The Role of 18F-FDOPA PET/CT in Recurrent Medullary Thyroid Cancer Patients with Elevated Serum Calcitonin Levels
Yıl: 2023 Cilt: 32 Sayı: 1 Sayfa Aralığı: 1 - 7 Metin Dili: İngilizce DOI: 10.4274/mirt.galenos.2022.81904 İndeks Tarihi: 25-05-2023
The Role of 18F-FDOPA PET/CT in Recurrent Medullary Thyroid Cancer Patients with Elevated Serum Calcitonin Levels
Öz: Objectives: To evaluate the diagnostic performance of18F-dihydroxyphenylalanine (FDOPA) positron emission tomography/computed tomography (PET/CT) in the detection of medullary thyroid carcinoma (MTC) recurrence in patients with elevated calcitonin levels. Methods: The patients who had undergone 18F-FDOPA PET/CT imaging for elevated calcitonin levels after primary surgery of MTC were included in the study. addition, if available 18F-fluorodeoxyglucose (FDG) PET/CT and Gallium-68 (68Ga)- DOTATATE PET/CT images of the patients were evaluated retrospectively. The sensitivity and diagnostic performance of 18F-DOPA PET/CT were investigated. Results: A total of 14 patients (9 F and 5 M; median age: 45) were included in the analysis. Three patients had MEN IIA syndrome and 1 patient had MEN IIB syndrome, 10 patients had a diagnosis of sporadic MTC. Median calcitonin levels of the patients were calculated as 757.5 (min-max: 28.5-7911) pg/mL. Nine patients and 5 patients had undergone ultrasound and contrast-enhanced computed tomography (ceCT) of the neck, respectively, before 18F-FDOPA PET/CT imaging. 18F-FDOPA PET/CT revealed pathological uptake in the thyroid bed, lymph nodes, and distant organs in three, five and two patients, respectively. Median maximum standardized uptake value for the recurrent or metastatic lesions were calculated as 6.4 (min-max: 1.9-18.4). The sensitivity of 18F-FDOPA PET/CT in the detection of recurrent disease was calculated as 64%. Eight patients had 68Ga-DOTATATE PET/CT and 7 of them had 18F-FDG PET/CT within 3 months period before 18F-FDOPA PET/CT. 18F-FDOPA PET/CT revealed recurrent disease in 4 of 5 and 2 of the 5 patients who had negative18F-FDG PET/CT and negative 68Ga- DOTATATE PET/CT, respectively. Conclusion: 18F-FDOPA PET/CT can detect recurrence in about two- thirds of patients with elevated calcitonin levels after primary surgery for MTC. Due to variable differentiation degree, different receptor status, and clinical behavior of MTC, all three radiopharmaceuticals can be beneficial and are complementary to each other in patient management.
Anahtar Kelime: Serum Kalsitonin Yüksekliği Bulunan Rekürren Medüller Tiroid Kanseri Hastalarında 18F-FDOPA PET/BT’nin Rolü
Öz: Amaç: Serum kalsitonin yüksekliği bulunan medüller tiroid kanseri (MTK) tanılı hastalarda rekürrensin saptanmasında18F-dihidroksifenilalanin (FDOPA) pozitron emisyon tomografisi/bilgisayarlı tomografinin (PET/BT) performansının değerlendirilmesidir. Yöntem: Primer MTK cerrahisi sonrasında yüksek kalsitonin düzeyi olan ve18F-FDOPA PET/BT uygulanmış olan hastalar çalışmaya dahil edildi. Ek olarak, eğer varsa 18F-florodeoksiglukoz (FDG) PET/BT ve Galyum-68 (68Ga)-DOTATATE PET/BT bulguları da retrospektif olarak değerlendirildi.18F- FDOPA PET/BT’nin duyarlılığı ve tanısal performansı araştırıldı. Bulgular: Toplam 14 hasta (9 K, 5 E, medyan yaş: 45) analize dahil edildi. Üç hastada MEN IIA, 1 hastada MEN IB sendromu, 10 hastada sporadik MTK mevcuttu. Hastaların medyan kalsitonin seviyeleri 757,5 (min-maks: 28.5-7911) pg/mL bulundu.18F-FDOPA PET/BT görüntülemesinden önce 9 hastaya boyun ultrasonu, 5 hastaya kontrastlı boyun BT uygulanmıştı.18F-FDOPA PET/BT’de 3 hastada tiroid yatağında nüks, 5 hastada lenf nodu metastazı ve 2 hastada uzak metastaz saptandı. Rekürren veya metastatik lezyonlarda medyan maksimum standartlaştırılmış alım değeri: 6,4 (min-maks: 1,9-18,4) olarak hesaplandı. Rekürren hastalığın saptanmasında18F-FDOPA PET/BT’nin duyarlılığı %64 bulundu. 18F-FDOPA PET/BT’den önceki 3 ay içerisinde 8 hastanın 68Ga-DOTATATE, 7 hastanın 18F-FDG PET/BT görüntülemeleri mevcuttu. 18F-FDOPA PET/BT, negatif 18F-FDG PET/ BT’si olan 5 hastanın 4’ünde ve negatif 68Ga-DOTATATE PET/BT’si olan 5 hastanın 2’sinde rekürren hastalığı gösterdi. Sonuç: 18F-FDOPA PET/BT, MTK için primer cerrahi sonrası yüksek kalsitonin düzeyi bulunan hastaların yaklaşık 2/3’ünde rekürrens saptayabilir. Tiroid medüller karsinomunun değişken diferansiyasyon derecesi, farklı reseptör durumu ve klinik davranışına bağlı olarak, her üç radyofarmasötik de hasta yönetiminde faydalı olabilir ve birbirine tamamlayıcıdır.
Anahtar Kelime: Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
- 1. Pitt SC, Moley JF. Medullary, anaplastic, and metastatic cancers of the thyroid. Semin Oncol 2010;37:567-579.
- 2. Machens A, Dralle H. Surgical treatment of medullary thyroid cancer. Recent Results Cancer Res 2015;204:187-205.
- 3. Pacini F, Castagna MG, Brilli L, Pentheroudakis G; ESMO Guidelines Working Group. Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012;23(Suppl 7):vii110- vii119.
- 4. American Thyroid Association Guidelines Task Force; Kloos RT, Eng C, Evans DB, Francis GL, Gagel RF, Gharib H, Moley JF, Pacini F, Ringel MD, Schlumberger M, Wells SA Jr. Medullary thyroid cancer: management guidelines of the American Thyroid Association. Thyroid 2009;19:565- 612. Erratum in: Thyroid 2009;19:1295.
- 5. Ong SC, Schöder H, Patel SG, Tabangay-Lim IM, Doddamane I, Gönen M, Shaha AR, Tuttle RM, Shah JP, Larson SM. Diagnostic accuracy of 18F-FDG PET in restaging patients with medullary thyroid carcinoma and elevated calcitonin levels. J Nucl Med 2007;48:501-507.
- 6. Wells SA Jr, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF, Lee N, Machens A, Moley JF, Pacini F, Raue F, Frank-Raue K, Robinson B, Rosenthal MS, Santoro M, Schlumberger M, Shah M, Waguespack SG; American Thyroid Association Guidelines Task Force on Medullary Thyroid Carcinoma. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid 2015;25:567-610.
- 7. Fialkowski E, DeBenedetti M, Moley J. Long-term outcome of reoperations for medullary thyroid carcinoma. World J Surg 2008;32:754-765.
- 8. Klain M, Hadoux J, Nappi C, Finessi M, Ambrosio R, Schlumberger M, Cuocolo A, Deandreis D, Salvatore D. Imaging medullary thyroid cancer patients with detectable serum markers: state of the art and future perspectives. Endocrine 2022;75:330-337.
- 9. Treglia G, Cocciolillo F, Di Nardo F, Poscia A, de Waure C, Giordano A, Rufini V. Detection rate of recurrent medullary thyroid carcinoma using fluorine-18 dihydroxyphenylalanine positron emission tomography: a meta-analysis. Acad Radiol 2012;19:1290-1299.
- 10. Romero-Lluch AR, Cuenca-Cuenca JI, Guerrero-Vázquez R, Martínez- Ortega AJ, Tirado-Hospital JL, Borrego-Dorado I, Navarro-González E. Diagnostic utility of PET/CT with 18F-DOPA and 18F-FDG in persistent or recurrent medullary thyroid carcinoma: the importance of calcitonin and carcinoembryonic antigen cutoff. Eur J Nucl Med Mol Imaging 2017;44:2004-2013.
- 11. Treglia G, Castaldi P, Villani MF, Perotti G, de Waure C, Filice A, Ambrosini V, Cremonini N, Santimaria M, Versari A, Fanti S, Giordano A, Rufini V. Comparison of 18F-DOPA, 18F-FDG and 68Ga-somatostatin analogue PET/CT in patients with recurrent medullary thyroid carcinoma. Eur J Nucl Med Mol Imaging 2012;39:569-580.
- 12. Treglia G, Rufini V, Salvatori M, Giordano A, Giovanella L. PET imaging in recurrent medullary thyroid carcinoma. Int J Mol Imaging 2012;2012:324686.
- 13. Slavikova K, Montravers F, Treglia G, Kunikowska J, Kaliska L, Vereb M, Talbot JN, Balogova S. What is currently the best radiopharmaceutical for the hybrid PET/CT detection of recurrent medullary thyroid carcinoma? Curr Radiopharm 2013;6:96-105.
- 14. Bozkurt MF, Virgolini I, Balogova S, Beheshti M, Rubello D, Decristoforo C, Ambrosini V, Kjaer A, Delgado-Bolton R, Kunikowska J, Oyen WJG, Chiti A, Giammarile F, Sundin A, Fanti S. Guideline for PET/CT imaging of neuroendocrine neoplasms with 68Ga-DOTA-conjugated somatostatin receptor targeting peptides and 18F-DOPA. Eur J Nucl Med Mol Imaging 2017;44:1588-1601. Erratum in: Eur J Nucl Med Mol Imaging 2017.
- 15. Chondrogiannis S, Marzola MC, Al-Nahhas A, Venkatanarayana TD, Mazza A, Opocher G, Rubello D. Normal biodistribution pattern and physiologic variants of 18F-DOPA PET imaging. Nucl Med Commun 2013;34:1141-1149.
- 16. S. Hoegerle, C. Altehoefer, N. Ghanem, I. Brink, E. Moser, and E. Nitzsche, “18F-DOPA positron emission tomography for tumour detection in patients with medullary thyroid carcinoma and elevated calcitonin levels,” European Journal of Nuclear Medicine, 2001;28:64-71.
- 17. Tan BB, Flaherty KR, Kazerooni EA, Iannettoni MD; American College of Chest Physicians. The solitary pulmonary nodule. Chest. 2003;123(Suppl 1):89S-96S.
- 18. Soussan M, Nataf V, Kerrou K, Grahek D, Pascal O, Talbot JN, Montravers F. Added value of early 18F-FDOPA PET/CT acquisition time in medullary thyroid cancer. Nucl Med Commun 2012;33:775-779.
| APA | Araz M, Soydal C, Demir Ö, GOKCAN M, kucuk n (2023). The Role of 18F-FDOPA PET/CT in Recurrent Medullary Thyroid Cancer Patients with Elevated Serum Calcitonin Levels. , 1 - 7. 10.4274/mirt.galenos.2022.81904 |
| Chicago | Araz Mine,Soydal Cigdem,Demir Özgür,GOKCAN MUSTAFA KURSAT,kucuk nuriye ozlem The Role of 18F-FDOPA PET/CT in Recurrent Medullary Thyroid Cancer Patients with Elevated Serum Calcitonin Levels. (2023): 1 - 7. 10.4274/mirt.galenos.2022.81904 |
| MLA | Araz Mine,Soydal Cigdem,Demir Özgür,GOKCAN MUSTAFA KURSAT,kucuk nuriye ozlem The Role of 18F-FDOPA PET/CT in Recurrent Medullary Thyroid Cancer Patients with Elevated Serum Calcitonin Levels. , 2023, ss.1 - 7. 10.4274/mirt.galenos.2022.81904 |
| AMA | Araz M,Soydal C,Demir Ö,GOKCAN M,kucuk n The Role of 18F-FDOPA PET/CT in Recurrent Medullary Thyroid Cancer Patients with Elevated Serum Calcitonin Levels. . 2023; 1 - 7. 10.4274/mirt.galenos.2022.81904 |
| Vancouver | Araz M,Soydal C,Demir Ö,GOKCAN M,kucuk n The Role of 18F-FDOPA PET/CT in Recurrent Medullary Thyroid Cancer Patients with Elevated Serum Calcitonin Levels. . 2023; 1 - 7. 10.4274/mirt.galenos.2022.81904 |
| IEEE | Araz M,Soydal C,Demir Ö,GOKCAN M,kucuk n "The Role of 18F-FDOPA PET/CT in Recurrent Medullary Thyroid Cancer Patients with Elevated Serum Calcitonin Levels." , ss.1 - 7, 2023. 10.4274/mirt.galenos.2022.81904 |
| ISNAD | Araz, Mine vd. "The Role of 18F-FDOPA PET/CT in Recurrent Medullary Thyroid Cancer Patients with Elevated Serum Calcitonin Levels". (2023), 1-7. https://doi.org/10.4274/mirt.galenos.2022.81904 |
| APA | Araz M, Soydal C, Demir Ö, GOKCAN M, kucuk n (2023). The Role of 18F-FDOPA PET/CT in Recurrent Medullary Thyroid Cancer Patients with Elevated Serum Calcitonin Levels. Molecular Imaging and Radionuclide Therapy, 32(1), 1 - 7. 10.4274/mirt.galenos.2022.81904 |
| Chicago | Araz Mine,Soydal Cigdem,Demir Özgür,GOKCAN MUSTAFA KURSAT,kucuk nuriye ozlem The Role of 18F-FDOPA PET/CT in Recurrent Medullary Thyroid Cancer Patients with Elevated Serum Calcitonin Levels. Molecular Imaging and Radionuclide Therapy 32, no.1 (2023): 1 - 7. 10.4274/mirt.galenos.2022.81904 |
| MLA | Araz Mine,Soydal Cigdem,Demir Özgür,GOKCAN MUSTAFA KURSAT,kucuk nuriye ozlem The Role of 18F-FDOPA PET/CT in Recurrent Medullary Thyroid Cancer Patients with Elevated Serum Calcitonin Levels. Molecular Imaging and Radionuclide Therapy, vol.32, no.1, 2023, ss.1 - 7. 10.4274/mirt.galenos.2022.81904 |
| AMA | Araz M,Soydal C,Demir Ö,GOKCAN M,kucuk n The Role of 18F-FDOPA PET/CT in Recurrent Medullary Thyroid Cancer Patients with Elevated Serum Calcitonin Levels. Molecular Imaging and Radionuclide Therapy. 2023; 32(1): 1 - 7. 10.4274/mirt.galenos.2022.81904 |
| Vancouver | Araz M,Soydal C,Demir Ö,GOKCAN M,kucuk n The Role of 18F-FDOPA PET/CT in Recurrent Medullary Thyroid Cancer Patients with Elevated Serum Calcitonin Levels. Molecular Imaging and Radionuclide Therapy. 2023; 32(1): 1 - 7. 10.4274/mirt.galenos.2022.81904 |
| IEEE | Araz M,Soydal C,Demir Ö,GOKCAN M,kucuk n "The Role of 18F-FDOPA PET/CT in Recurrent Medullary Thyroid Cancer Patients with Elevated Serum Calcitonin Levels." Molecular Imaging and Radionuclide Therapy, 32, ss.1 - 7, 2023. 10.4274/mirt.galenos.2022.81904 |
| ISNAD | Araz, Mine vd. "The Role of 18F-FDOPA PET/CT in Recurrent Medullary Thyroid Cancer Patients with Elevated Serum Calcitonin Levels". Molecular Imaging and Radionuclide Therapy 32/1 (2023), 1-7. https://doi.org/10.4274/mirt.galenos.2022.81904 |
