Jakob W Kist1, Bart de Keizer2, Manfred van der Vlies3, Adrienne H Brouwers4, Dyde A Huysmans5, Friso M van der Zant6, Rick Hermsen7, Marcel P M Stokkel8, Otto S Hoekstra9, Wouter V Vogel. 1. Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands j.kist@nki.nl. 2. Department of Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands. 3. Department of Diagnostics, Groene Hart Ziekenhuis, Gouda, The Netherlands. 4. Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 5. Department of Nuclear Medicine, Catharina Hospital Eindhoven, Eindhoven, The Netherlands. 6. Department of Nuclear Medicine, Medical Center Alkmaar, Alkmaar, The Netherlands. 7. Department of Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands; and. 8. Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands. 9. Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands.
Abstract
UNLABELLED: Patients with suspected recurrence from differentiated thyroid carcinoma, based on an increased thyroglobulin (Tg) level and negative neck ultrasound (US), pose a clinical dilemma. Because standard imaging has a low yield identifying potential recurrence, blind (131)I treatment is often applied. However, a tumor-negative (131)I whole-body scintigraphy (WBS) prevails in 38%-50% of patients. We performed a prospective multicenter observational cohort study to test the hypothesis that (124)I PET/CT can identify the patients with a tumor-negative posttherapy (131)I WBS. METHODS: Our study was designed to include 100 patients with detectable Tg and a negative neck US, who were planned for blind (131)I therapy. All patients underwent (124)I PET/CT after administration of recombinant human thyroid-stimulating hormone. Subsequently, after 4-6 wk of thyroid hormone withdrawal patients were treated with 5.5-7.4 GBq of (131)I, followed by WBS a week later. The primary endpoint was the number of (131)I therapies that could have been omitted using the predicted outcome of the (124)I PET/CT, operationalized as the concordance of tumor detection by (124)I PET/CT, using post-(131)I therapy WBS as the reference test. The study would be terminated if 3 patients had a negative (124)I PET/CT and a positive posttherapy (131)I scan. RESULTS: After inclusion of 17 patients, we terminated the study preliminarily because the stopping rule had been met. Median Tg level at (131)I therapy was 28 μg/L (interquartile range, 129). Eight posttherapy WBS were negative (47%), all of which were correctly predicted by negative (124)I PET/CT. Nine posttherapy WBS showed iodine-avid tumor, of which 4 also had positive (124)I PET/CT findings. Sensitivity, specificity, negative predictive value, and positive predictive value of (124)I PET/CT were 44% (confidence interval [CI], 14%-79%), 100% (CI, 63%-100%), 62% (CI, 32%-86%), and 100% (CI, 40%-100%), respectively. Implementation of (124)I PET in this setting would have led to 47% (8/17) less futile (131)I treatments, but 29% of patients (5/17) would have been denied potentially effective therapy. CONCLUSION: In patients with biochemical evidence of recurrent differentiated thyroid carcinoma and a tumor-negative neck US, the high false-negative rate of (124)I PET/CT after recombinant human thyroid-stimulating hormone (124)I PET/CT as implemented in this study precludes its use as a scouting procedure to prevent futile blind (131)I therapy.
UNLABELLED: Patients with suspected recurrence from differentiated thyroid carcinoma, based on an increased thyroglobulin (Tg) level and negative neck ultrasound (US), pose a clinical dilemma. Because standard imaging has a low yield identifying potential recurrence, blind (131)I treatment is often applied. However, a tumor-negative (131)I whole-body scintigraphy (WBS) prevails in 38%-50% of patients. We performed a prospective multicenter observational cohort study to test the hypothesis that (124)I PET/CT can identify the patients with a tumor-negative posttherapy (131)I WBS. METHODS: Our study was designed to include 100 patients with detectable Tg and a negative neck US, who were planned for blind (131)I therapy. All patients underwent (124)I PET/CT after administration of recombinant human thyroid-stimulating hormone. Subsequently, after 4-6 wk of thyroid hormone withdrawalpatients were treated with 5.5-7.4 GBq of (131)I, followed by WBS a week later. The primary endpoint was the number of (131)I therapies that could have been omitted using the predicted outcome of the (124)I PET/CT, operationalized as the concordance of tumor detection by (124)I PET/CT, using post-(131)I therapy WBS as the reference test. The study would be terminated if 3 patients had a negative (124)I PET/CT and a positive posttherapy (131)I scan. RESULTS: After inclusion of 17 patients, we terminated the study preliminarily because the stopping rule had been met. Median Tg level at (131)I therapy was 28 μg/L (interquartile range, 129). Eight posttherapy WBS were negative (47%), all of which were correctly predicted by negative (124)I PET/CT. Nine posttherapy WBS showed iodine-avid tumor, of which 4 also had positive (124)I PET/CT findings. Sensitivity, specificity, negative predictive value, and positive predictive value of (124)I PET/CT were 44% (confidence interval [CI], 14%-79%), 100% (CI, 63%-100%), 62% (CI, 32%-86%), and 100% (CI, 40%-100%), respectively. Implementation of (124)I PET in this setting would have led to 47% (8/17) less futile (131)I treatments, but 29% of patients (5/17) would have been denied potentially effective therapy. CONCLUSION: In patients with biochemical evidence of recurrent differentiated thyroid carcinoma and a tumor-negative neck US, the high false-negative rate of (124)I PET/CT after recombinant human thyroid-stimulating hormone (124)I PET/CT as implemented in this study precludes its use as a scouting procedure to prevent futile blind (131)I therapy.
Authors: Laura Fugazzola; Rossella Elisei; Dagmar Fuhrer; Barbara Jarzab; Sophie Leboulleux; Kate Newbold; Jan Smit Journal: Eur Thyroid J Date: 2019-08-28
Authors: David Kersting; Walter Jentzen; Miriam Sraieb; Pedro Fragoso Costa; Maurizio Conti; Lale Umutlu; Gerald Antoch; Michael Nader; Ken Herrmann; Wolfgang Peter Fendler; Christoph Rischpler; Manuel Weber Journal: EJNMMI Phys Date: 2021-02-15
Authors: Di Wu; Cristiane Jeyce Gomes-Lima; Kanchan Kulkarni; Kenneth D Burman; Leonard Wartofsky; Douglas Van Nostrand Journal: World J Nucl Med Date: 2020-01-17
Authors: Jakob W Kist; Manfred van der Vlies; Otto S Hoekstra; Henri N J M Greuter; Bart de Keizer; Marcel P M Stokkel; Wouter V Vogel; Marc C Huisman; Arthur van Lingen Journal: EJNMMI Res Date: 2016-04-27 Impact factor: 3.138
Authors: Elizabeth J de Koster; Taban Sulaiman; Jaap F Hamming; Abbey Schepers; Marieke Snel; Floris H P van Velden; Lioe-Fee de Geus-Oei; Dennis Vriens Journal: Diagnostics (Basel) Date: 2021-03-19