García-Callejo FJ, Redondo-Martínez J, Pérez-Carbonell T, Martínez-Beneyto MP, Monzó-Gandía R, Pellicer-Zoghbi V

Language: Spanish
References: 0
Page: 28-41
PDF size: 156.81 Kb.

ABSTRACT

Background: Differentiated thyroid carcinomas (DTC) have got ability for regional recurrence that must be not underestimated. Detection of thyroglobulin (TGB) may be not useful if the organism synthesizes autoantibodies, and there is no consensus about the image technique of choice.
Objetive: To investigate the added clinical value of PET-CT with 18F-FDG in defining the recurrence of the disease in patients who show ultrasonography or I131 whole body scintigraphy with uncertain results.
Patients and Method: A retrospective study was done following-up patients with DTC from 2001 to 2016. Therapy in all of them was surgery and I131 afterwards. The increase in TGB levels was suggestive of recurrence. The whole group underwent a thorough neck exploration, and a fine needle aspiration (FNA), ultrasonography and PET-CT were always done. The histopathologic result after the rescue surgery allowed the analysis of positive and negative false for each technique, as well as their sensitivity and positive predictive value.
Results: Twenty-four patients were included. Neck exploration was suggestive of recurrence in 10 cases, FNA identified metastases in 15, the ultrasonography showed abnormalities in 19 and the PET-CT detected significant uptake –considering a 2.5 cutoff SUVmax value– in 18. As a result, the sensitivity, positive predictive value and accuracy were 82%, 78% and 71%, respectively. FNA and ultrasonography jointly altered showed indexes of 85%, 61% and 62.5%, respectively, exactly the same average that the association between a positive FNA and PET-CT with pathologic uptake. Physical neck exam was the diagnostic tool with the higher sensitivity –90%–, but a poorer accuracy –59%–.
Conclusions: Detection of recurrence in DTC with PET-CT shows a mild achievement compared to ultrasonography, but both presented similar diagnostic values when carried on concomitant to the practice of a FNA.