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FDG-PET performed concurrently with initial I-131 ablation for differentiated thyroid cancer

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Abstract

Objective

Differentiated thyroid cancers (DTCs) are commonly treated by total thyroidectomy followed by I-131 radioiodine ablation to eradicate any residual thyroid tissue and to detect any metastatic lesions on post-treatment whole body scans (TxWBS). However, some DTCs do not trap iodine, resulting in negative whole body scanning. Fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) has proven to be a valuable diagnostic technique for detecting many types of malignant tumors and metastases. The purpose of this study was to evaluate FDG-PET performed concurrently with initial I-131 ablation for its ability to detect lymph node metastasis and for its role in the management of DTC patients.

Methods

A total of 54 patients (16 males and 38 females; median age = 50 years) with histologically proven DTC underwent both FDG-PET and subsequent I-131 ablation. A dose of 3.7 GBq I-131 was administered to 51 patients, 2.96 GBq was administered to 1 patient, and 2.22 GBq was administered to 2 patients. FDG-PET or PET/CT was performed 3–4 days prior to ablation. TxWBS was conducted 1 week after therapy. FDG-PET scans and TxWBS were interpreted by consensus of 2 experienced radiologists. Serum thyroglobulin (Tg) levels at 3–6 months after ablation were compared between PET-positive and PET-negative patients.

Results

FDG-PET was positive in 25 sites (thyroid bed: n = 9; cervical lymph nodes: n = 12; mediastinal lymph nodes: n = 3; and axillary lymph nodes: n = 1) of 18 patients (33%). Only 5 of 16 lymph nodes (31%) that were PET-positive were also positive on TxWBS. The success rate of Tg-negative after ablation was significantly lower for patients with PET-positive scans than for those with PET-negative scans (p = 0.026).

Conclusions

FDG-PET performed concurrently with I-131 ablation can detect lymph node metastases in which radioiodine does not accumulate and may influence the management and treatment options for DTC patients.

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Authors and Affiliations

  1. Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya, 466-8550, Japan

    Shingo Iwano, Shinji Ito, Kenichi Tsuchiya & Shinji Naganawa

  2. Department of Radiological Technology, Nagoya University School of Health Sciences, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya, 461-8673, Japan

    Katsuhiko Kato

Authors
  1. Shingo Iwano
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  2. Katsuhiko Kato
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  3. Shinji Ito
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  4. Kenichi Tsuchiya
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  5. Shinji Naganawa
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Correspondence to Shingo Iwano.

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Iwano, S., Kato, K., Ito, S. et al. FDG-PET performed concurrently with initial I-131 ablation for differentiated thyroid cancer. Ann Nucl Med 26, 207–213 (2012). https://doi.org/10.1007/s12149-011-0559-y

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  • DOI: https://doi.org/10.1007/s12149-011-0559-y

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