Open Access

Clinical relevance of 18F-FDG PET/CT in the postoperative follow-up of patients with history of medullary thyroid cancer

Jelena Saponjski
Jelena Saponjski
, 
Djuro Macut
Djuro Macut
, 
Dragana Sobic Saranovic
Dragana Sobic Saranovic
, 
Branislava Radovic
Branislava Radovic
 and 
Vera Artiko
Vera Artiko
   | Nov 22, 2020
Radiology and Oncology's Cover Image
About this article
Previous Article
Next Article
Cite
Article Category: Research Article
Published Online: Nov 22, 2020
Page range: 18 - 25
Received: Aug 06, 2020
Accepted: Oct 17, 2020
DOI: https://doi.org/10.2478/raon-2020-0069
© 2021 Jelena Saponjski, Djuro Macut, Dragana Sobic Saranovic, Branislava Radovic, Vera Artiko, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Patient with diagnosis of MTC after total thyroidectomy. (A, B) FDG PET/CT confirmed high uptake metastases in the mediastinal lymph nodes and uneven distribution of FDG in the liver. (C)99mTc-DMSA spot view scintigraphy finding is negative. (D)99mTc - tektrotyd SPECT finding is negative. (E)123I – MIBG WB finding showed high uptake in multiple liver metastases. (F)123I – MIBG SPECT finding showed high uptake in multiple liver metastases.
Patient with diagnosis of MTC after total thyroidectomy. (A, B) FDG PET/CT confirmed high uptake metastases in the mediastinal lymph nodes and uneven distribution of FDG in the liver. (C)99mTc-DMSA spot view scintigraphy finding is negative. (D)99mTc - tektrotyd SPECT finding is negative. (E)123I – MIBG WB finding showed high uptake in multiple liver metastases. (F)123I – MIBG SPECT finding showed high uptake in multiple liver metastases.

Figure 2

Patient with diagnosis of MTC after total thyroidectomy. (A, B) FDG PET/ CT confirmed high uptake metastases in the lymph nodes of the neck, mediastinum and abdomen. (C)99mTc-DMSA planar spot view scintigraphy showed uptake only in the few lymph nodes in the neck and mediastinum.
Patient with diagnosis of MTC after total thyroidectomy. (A, B) FDG PET/ CT confirmed high uptake metastases in the lymph nodes of the neck, mediastinum and abdomen. (C)99mTc-DMSA planar spot view scintigraphy showed uptake only in the few lymph nodes in the neck and mediastinum.

Figure 3

Patient with diagnosis of MTC after total thyroidectomy. (A) FDG PET/CT confirmed high uptake in metastases in the mediastinal lymph nodes. (B)99mTc- tektrotyd scintigraphy confirmed high uptake in metastases in the mediastinal lymph nodes. (C)99mTc-DMSA planar spot view scintigraphy finding was negative showed uptake only in the few lymph nodes in the neck and mediastinum.
Patient with diagnosis of MTC after total thyroidectomy. (A) FDG PET/CT confirmed high uptake in metastases in the mediastinal lymph nodes. (B)99mTc- tektrotyd scintigraphy confirmed high uptake in metastases in the mediastinal lymph nodes. (C)99mTc-DMSA planar spot view scintigraphy finding was negative showed uptake only in the few lymph nodes in the neck and mediastinum.

Figure 4

Kaplan Meier progression-free survival curve in positive FDG patients with median survival of 15 months (95% CI 11.14 ± 18.85 months), while median survival in disease free patients was 30 months (95% CI 1.08+58.92 months).
Kaplan Meier progression-free survival curve in positive FDG patients with median survival of 15 months (95% CI 11.14 ± 18.85 months), while median survival in disease free patients was 30 months (95% CI 1.08+58.92 months).

Concordance of the 18F-FDG PET/CT findings with the results of other radionuclide methods in selected number of medullary thyroid carcinoma patients

18F-FDG PET/CT99mTc(V)-DMSA99mTc-HYNIC-TOC123I-MIBG
14 TP (100%)4 TP (28.6%)5 TP (35.7%)3 TP (21.4%)
4 FN (28.6%)3 FN (21.4%)2 FN (14.3%)
14 TN (100%)11 TN (78.6%)1 FP (7%)3 TN (21.4%)
2 FP (14.3%)1 TN (7%)2 FP (14.3%)
1 FP (25%)
4 FP (100%)2 TN (50%)1 FP (7%)
1 FN (100%)1 FN (100%)1 FN (100%)

18F-FDG PET/CT findings in medullary thyroid carcinoma patients with calcitonin levels

FindingsNumber%Increased calcitonin levelsCalcitonin levels above 1000 pg/ml
TP35/6752.235/35 (100%)18/35 (51%)
TN25/6737.318/25 (72%)0
FP4/6762/4 (50%)0
FN3/674.52/3 (66%)2/3 (66%)
Sensitivity92.11% (95% CI 78.62% to 98.34%)
Specificity86.21% (95% CI 68.34% to 96.11%)
Positive predictive value89.74% (95% CI 77.81% to 95.62%
Negative predictive value89.29% (95% CI 73.59% to 96.14%)
Accuracy89.55% (95% CI 79.65% to 95.70%)

99mTc-DMSA scintigraphy findings in medullary thyroid carcinoma patients

FindingsNumber%
TP4
TN13
FP3
FN5
Sensitivity44.44% (95% CI 13.70% to 78.80%)
Specificity81.25% (95% CI 54.35% to 95.95%)
Positive predictive value57.14% (95% CI 27.55% to 82.38%)
Negative predictive value72.22% (95% CI 58.07% to 83.00%)
Accuracy68.00% (95% CI 46.50% to 85.05%)
eISSN:
1581-3207
Language:
English
Publication timeframe:
4 times per year
Journal Subjects:
Medicine, Clinical Medicine, Internal Medicine, Haematology, Oncology, Radiology
Journal RSS Feed