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European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 8/2014

01-08-2014 | Original Article

18F-FDG uptake as a prognostic variable in primary differentiated thyroid cancer incidentally detected by PET/CT: a multicentre study

Authors: Arnoldo Piccardo, Matteo Puntoni, Francesco Bertagna, Giorgio Treglia, Luca Foppiani, Federico Arecco, Raffaele Giubbini, Mehrdad Naseri, Angelina Cistaro, Manlio Cabria, Francesca Bardesono, Luca Ceriani, Fabio Orlandi, Luca Giovanella

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 8/2014

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Abstract

Purpose

Our aim was to investigate the association between 18F-fluorodeoxyglucose (FDG) uptake and event-free survival in patients in whom a differentiated thyroid cancer (DTC) was detected by 18F-FDG positron emission tomography (PET)/CT.

Methods

Among 884 focal 18F-FDG PET thyroid incidentalomas referred to our 4 Nuclear Medicine Departments, we investigated 54 patients in whom a DTC was confirmed and a clinical follow-up was available. The ratio between maximum standardized uptake value (SUVmax) of DTC and SUVmean of the liver (SUV ratio) was recorded for each scan. All patients underwent total thyroidectomy and 131I remnant ablation. After a median follow-up of 39 months we assessed the outcome. The association between disease persistence/progression, 18F-FDG uptake and other risk factors (T, N, M and histological subtype) was evaluated through univariate and multivariate analyses.

Results

Of the 54 patients, 39 achieved complete remission. The remaining 15 showed persistence/progression of disease. High 18F-FDG uptake, i.e. SUV ratio ≥3, showed a low positive predictive value (48 %). Low 18F-FDG uptake (SUV ratio < 3) displayed a high negative predictive value (93 %). The median of SUV ratios in T1–T2 (2.2), in M0 (2.7) and in non-virulent subtypes (2.7) were significantly lower (p < 0.03) than in T3–T4 (5.0), M1 (7.3) and virulent subtypes (6.0). Kaplan-Maier analysis showed a significant association between high 18F-FDG uptake and disease persistence/progression (p = 0.001). When we adjusted risk estimates by using a multivariate Cox model, only T (p = 0.05) remained independently associated with disease persistence/progression.

Conclusion

An intense 18F-FDG uptake of the primary DTC is associated with persistence/progression of disease. However, when all other prognostic factors have been taken into account, 18F-FDG uptake does not add further prognostic information.
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Metadata
Title
18F-FDG uptake as a prognostic variable in primary differentiated thyroid cancer incidentally detected by PET/CT: a multicentre study
Authors
Arnoldo Piccardo
Matteo Puntoni
Francesco Bertagna
Giorgio Treglia
Luca Foppiani
Federico Arecco
Raffaele Giubbini
Mehrdad Naseri
Angelina Cistaro
Manlio Cabria
Francesca Bardesono
Luca Ceriani
Fabio Orlandi
Luca Giovanella
Publication date
01-08-2014
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 8/2014
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-014-2774-y

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