18-Fluorodeoxyglucose Positron Emission Tomography in the Early Diagnostic Workup of Differentiated Thyroid Cancer Patients with a Negative Post-Therapeutic Iodine Scan and Detectable Thyroglobulin

Deborah van Dijk; John T. M. Plukker; Ha T. T. Phan; Anneke C. Muller Kobold; Anouk N. A. van der Horst-Schrivers; Liesbeth Jansen; Wim J. Sluiter; Adrienne H. Brouwers; Thera P. Links

doi:10.1089/thy.2012.0498

18-Fluorodeoxyglucose Positron Emission Tomography in the Early Diagnostic Workup of Differentiated Thyroid Cancer Patients with a Negative Post-Therapeutic Iodine Scan and Detectable Thyroglobulin

Deborah van Dijk, John T. M. Plukker, Ha T. T. Phan, Anneke C. Muller Kobold, Anouk N. A. van der Horst-Schrivers, Liesbeth Jansen, Wim J. Sluiter, Adrienne H. Brouwers, Thera P. Links^*

^*Corresponding author for this work

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Abstract

Background: Surgery and high-dose radioactive iodine (I-131) treatment are the cornerstones in the treatment of differentiated thyroid cancer. Patients without I-131 uptake on the post-therapeutic whole body scan (WBS), but with detectable thyroglobulin (Tg) during thyroxine withdrawal (Tg-off), are evaluated with an 18-fluorodeoxyglucose positron emission tomography (F-18-FDG-PET) for tumor localization within three months. The yield of F-18-FDG-PET imaging and clinical usefulness of a Tg-off cutoff value to predict a positive scan were assessed.

Methods: From 2002 to 2011, 52 patients with a negative WBS and concurrent detectable Tg-off were evaluated. Thirty-five PET scans were performed during initial treatment, 17 after recurrent disease. Thirty-two patients were on substitution therapy, 17 were evaluated with endogenous thyrotropin elevation, and 3 after recombinant human thyrotropin stimulation. To determine the Tg-off cutoff value, a receiver operating characteristic curve was used.

Results: Nine (17%) F-18-FDG-PET scans were true positive, 3 (6%) false positive, 36 (69%) true negative, and 4 (8%) false negative (sensitivity 69%, specificity 92%). In 13%, a true-positive scan resulted in a change in the clinical management. The area under the receiver operating characteristic curve is 0.82 [CI 0.64-0.99] (p <0.01), and the Tg-off cutoff value is 38.00 ng/mL (sensitivity 67%, specificity 95%). Ninety percent of F-18-FDG-PET true-positive patients had a Tg-off >2.00 ng/mL.

Conclusions: An F-18-FDG-PET within three months after a negative WBS with detectable Tg-off showed additional tumor localization in 17% of the patients, leading to a change in clinical management in 13%. A clinically useful Tg-off cutoff value was not found, but 90% of positive F-18-FDG-PET scans occurred in patients with a Tg-off >2.00 ng/mL.

Original language	English
Pages (from-to)	1003-1009
Number of pages	7
Journal	Thyroid
Volume	23
Issue number	8
DOIs	https://doi.org/10.1089/thy.2012.0498
Publication status	Published - 21-Aug-2013

Keywords

RECOMBINANT HUMAN THYROTROPIN
SERUM THYROGLOBULIN
FOLLOW-UP
HORMONE WITHDRAWAL
I-131 SCAN
FDG PET
CARCINOMA
PAPILLARY
IMPACT
THERAPY

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18-Fluorodeoxyglucose Positron Emission Tomography in the Early Diagnostic Workup of Differentiated Thyroid Cancer Patients with a Negative Post-Therapeutic Iodine Scan and Detectable ThyroglobulinFinal publisher's version, 288 KBLicence: Unspecified

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van Dijk, D., Plukker, J. T. M., Phan, H. T. T., Kobold, A. C. M., van der Horst-Schrivers, A. N. A., Jansen, L., Sluiter, W. J., Brouwers, A. H., & Links, T. P. (2013). 18-Fluorodeoxyglucose Positron Emission Tomography in the Early Diagnostic Workup of Differentiated Thyroid Cancer Patients with a Negative Post-Therapeutic Iodine Scan and Detectable Thyroglobulin. Thyroid, 23(8), 1003-1009. https://doi.org/10.1089/thy.2012.0498

@article{917f15d541ec4a1e834e04fefec157a6,

title = "18-Fluorodeoxyglucose Positron Emission Tomography in the Early Diagnostic Workup of Differentiated Thyroid Cancer Patients with a Negative Post-Therapeutic Iodine Scan and Detectable Thyroglobulin",

abstract = "Background: Surgery and high-dose radioactive iodine (I-131) treatment are the cornerstones in the treatment of differentiated thyroid cancer. Patients without I-131 uptake on the post-therapeutic whole body scan (WBS), but with detectable thyroglobulin (Tg) during thyroxine withdrawal (Tg-off), are evaluated with an 18-fluorodeoxyglucose positron emission tomography (F-18-FDG-PET) for tumor localization within three months. The yield of F-18-FDG-PET imaging and clinical usefulness of a Tg-off cutoff value to predict a positive scan were assessed.Methods: From 2002 to 2011, 52 patients with a negative WBS and concurrent detectable Tg-off were evaluated. Thirty-five PET scans were performed during initial treatment, 17 after recurrent disease. Thirty-two patients were on substitution therapy, 17 were evaluated with endogenous thyrotropin elevation, and 3 after recombinant human thyrotropin stimulation. To determine the Tg-off cutoff value, a receiver operating characteristic curve was used.Results: Nine (17%) F-18-FDG-PET scans were true positive, 3 (6%) false positive, 36 (69%) true negative, and 4 (8%) false negative (sensitivity 69%, specificity 92%). In 13%, a true-positive scan resulted in a change in the clinical management. The area under the receiver operating characteristic curve is 0.82 [CI 0.64-0.99] (p <0.01), and the Tg-off cutoff value is 38.00 ng/mL (sensitivity 67%, specificity 95%). Ninety percent of F-18-FDG-PET true-positive patients had a Tg-off >2.00 ng/mL.Conclusions: An F-18-FDG-PET within three months after a negative WBS with detectable Tg-off showed additional tumor localization in 17% of the patients, leading to a change in clinical management in 13%. A clinically useful Tg-off cutoff value was not found, but 90% of positive F-18-FDG-PET scans occurred in patients with a Tg-off >2.00 ng/mL.",

keywords = "RECOMBINANT HUMAN THYROTROPIN, SERUM THYROGLOBULIN, FOLLOW-UP, HORMONE WITHDRAWAL, I-131 SCAN, FDG PET, CARCINOMA, PAPILLARY, IMPACT, THERAPY",

author = "{van Dijk}, Deborah and Plukker, {John T. M.} and Phan, {Ha T. T.} and Kobold, {Anneke C. Muller} and {van der Horst-Schrivers}, {Anouk N. A.} and Liesbeth Jansen and Sluiter, {Wim J.} and Brouwers, {Adrienne H.} and Links, {Thera P.}",

year = "2013",

month = aug,

day = "21",

doi = "10.1089/thy.2012.0498",

language = "English",

volume = "23",

pages = "1003--1009",

journal = "Thyroid",

issn = "1050-7256",

publisher = "MARY ANN LIEBERT, INC",

number = "8",

}

van Dijk, D, Plukker, JTM, Phan, HTT, Kobold, ACM , van der Horst-Schrivers, ANA , Jansen, L, Sluiter, WJ, Brouwers, AH & Links, TP 2013, '18-Fluorodeoxyglucose Positron Emission Tomography in the Early Diagnostic Workup of Differentiated Thyroid Cancer Patients with a Negative Post-Therapeutic Iodine Scan and Detectable Thyroglobulin', Thyroid, vol. 23, no. 8, pp. 1003-1009. https://doi.org/10.1089/thy.2012.0498

18-Fluorodeoxyglucose Positron Emission Tomography in the Early Diagnostic Workup of Differentiated Thyroid Cancer Patients with a Negative Post-Therapeutic Iodine Scan and Detectable Thyroglobulin. / van Dijk, Deborah; Plukker, John T. M.; Phan, Ha T. T. et al.
In: Thyroid, Vol. 23, No. 8, 21.08.2013, p. 1003-1009.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - 18-Fluorodeoxyglucose Positron Emission Tomography in the Early Diagnostic Workup of Differentiated Thyroid Cancer Patients with a Negative Post-Therapeutic Iodine Scan and Detectable Thyroglobulin

AU - van Dijk, Deborah

AU - Plukker, John T. M.

AU - Phan, Ha T. T.

AU - Kobold, Anneke C. Muller

AU - van der Horst-Schrivers, Anouk N. A.

AU - Jansen, Liesbeth

AU - Sluiter, Wim J.

AU - Brouwers, Adrienne H.

AU - Links, Thera P.

PY - 2013/8/21

Y1 - 2013/8/21

N2 - Background: Surgery and high-dose radioactive iodine (I-131) treatment are the cornerstones in the treatment of differentiated thyroid cancer. Patients without I-131 uptake on the post-therapeutic whole body scan (WBS), but with detectable thyroglobulin (Tg) during thyroxine withdrawal (Tg-off), are evaluated with an 18-fluorodeoxyglucose positron emission tomography (F-18-FDG-PET) for tumor localization within three months. The yield of F-18-FDG-PET imaging and clinical usefulness of a Tg-off cutoff value to predict a positive scan were assessed.Methods: From 2002 to 2011, 52 patients with a negative WBS and concurrent detectable Tg-off were evaluated. Thirty-five PET scans were performed during initial treatment, 17 after recurrent disease. Thirty-two patients were on substitution therapy, 17 were evaluated with endogenous thyrotropin elevation, and 3 after recombinant human thyrotropin stimulation. To determine the Tg-off cutoff value, a receiver operating characteristic curve was used.Results: Nine (17%) F-18-FDG-PET scans were true positive, 3 (6%) false positive, 36 (69%) true negative, and 4 (8%) false negative (sensitivity 69%, specificity 92%). In 13%, a true-positive scan resulted in a change in the clinical management. The area under the receiver operating characteristic curve is 0.82 [CI 0.64-0.99] (p <0.01), and the Tg-off cutoff value is 38.00 ng/mL (sensitivity 67%, specificity 95%). Ninety percent of F-18-FDG-PET true-positive patients had a Tg-off >2.00 ng/mL.Conclusions: An F-18-FDG-PET within three months after a negative WBS with detectable Tg-off showed additional tumor localization in 17% of the patients, leading to a change in clinical management in 13%. A clinically useful Tg-off cutoff value was not found, but 90% of positive F-18-FDG-PET scans occurred in patients with a Tg-off >2.00 ng/mL.

AB - Background: Surgery and high-dose radioactive iodine (I-131) treatment are the cornerstones in the treatment of differentiated thyroid cancer. Patients without I-131 uptake on the post-therapeutic whole body scan (WBS), but with detectable thyroglobulin (Tg) during thyroxine withdrawal (Tg-off), are evaluated with an 18-fluorodeoxyglucose positron emission tomography (F-18-FDG-PET) for tumor localization within three months. The yield of F-18-FDG-PET imaging and clinical usefulness of a Tg-off cutoff value to predict a positive scan were assessed.Methods: From 2002 to 2011, 52 patients with a negative WBS and concurrent detectable Tg-off were evaluated. Thirty-five PET scans were performed during initial treatment, 17 after recurrent disease. Thirty-two patients were on substitution therapy, 17 were evaluated with endogenous thyrotropin elevation, and 3 after recombinant human thyrotropin stimulation. To determine the Tg-off cutoff value, a receiver operating characteristic curve was used.Results: Nine (17%) F-18-FDG-PET scans were true positive, 3 (6%) false positive, 36 (69%) true negative, and 4 (8%) false negative (sensitivity 69%, specificity 92%). In 13%, a true-positive scan resulted in a change in the clinical management. The area under the receiver operating characteristic curve is 0.82 [CI 0.64-0.99] (p <0.01), and the Tg-off cutoff value is 38.00 ng/mL (sensitivity 67%, specificity 95%). Ninety percent of F-18-FDG-PET true-positive patients had a Tg-off >2.00 ng/mL.Conclusions: An F-18-FDG-PET within three months after a negative WBS with detectable Tg-off showed additional tumor localization in 17% of the patients, leading to a change in clinical management in 13%. A clinically useful Tg-off cutoff value was not found, but 90% of positive F-18-FDG-PET scans occurred in patients with a Tg-off >2.00 ng/mL.

KW - RECOMBINANT HUMAN THYROTROPIN

KW - SERUM THYROGLOBULIN

KW - FOLLOW-UP

KW - HORMONE WITHDRAWAL

KW - I-131 SCAN

KW - FDG PET

KW - CARCINOMA

KW - PAPILLARY

KW - IMPACT

KW - THERAPY

U2 - 10.1089/thy.2012.0498

DO - 10.1089/thy.2012.0498

M3 - Article

SN - 1050-7256

VL - 23

SP - 1003

EP - 1009

JO - Thyroid

JF - Thyroid

IS - 8

ER -

18-Fluorodeoxyglucose Positron Emission Tomography in the Early Diagnostic Workup of Differentiated Thyroid Cancer Patients with a Negative Post-Therapeutic Iodine Scan and Detectable Thyroglobulin

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Keywords

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