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Technetium-99m-Furifosmin in the Follow-Up of Differentiated Thyroid Carcinoma

Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Essen, Essen, Germany

Correspondence: For correspondence or reprints contact: K Brandt-Mainz, MD, Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Essen, Hufelandtr.55, D-45122 Essen, Germany.

ABSTRACT

Tumor scintigraphy with flow tracers, such as ²⁰¹Tl-chloride, has an established role in the follow-up of differentiated thyroid cancer. We investigated a new tracer, ^99mTc-furifosmin (Technescan Q12, Mallinckrodt Diagnostika, Hennef, Germany), in patients with elevated thyroglobulin levels or sonographic suspicion of lymph node metastases or recurrent disease. Methods: In a prospective study, we examined 20 patients with ^99mTc-furifosmin. All patients under went a ¹⁸F-fluorodeoxyglucose (FDG) PET scan of the neck and chest Positive ^99mTc-furifosmin findings were validated by biopsy, ¹³¹I scan, CT or ¹⁸F-FDG PET examinations. Results: In three patients with cervical lymph node metastases detected on a planar ^99mTc-furifosmin scan, we found a rapid tracer accumulation in the tumor (maximum < 2 min) and a significant washout in 2 of 3 patients after 4 hr. The visual contrast and the tumor-to-nontumor ratio was rather poor (average 1.2:1). In 3 additional patients, 3 pulmonary and 2 mediastinal lymph node metastases were detected by the ^99mTc-furifosmin SPECT scan. Two patients were true-negative, and in 13 of 18 patients, the tumor could be localized by ¹⁸F-FDG PET (10 cervical, 6 mediastinal, 4 pulmonary metastases, 1 bone metastasis); 5 patients were false-negative. In 3 of these false-negative cases we could not localize the tumor with other diagnostic methods. Two patients had a true-negative PET examination. Conclusion: The statistical analysis of our data on ^99mTc furifosmin reveals that the sensitivity and 95% confidence interval of 33% (11–56%)on a patient-by-patient basis and of 34% (17%–57%) for the lesion-by-lesion analysis is significantly lower than the sensitivity and 95% confidence interval of 72% (50%–89%)on a patient-by-patient basis and of 91% (78%–100%)on lesion-by lesion basis for ¹⁸F-FDG. The sensitivity of ^99mTc-furifosmin appears to be poor,even for cervical and mediastinal tumor manifestations where the value of ²⁰¹Tl-chloride is established.

Key Words: technetium-99m-furifosmin • differentiated thyroid carcinoma • fluorine-18-fluorodeoxyglucose • PET

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