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Fluorodeoxyglucose-positron emission tomography scan-positive recurrent papillary thyroid cancer and the prognosis and implications for surgical management.

Schreinemakers JM, Vriens MR, Munoz-Perez N, Guerrero MA, Suh I, Rinkes IH, Gosnell J, Shen WT, Clark OH, Duh QY - World J Surg Oncol (2012)

Bottom Line: The medical and surgical treatments and outcome of these patients were compared.Patients who had a PET-positive lesion had a significantly higher TNM stage (P = 0.01), higher age (P = 0.03), and higher thyroglobulin (P = 0.024).In some patients loco-regional control can be obtained without evidence of residual disease by reoperation if the lesion is localized in the neck or mediastinum.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, University of California, 1600 Divisadero Street, Box 1711, San Francisco, CA 94115, USA.

ABSTRACT

Background: To compare outcomes for patients with recurrent or persistent papillary thyroid cancer (PTC) who had metastatic tumors that were fluorodeoxyglucose-positron emission tomography (FDG-PET) positive or negative, and to determine whether the FDG-PET scan findings changed the outcome of medical and surgical management.

Methods: From a prospective thyroid cancer database, we retrospectively identified patients with recurrent or persistent PTC and reviewed data on demographics, initial stage, location and extent of persistent or recurrent disease, clinical management, disease-free survival and outcome. We further identified subsets of patients who had an FDG-PET scan or an FDG-PET/CT scan and whole-body radioactive iodine scans and categorized them by whether they had one or more FDG-PET-avid (PET-positive) lesions or PET-negative lesions. The medical and surgical treatments and outcome of these patients were compared.

Results: Between 1984 and 2008, 41 of 141 patients who had recurrent or persistent PTC underwent FDG-PET (n = 11) or FDG-PET/CT scans (n = 30); 22 patients (54%) had one or more PET-positive lesion(s), 17 (41%) had PET-negative lesions, and two had indeterminate lesions. Most PET-positive lesions were located in the neck (55%). Patients who had a PET-positive lesion had a significantly higher TNM stage (P = 0.01), higher age (P = 0.03), and higher thyroglobulin (P = 0.024). Only patients who had PET-positive lesions died (5/22 vs. 0/17 for PET-negative lesions; P = 0.04). In two of the seven patients who underwent surgical resection of their PET-positive lesions, loco-regional control was obtained without evidence of residual disease.

Conclusion: Patients with recurrent or persistent PTC and FDG-PET-positive lesions have a worse prognosis. In some patients loco-regional control can be obtained without evidence of residual disease by reoperation if the lesion is localized in the neck or mediastinum.

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Flow chart showing patient selection and outcome for patients with PTC treated at the University of California San Francisco between 1984 and 2008.
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Figure 1: Flow chart showing patient selection and outcome for patients with PTC treated at the University of California San Francisco between 1984 and 2008.

Mentions: For the 24-year period, 1052 patients with PTC were identified, 141 of whom had recurrent or persistent PTC. There were nearly twice as many women as men, and the mean age was 46 years (Table 1). Forty-one patients (29%) underwent an FDG-PET scan, of which thirty were FDG-PET/CT scans. Twenty-two patients (54%) had one or more lesions that were FDG-PET-positive, seventeen (41%) had a FDG-PET-negative lesion, and two (5%) had a lesion with uncertain uptake (Figure 1). FDG-PET-positive lesions were most often seen in the neck (41%), followed by neck and lung (25%), lungs (17%), and multiple sites (13%). The median standard uptake value was 4.20 g/ml (range 1.5 to 29).


Fluorodeoxyglucose-positron emission tomography scan-positive recurrent papillary thyroid cancer and the prognosis and implications for surgical management.

Schreinemakers JM, Vriens MR, Munoz-Perez N, Guerrero MA, Suh I, Rinkes IH, Gosnell J, Shen WT, Clark OH, Duh QY - World J Surg Oncol (2012)

Flow chart showing patient selection and outcome for patients with PTC treated at the University of California San Francisco between 1984 and 2008.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3539949&req=5

Figure 1: Flow chart showing patient selection and outcome for patients with PTC treated at the University of California San Francisco between 1984 and 2008.
Mentions: For the 24-year period, 1052 patients with PTC were identified, 141 of whom had recurrent or persistent PTC. There were nearly twice as many women as men, and the mean age was 46 years (Table 1). Forty-one patients (29%) underwent an FDG-PET scan, of which thirty were FDG-PET/CT scans. Twenty-two patients (54%) had one or more lesions that were FDG-PET-positive, seventeen (41%) had a FDG-PET-negative lesion, and two (5%) had a lesion with uncertain uptake (Figure 1). FDG-PET-positive lesions were most often seen in the neck (41%), followed by neck and lung (25%), lungs (17%), and multiple sites (13%). The median standard uptake value was 4.20 g/ml (range 1.5 to 29).

Bottom Line: The medical and surgical treatments and outcome of these patients were compared.Patients who had a PET-positive lesion had a significantly higher TNM stage (P = 0.01), higher age (P = 0.03), and higher thyroglobulin (P = 0.024).In some patients loco-regional control can be obtained without evidence of residual disease by reoperation if the lesion is localized in the neck or mediastinum.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, University of California, 1600 Divisadero Street, Box 1711, San Francisco, CA 94115, USA.

ABSTRACT

Background: To compare outcomes for patients with recurrent or persistent papillary thyroid cancer (PTC) who had metastatic tumors that were fluorodeoxyglucose-positron emission tomography (FDG-PET) positive or negative, and to determine whether the FDG-PET scan findings changed the outcome of medical and surgical management.

Methods: From a prospective thyroid cancer database, we retrospectively identified patients with recurrent or persistent PTC and reviewed data on demographics, initial stage, location and extent of persistent or recurrent disease, clinical management, disease-free survival and outcome. We further identified subsets of patients who had an FDG-PET scan or an FDG-PET/CT scan and whole-body radioactive iodine scans and categorized them by whether they had one or more FDG-PET-avid (PET-positive) lesions or PET-negative lesions. The medical and surgical treatments and outcome of these patients were compared.

Results: Between 1984 and 2008, 41 of 141 patients who had recurrent or persistent PTC underwent FDG-PET (n = 11) or FDG-PET/CT scans (n = 30); 22 patients (54%) had one or more PET-positive lesion(s), 17 (41%) had PET-negative lesions, and two had indeterminate lesions. Most PET-positive lesions were located in the neck (55%). Patients who had a PET-positive lesion had a significantly higher TNM stage (P = 0.01), higher age (P = 0.03), and higher thyroglobulin (P = 0.024). Only patients who had PET-positive lesions died (5/22 vs. 0/17 for PET-negative lesions; P = 0.04). In two of the seven patients who underwent surgical resection of their PET-positive lesions, loco-regional control was obtained without evidence of residual disease.

Conclusion: Patients with recurrent or persistent PTC and FDG-PET-positive lesions have a worse prognosis. In some patients loco-regional control can be obtained without evidence of residual disease by reoperation if the lesion is localized in the neck or mediastinum.

Show MeSH
Related in: MedlinePlus