The Role of Positron Emission Tomography/Computed Tomography in the Management of Recurrent Papillary Thyroid Carcinoma

• Published in: The Laryngoscope 2005-02, Vol.115 (2), p.237-243
• Main Authors: Nahas, Zayna, Goldenberg, David, Fakhry, Carol, Ewertz, Marjorie, Zeiger, Martha, Ladenson, Paul W., Wahl, Richard, Tufano, Ralph P.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Carcinoma, Papillary - blood; Carcinoma, Papillary - diagnostic imaging; Endocrinopathies; Female; Humans; Image Processing, Computer-Assisted; Male; Medical sciences; Middle Aged; Neoplasm Recurrence, Local - blood; Neoplasm Recurrence, Local - diagnostic imaging; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Otorhinolaryngology. Stomatology; papillary thyroid carcinoma; positron emission tomography with radiolabeled glucose analogue 2-flouro-2-deoxy-D-glucose; Positron emission tomography/computed tomography; Positron-Emission Tomography; Sensitivity and Specificity; Thyroglobulin - blood; Thyroid Neoplasms - blood; Thyroid Neoplasms - diagnostic imaging; Thyroid Neoplasms - pathology; Thyroid. Thyroid axis (diseases); Tomography, X-Ray Computed
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1097/01.mlg.0000154725.00787.00

Objectives/Hypothesis: The aim of the study was to evaluate the role of combined positron emission tomography/computed tomography (PET/CT) fusion imaging in the detection and management of recurrent papillary thyroid cancer. Study Design: A retrospective analysis of 33 patients with suspected recurrent papillary thyroid carcinoma who had undergone PET/CT was performed. PET/CT was compared with standard imaging techniques in each patient to determine whether PET/CT contributed to the therapeutic management plan. Histopathological findings were correlated to PET/CT in patients who underwent surgery. Methods: The senior author reviewed the charts of 33 patients with recurrent papillary thyroid carcinoma to determine the impact PET/CT had on management. PET/CT was compared with conventional imaging results. In surgical patients, PET/CT was compared with histopathological findings to determine its sensitivity, specificity, accuracy, positive predictive value, and negative predictive value. Results: In 67% of the cases (22 of 33), PET/CT supplied additional information that altered or confirmed the management plan. Twenty of 33 patients underwent surgery with 36 sites assessed by histopathological analysis. PET/CT correlated with histopathological findings in 25 of 36 distinct anatomical sites, with an accuracy of 70%. The sensitivity of PET/CT in identifying recurrence was found to be 66%, with a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 27%. Conclusion: Combined PET/CT fusion scanning was most useful in the detection and management of recurrent papillary thyroid cancer in patients who had average thyroglobulin levels greater than 10 ng/mL and when the tumor no longer concentrated radioactive iodine. In 100% of the cases in which PET/CT localized a region suspicious for malignancy, histopathological analysis confirmed the results. When PET/CT is positive, it is a powerful tool for predicting exact locations of recurrent papillary thyroid cancer, thus making it a reliable guide for surgical planning. PET/CT is a supplement to conventional imaging and fine‐needle aspiration in the workup of recurrent papillary thyroid cancer. A negative finding on PET/CT is not sufficiently reliable to preclude further investigation and treatment.