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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. Introduction.

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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

positron emission tomography pet i
Positron Emission Tomography (PET) ~ I
  • Tracer: [18F]fluorodeoxyglucose (FDG)
  • Cells with higher glucose requirements
positron emission tomography pet ii
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
the purpose of this study
The Purpose of this Study
  • To review for cases in which an abnormality was identified by PET in the region or the thyroid
methods i
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
methods ii
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
methods iii
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).

methods iv
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
methods v
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.
results iii
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
results iv
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.
discussion i
Discussion ~ I
  • Current methods of detecting thyroid malignancy and recurrence
    • Sonography
    • 131I
    • 123I whole-body scan
    • Serum thyroglobulin levels
    • Thallium-201 scintigraphy
discussion ii
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
discussion iii
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
discussion iv
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.
conclusion
Conclusion
  • 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
ad