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Sensitivity and Prognostic Value of Positron Emission Tomography with F-18-Fluorodeoxyglucose and Sensitivity of Immunoscintigraphy in Patients with Medullary Thyroid Carcinoma Treated with Anticarcinoembryonic Antigen-Targeted Radioimmunotherapy

Nuclear Medicine (A.O., C.A., F.K.-B.), Endocrinology (A.M.), and Endocrine Surgery (E.M.) Departments, University Hospital, 44093 Nantes, France; Nuclear Medicine (P.-Y.S., C.R., F.K.-B.) and Statistic (L.C.) Departments, René Gauducheau Cancer Center, 44805 Nantes, France; Nuclear Medicine Department (C.B., F.B.-C.), University Hospital, 69495 Lyon, France; Nuclear Medicine Department (S.B.), François Baclesse Cancer Center, 14076 Caen, France; Nuclear Medicine Department (J.-P.V.), University Hospital, 38043 Grenoble, France; Oncology Research Department (J.B., J.-F.C., F.K.-B.), Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 601, 44093 Nantes, France; and Garden State Cancer Center (D.M.G.), Center for Molecular Medicine and Immunology, Belleville, New Jersey 07109-0023

Address all correspondence and requests for reprints to: Françoise Kraeber-Bodéré, Oncology Research Department, Institut National de la Santé et de la Recherche Médicale U601, Institut de Biologie, 9 quai Moncousu, 44093 Nantes Cedex 1, France. E-mail: francoise.bodere{at}chu-nantes.fr.

Context: Patients with progressive medullary thyroid carcinoma (MTC) undergo multiple imaging procedures for diagnosis of relapse and staging.

Objective: Our objective was to assess the sensitivity and prognostic value of ¹⁸F-2-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET)/computed tomography (CT), and the imaging sensitivity of pretargeted iodine-131-radioimmunotherapy (RIT) in patients with progressive MTC.

Design/Setting/Patients: We performed a prospective multicenter study in high-risk patients with rapidly progressing MTC enrolled in a phase-II pretargeted RIT study, as documented by short serum calcitonin (Ct) or carcinoembryonic antigen (CEA) doubling time (DT).

Interventions/Main Outcome Measures: Patients underwent neck-thoracic-abdominal CT, spine and pelvic magnetic resonance imaging, whole-body post-RIT immunoscintigraphy (IS) with iodine-131, and whole-body ¹⁸F-FDG-PET/CT imaging. Imaging sensitivity and the correlation between FDG uptake and biomarkers DT were evaluated.

Results: A total of 33 patients with mean CEA and Ct DTs of 1.90 yr (range 0.21–8.50) and 1.52 yr (range 0.09–6.01), respectively, were evaluated. Sensitivity of FDG-PET/CT was 83% for neck, 85% for mediastinal, 75% for lung, 60% for liver, and 67% for bone metastases; overall sensitivity was 76%. Median standardized uptake value (SUVmax) was 5.23 (2.06–13.90). SUVmax correlated significantly with Ct DT (P = 0.011) and minimal DT (minimal value between CEA DT and Ct DT) (P = 0.027). Overall sensitivity of post-RIT IS, CT, and bone magnetic resonance imaging were 94, 74, and 85%, respectively.

Conclusions: These results demonstrate the value of FDG-PET/CT for staging of patients with progressive MTC, especially in the neck and mediastinum, with possible prognostication by SUV quantification. Post-RIT IS was the most sensitive of the imaging modalities studied prospectively.