How [[sup.18]F]FDG-PET/CT Affects the Management of Patients with Differentiated Thyroid Carcinoma in Clinical Routines

• Published in: Cancers 2024-01, Vol.16 (3)
• Main Authors: Vogel, Jonas, Sekler, Julia, Gückel, Brigitte, Pfannenberg, Christina, Nikolaou, Konstantin, La Fougère, Christian, Dittmann, Helmut, Reinert, Christian Philipp
• Format: Article
• Language: English
• Subjects: Cancer; Carcinoma; Care and treatment; Development and progression; Health aspects; PET imaging; Thyroid cancer; Thyroid gland
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers16030588

[[sup.18]F]FDG-PET/CT is a new imaging modality used in routine practice for many tumor diseases. The combination of morphological and metabolic information has demonstrated superiority over pure morphological imaging, significantly impacting treatment decisions and patient outcomes in many tumor entities. However, the role of [[sup.18]F]FDG-PET/CT in differentiated thyroid carcinoma remains unclear. While potential benefits are acknowledged, there is a lack of clear recommendations and guidelines on when to use this imaging technique. Our study aims to evaluate the influence of FDG-PET/CT on decision making in clinical routines. The impact on clinical decision making was evaluated through questionnaires given to referring physicians before and after PET/CT examinations. The results demonstrate a significant influence of [[sup.18]F]FDG-PET/CT on patient management in our cohort, leading to the avoidance of both additional invasive and imaging diagnostics. Therefore, our study suggests that the (clinically indicated) use of PET/CT in differentiated thyroid carcinoma could result in better therapy management and ultimately lead to improved patient outcomes. Purpose: To investigate the impact of [[sup.18]F]FDG-PET/CT on the management of differentiated thyroid carcinoma (DTC) in routine clinical settings. Material and methods: In total, 98 patients (55 females, age 56 ± 18 years) with histologically confirmed thyroid cancer, including all types of DTC and poorly differentiated thyroid cancer (PDTC, n = 7), underwent [[sup.18]F]FDG-PET/CT for staging or recurrence diagnostics performed using a state-of-the art clinical scanner (Biograph mCT, Siemens Healthineers) with a standardized examination protocol. The impact of PET/CT on clinical decision making was prospectively evaluated using standardized questionnaires completed by the referring physicians before and after PET/CT. Patient outcome was analyzed for OS drawn from patient records. Results: Referring physicians were unable to establish a treatment plan for 81% of patients with thyroid cancer in the absence of PET/CT. The use of PET/CT had a notable influence on patient management, leading to the development of a well-defined treatment plan for 92% of patients. Moreover, after PET/CT a change in pre-PET/CT-intended treatments occurred in 32% of cases, and further invasive diagnostic could be waived in 7% of cases. [[sup.18]F]FDG-PET/CT revealed a tumor detection rate of 68% (local tumor: 19%, lymph node m