1S - 93. [Full Text] [PDF]

				R. J. Robbins, R. M. Tuttle, R. N. Sharaf, S. M. Larson, H. K. Robbins, R. A. Ghossein, A. Smith, and W. D. Drucker Preparation by Recombinant Human Thyrotropin or Thyroid Hormone Withdrawal Are Comparable for the Detection of Residual Differentiated Thyroid Carcinoma J. Clin. Endocrinol. Metab., February 1, 2001; 86(2): 619 - 625. [Abstract] [Full Text]

				B. Schluter, K. H. Bohuslavizki, W. Beyer, M. Plotkin, R. Buchert, and M. Clausen Impact of FDG PET on Patients with Differentiated Thyroid Cancer Who Present with Elevated Thyroglobulin and Negative 131I Scan J. Nucl. Med., January 1, 2001; 42(1): 71 - 76. [Abstract] [Full Text] [PDF]

				H. A. Macapinlac Clinical Usefulness of FDG PET in Differentiated Thyroid Cancer J. Nucl. Med., January 1, 2001; 42(1): 77 - 78. [Full Text] [PDF]

				F. Grunwald and H.-J. Biersack FDG PET in Thyroid Cancer: Thyroxine or Not? J. Nucl. Med., December 1, 2000; 41(12): 1996 - 1998. [Full Text] [PDF]

				M. van Tol, P. L. Jager, R. P. F. Dullaart, and T. P. Links Follow-Up in Patients with Differentiated Thyroid Carcinoma with Positive 18F-Fluoro-2-Deoxy- D-Glucose-Positron Emission Tomography Results, Elevated Thyroglobulin Levels, and Negative High-Dose 131I Posttreatment Whole Body Scans J. Clin. Endocrinol. Metab., May 1, 2000; 85(5): 2082a - 2083. [Full Text]

				W. Wang, S. M. Larson, M. Fazzari, S. K. Tickoo, K. Kolbert, G. Sgouros, H. Yeung, H. Macapinlac, J. Rosai, and R. J. Robbins Prognostic Value of [18F]Fluorodeoxyglucose Positron Emission Tomographic Scanning in Patients with Thyroid Cancer J. Clin. Endocrinol. Metab., March 1, 2000; 85(3): 1107 - 1113. [Abstract] [Full Text]