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Incidental Thyroid Carcinoma Identified by Positron Emission Tomography Scanning Obtained for Metastatic Evaluation

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Incidental Thyroid Carcinoma Identified by Positron Emission Tomography Scanning Obtained for Metastatic Evaluation

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Incidental Thyroid Carcinoma Identified by Positron Emission Tomography Scanning Obtained for Metastatic Evaluation

The American Surgeon, Vol 67:p582-584, June 2001

Peyton W. Davis, Nancy D. Perrier, Lee Adler, and Edward A. Levine.

Speaker: 8700021 陳修弘

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Positron Emission Tomography (PET) ~ I

  • Tracer: [18F]fluorodeoxyglucose (FDG)

  • Cells with higher glucose requirements

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Positron Emission Tomography (PET) ~ II

  • Evaluation of patients at risk of having metastatic disease

    • Staging of malignant melanoma

    • Therapeutic management of patients with recurrent colorectal carcinoma

    • Identification of esophageal and gastric carcinoma

    • Evaluating patients with suspicious thyroid nodules

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The Purpose of this Study

  • To review for cases in which an abnormality was identified by PET in the region or the thyroid

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Methods ~ I

  • Patients were for scanning as part of a metastatic workup

  • PET scans or the chest or torso for known or suspected extrathyroidal malignancy

    • 1284 consecutive patients at Wake Forest University Baptist Medical Center

    • ECAT 951 scanner (CTI, Knoxville, TN)

    • Between April 1998 and May 2000

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Methods ~ II

  • PET procedure

    • Patients received a 4-minute-per-bed position transmission scan

    • Followed by intravenous administration of 15- to 20-mCi FDG

    • After a 45-min to one-hr delay 7-minute-per-bed position emission imaging was performed

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Methods ~ III

  • The emission scan and the transmission scan were reconstructed and reviewed on a workstation in all three orthogonal planes

  • The peak activity per cubic centimeter in suspicious areas was corrected for

    • the dose administered

    • lean body weight

    • radioactive decay

    • blood glucose level

      to produce a standardized uptake value (SUV).

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Methods ~ IV

  • Four patients with a suspicious area in the thyroid region who were followed up with a fine-needle aspiration (FNA) biopsy under ultrasound guidance.

    • Two malignant melanoma

    • One gastric adenocarcinoma

    • One colon adenocarcinoma

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Methods ~ V

  • They subsequently underwent surgical resection and appropriate adjuvant therapies for their original malignancy

  • At a later date all cases underwent a definitive resection for the thyroid FNA findings.

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Results ~ I

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Results ~ II

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Results ~ III

  • PET scan results:

    • P1: No other abnormalities

    • P2: Hilum of the right lung

    • P3: Gastroesophageal junction and left lung

    • P4: Suspicious area in the liver

    • P5: Rectal and thyroid uptake only

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Results ~ IV

  • FNA results

    • Revealed papillary carcinoma of the thyroid in the five cases

    • Case five underwent surgery based on uncertainty of a negative ultrasound guided FNA

    • Histology: supported the diagnosis of papillary carcinoma without any evidence of metastatic disease from the original malignancy.

    • No patients has suffered a recurrence of the thyroid lesion.

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Discussion ~ I

  • Current methods of detecting thyroid malignancy and recurrence

    • Sonography

    • 131I

    • 123I whole-body scan

    • Serum thyroglobulin levels

    • Thallium-201 scintigraphy

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Discussion ~ II

  • PET V.S these other modalities

    • Superior to scintigraphy in the identification of benign versus malignant thyroid tumors

    • In one study of six patienst with positive PET and negative 131I scans five had positive histology for carcinoma

    • PET has a sensitivity of 94% and specificity of 95% fir metastatic disease in patients with negative 131I scan

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Discussion ~ III

  • Other studies have supported the usefulness of PET in evaluating metastatic thyroid disease in patients with negative thallium scans.

  • FDG PET can stratify these patients into high- and low-risk subsets

  • FDG PET has definite usefulness in treating patients with known thyroid malignancy or metastases

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Discussion ~ IV

  • In this report, authors address cases in which PET identified an area of occult thyroid carcinoma

  • These scans were useful in the management of these patients in that metastatic disease was not the cause of their PET abnormality.

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  • These incidental findings suggest

    • The diagnosis of a primary thyroid malignancy should be entertained for abnormalities of the thyroid observed on PET

    • Support a potential role for FDG-PET as a component of the evaluation of primary thyroid malignancies

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