Aurélien Archier1,2, Céline Heimburger3, Carole Guerin4, Isabelle Morange5, Fausto F Palazzo4, Jean-François Henry4, Olivier Schneegans6, Olivier Mundler1,2, Ahmad Esmaeel Abdullah1, Frédéric Sebag4, Alessio Imperiale3,7, David Taïeb8,9,10. 1. Department of Nuclear Medicine, La Timone University Hospital, Aix-Marseille University, Marseille, France. 2. European Center for Research in Medical Imaging, Aix-Marseille University, Marseille, France. 3. Department of Biophysics and Nuclear Medicine, University Hospitals of Strasbourg, Strasbourg, France. 4. Department of Endocrine Surgery, Conception Hospital, Aix-Marseille University, Marseille, France. 5. Department of Endocrinology, Conception Hospital, Aix-Marseille University, Marseille, France. 6. Department of Nuclear Medicine, Paul Strauss Cancer Center, Strasbourg, France. 7. Faculty of Medicine, ICube, UMR 7357 University of Strasbourg/CNRS and FMTS, Strasbourg, France. 8. Department of Nuclear Medicine, La Timone University Hospital, Aix-Marseille University, Marseille, France. david.taieb@ap-hm.fr. 9. European Center for Research in Medical Imaging, Aix-Marseille University, Marseille, France. david.taieb@ap-hm.fr. 10. Inserm UMR1068 Marseille Cancerology Research Center, Institut Paoli-Calmettes, Marseille, France. david.taieb@ap-hm.fr.
Abstract
PURPOSE: To evaluate the performance of (18)F-L-dihydroxyphenylalanine ((18)F-DOPA) PET/CT in the detection of locoregional and distant medullary thyroid carcinoma (MTC) metastases and to compare imaging findings with histological data. METHODS: We retrospectively evaluated 86 MTC patients with persistently high serum calcitonin levels after initial surgery who had undergone (18)F-DOPA PET/CT between January 2007 and December 2014 in two referral centres. They were followed up for at least 6 months after the PET/CT assessment. The results were compared with histological data or with the findings obtained during follow-up using a complementary imaging modality. RESULTS: (18)F-DOPA PET/CT was positive in 65 of the 86 patients, corresponding to a patient-based sensitivity of 75.6 %. Distant metastatic disease (M1) was seen in 29 patients including 11 with previously unknown metastases revealed only by PET/CT. Among the 36 patients without distant metastatic spread, 25 had nodal involvement limited to the neck, and 10 of these 25 patients underwent reoperation. The lymph node compartment-based sensitivity of (18)F-DOPA PET/CT was 100 % in the two institutions but lesion-based sensitivity was only 24 %. Preoperative and postoperative median calcitonin levels were 405 pg/mL (range 128 - 1,960 pg/mL) and 259 pg/mL (range 33 - 1,516 pg/mL), respectively. None of the patients achieved normalization of serum calcitonin after reoperation. CONCLUSION: (18)F-DOPA PET/CT enables early diagnosis of a significant number of patients with distant metastasis. It has a limited sensitivity in the detection of residual disease but provides high performance for regional analysis. A surgical compartment-oriented approach could be the approach of choice whatever the number of nodes revealed by (18)F-DOPA PET/CT.
PURPOSE: To evaluate the performance of (18)F-L-dihydroxyphenylalanine ((18)F-DOPA) PET/CT in the detection of locoregional and distant medullary thyroid carcinoma (MTC) metastases and to compare imaging findings with histological data. METHODS: We retrospectively evaluated 86 MTC patients with persistently high serum calcitonin levels after initial surgery who had undergone (18)F-DOPA PET/CT between January 2007 and December 2014 in two referral centres. They were followed up for at least 6 months after the PET/CT assessment. The results were compared with histological data or with the findings obtained during follow-up using a complementary imaging modality. RESULTS: (18)F-DOPA PET/CT was positive in 65 of the 86 patients, corresponding to a patient-based sensitivity of 75.6 %. Distant metastatic disease (M1) was seen in 29 patients including 11 with previously unknown metastases revealed only by PET/CT. Among the 36 patients without distant metastatic spread, 25 had nodal involvement limited to the neck, and 10 of these 25 patients underwent reoperation. The lymph node compartment-based sensitivity of (18)F-DOPA PET/CT was 100 % in the two institutions but lesion-based sensitivity was only 24 %. Preoperative and postoperative median calcitonin levels were 405 pg/mL (range 128 - 1,960 pg/mL) and 259 pg/mL (range 33 - 1,516 pg/mL), respectively. None of the patients achieved normalization of serum calcitonin after reoperation. CONCLUSION: (18)F-DOPA PET/CT enables early diagnosis of a significant number of patients with distant metastasis. It has a limited sensitivity in the detection of residual disease but provides high performance for regional analysis. A surgical compartment-oriented approach could be the approach of choice whatever the number of nodes revealed by (18)F-DOPA PET/CT.
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