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Diagnostic Accuracy and Prognostic Value of ¹⁸F-FDG PET in Hürthle Cell Thyroid Cancer Patients

¹ Nuclear Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, New York; ² Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; ³ Epidemiology and Biostatistics Department, Memorial Sloan-Kettering Cancer Center, New York, New York; and ⁴ Endocrinology Service, Memorial Sloan-Kettering Cancer Center, New York, New York

Correspondence: For correspondence or reprints contact: Daniel A. Pryma, MD, Department of Radiology, University of Pittsburgh Medical Center, Room E-177, 200 Lothrop St., Pittsburgh, PA 15213. E-mail: prymada{at}upmc.edu

Hürthle cell carcinoma is an uncommon and occasionally aggressive differentiated thyroid cancer associated with increased mortality compared with other differentiated thyroid malignancies. Because it generally has lower iodine avidity, ¹⁸F-FDG PET has been suggested as a more accurate imaging modality. However, there is limited information with regard to the true diagnostic accuracy and prognostic value of ¹⁸F-FDG PET in this disease. Methods: All patients with Hürthle cell thyroid cancer who underwent their first ¹⁸F-FDG PET scan between May 1996 and February 2003 were identified retrospectively. ¹⁸F-FDG PET scans were reviewed and compared with all available imaging studies, including CT, ultrasound, and radioiodine scintigraphy (RIS). Abnormal ¹⁸F-FDG uptake was assessed visually and by measuring the maximum standardized uptake value (SUVmax) of the most intense lesion. Clinical follow-up for at least 1 y or until death was required for inclusion. Results: Forty-four patients met inclusion criteria. The median follow-up was 2.9 y. There were 24 positive and 20 negative ¹⁸F-FDG PET scans with 1 false-positive and 1 false-negative study, resulting in a diagnostic sensitivity of 95.8% and a specificity of 95%. In 5 of 11 patients who had both positive CT and ¹⁸F-FDG PET findings, ¹⁸F-FDG PET revealed additional sites of disease. Furthermore, ¹⁸F-FDG PET correctly classified as negative 3 patients with false-positive CT findings. In 3 of 6 patients with positive RIS, ¹⁸F-FDG PET revealed additional sites of metastatic disease. Ten patients with positive ¹⁸F-FDG PET had negative RIS. Only 1 patient with negative ¹⁸F-FDG PET had positive RIS. The SUVmax also provided prognostic information: In a stepwise fashion, each increase in intensity by SUVmax unit was associated with a 6% increase in mortality (P < 0.001). The 5-y overall survival in patients with SUVmax < 10 was 92%; it declined to 64% in those with SUVmax > 10 (P < 0.01). Conclusion: ¹⁸F-FDG PET has excellent diagnostic accuracy in Hürthle cell thyroid cancer patients, improving on CT and RIS. Intense ¹⁸F-FDG uptake in lesions is an indicator of a poor prognosis. Our data suggest that all patients with Hürthle cell thyroid cancer should undergo ¹⁸F-FDG PET as part of their initial postoperative staging and periodically to screen for occult recurrence, particularly in patients with elevated serum thyroglobulin.

Key Words: thyroid cancer • ¹⁸F-FDG PET • Hürthle cell thyroid cancer • CT • radioactive iodine scintigraphy

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