The role of positron emission tomography scanning in patients with radioactive iodine scan-negative, recurrent differentiated thyroid cancer.

An elevated thyroglobulin (Tg) level after total thyroidectomy for differentiated thyroid cancer is often associated with disease recurrence. 131I-whole body scans (131I-WBS) and cross-sectional imaging are commonly used to localize occult metastases in these patients. Localizing disease when 131I-WBS are negative and cross-section imaging is equivocal remains a challenge. The medical records of 12 patients with thyroid cancer undergoing positive positron emission tomography (PET) scans for 131I-WBS-negativeTg elevations or the presence of anti-Tg antibodies were identified and charts were reviewed in a retrospective fashion. All had been treated with total thyroidectomy and 131I ablation in the past. Computed tomography, magnetic resonance imaging, or ultrasound studies revealed suspicious lesions in eight patients. All 12 patients underwent resection of the PET-positive lesions. All resections were positive for thyroid cancer in the regions predicted by the positive PET scan. All nine (100%) patients with elevated preoperative Tg levels experienced a reduction in Tg level after resection. PET scans accurately predict the presence of recurrent thyroid cancer when 131I-WBS are negative. PET scans should be considered in the follow up of 131I-WBS-negative patients with thyroid cancer who are suspected of having recurrent disease.