ABSTRACT
Thyroid cancer is the single most prevalent endocrine malignancy; differentiated thyroid cancer (DTC) accounts for more than 90 % of all malignancies and its incidence has been rising steadily. For more patients, surgical treatment, radioactive iodine (RAI) ablation, and thyroid-stimulating hormone (TSH) suppressive therapy achieve an overall survival (OS) rate of 97.7 % at 5 years. Nevertheless, locoregional recurrence occurs in up to 20 % and distant metastases in approximately 10 % at 10 years. Two-thirds of these patients will never be cured with radioactive iodine therapy and will become RAI-refractory, with a 3-year OS rate of less than 50 %. Over the last decade, substantial progress has been made in the management of RAI-refractory DTC. Given the controversy in some areas, the Spanish Task Force for Thyroid Cancer on behalf of Spanish Society of Endocrinology Thyroid Cancer Working Group (GTSEEN) and the Spanish Rare Cancer Working Group (GETHI) have created a national joint task force to reach a consensus addressing the most challenging aspects of management in these patients. In this way, multidisciplinary management should be mandatory and nuclear medicine targeted therapy, novel molecular targeted agents, and combinations are currently changing the natural history of RAI-refractory DTC (AU)
No disponible
Subject(s)
Humans , Male , Female , Consensus Development Conferences as Topic , Societies, Medical/organization & administration , Societies, Medical/standards , Thyroid Neoplasms/drug therapy , Thyroid Neoplasms/radiotherapy , Radiotherapy/methods , Iodine/radiation effects , Antineoplastic Agents/therapeutic use , Thyroid Gland , Thyroid Gland/pathology , Thyroid Gland , Fluorodeoxyglucose F18/administration & dosage , Positron-Emission TomographyABSTRACT
Anaplastic thyroid cancer (ATC) is the most aggressive solid tumor and almost uniformly lethal in humans. The Boards of the Thyroid Cancer Group of the Spanish Society of Endocrinology and Nutrition and the Grupo Español de Enfermedades Huérfanas e Infrecuentes of the Spanish Society of Oncology requested that an independent task force draft a more comprehensive consensus statement regarding ATC. All relevant literature was reviewed, including serial PubMed searches together with additional articles. This is the first, comprehensive Spanish consensus statement for ATC and includes the characteristics, diagnosis, initial evaluation, treatment goals, recommendations and modalities for locoregional and advanced disease, palliative care options, surveillance, and long-term monitoring. Newer systemic therapies are being investigated, but more effective combinations are needed to improve patient outcomes. Though more aggressive radiotherapy has reduced locoregional recurrences, median overall survival has not improved in more than 50 years (AU)
No disponible
Subject(s)
Humans , Male , Female , Thyroid Carcinoma, Anaplastic/complications , Thyroid Carcinoma, Anaplastic/epidemiology , Thyroid Carcinoma, Anaplastic/genetics , Consensus , Neoplasm Metastasis/diagnosis , Neoplasm Metastasis/drug therapy , Thyroid Carcinoma, Anaplastic/radiotherapy , Adenocarcinoma, Papillary/complications , Adenocarcinoma, Papillary/drug therapy , Prognosis , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Quality of Life , Palliative CareABSTRACT
Anaplastic thyroid cancer (ATC) is the most aggressive solid tumor and almost uniformly lethal in humans. The Boards of the Thyroid Cancer Group of the Spanish Society of Endocrinology and Nutrition and the Grupo Español de Enfermedades Huérfanas e Infrecuentes of the Spanish Society of Oncology requested that an independent task force draft a more comprehensive consensus statement regarding ATC. All relevant literature was reviewed, including serial PubMed searches together with additional articles. This is the first, comprehensive Spanish consensus statement for ATC and includes the characteristics, diagnosis, initial evaluation, treatment goals, recommendations and modalities for locoregional and advanced disease, palliative care options, surveillance, and long-term monitoring. Newer systemic therapies are being investigated, but more effective combinations are needed to improve patient outcomes. Though more aggressive radiotherapy has reduced locoregional recurrences, median overall survival has not improved in more than 50 years.
Subject(s)
Thyroid Carcinoma, Anaplastic/therapy , Thyroid Neoplasms/therapy , Algorithms , Combined Modality Therapy , Consensus , Humans , SpainABSTRACT
Thyroid cancer is the single most prevalent endocrine malignancy; differentiated thyroid cancer (DTC) accounts for more than 90 % of all malignancies and its incidence has been rising steadily. For more patients, surgical treatment, radioactive iodine (RAI) ablation, and thyroid-stimulating hormone (TSH) suppressive therapy achieve an overall survival (OS) rate of 97.7 % at 5 years. Nevertheless, locoregional recurrence occurs in up to 20 % and distant metastases in approximately 10 % at 10 years. Two-thirds of these patients will never be cured with radioactive iodine therapy and will become RAI-refractory, with a 3-year OS rate of less than 50 %. Over the last decade, substantial progress has been made in the management of RAI-refractory DTC. Given the controversy in some areas, the Spanish Task Force for Thyroid Cancer on behalf of Spanish Society of Endocrinology Thyroid Cancer Working Group (GTSEEN) and the Spanish Rare Cancer Working Group (GETHI) have created a national joint task force to reach a consensus addressing the most challenging aspects of management in these patients. In this way, multidisciplinary management should be mandatory and nuclear medicine targeted therapy, novel molecular targeted agents, and combinations are currently changing the natural history of RAI-refractory DTC.
Subject(s)
Cell Differentiation/drug effects , Iodine Radioisotopes , Practice Guidelines as Topic/standards , Protein Kinase Inhibitors/therapeutic use , Radiation Tolerance/drug effects , Thyroid Neoplasms/drug therapy , Cell Differentiation/radiation effects , Consensus , Disease Management , Humans , Molecular Targeted TherapyABSTRACT
Background: Of all thyroid cancers,< 5 % are medullary (MTC). It is a well-characterized neuroendocrine tumor arising from calcitonin-secreting C cells, and RET gene plays a central role on its pathogeny. Methods: The electronic search was conducted using MEDLINE (PubMed), EMBASE and Cochrane Central Register of Controlled Trials. Quality assessments of selected current articles, guidelines and reviews of MTC were performed. Results: This consensus updates and summarizes biology, treatment and prognostic considerations of MTC. Conclusions: Multidisciplinary teams and specialized centers are recommended for the management of MTC patients. In the metastatic setting, those patients with large volume of disease are candidates to start systemic treatment mainly if they are symptomatic and the tumor has progressed in the last 12-14 months. Wait and see strategy should be offered to patients with: disseminated disease with only high levels of calcitonin and no macroscopic structural disease, low burden and absence of progression (AU)
No disponible
Subject(s)
Humans , Male , Female , Thyroid Neoplasms/diagnosis , Thyroid Neoplasms/epidemiology , Thyroid Carcinoma, Anaplastic/diagnosis , Thyroid Carcinoma, Anaplastic/epidemiology , Consensus Development Conferences as Topic , Prognosis , Societies, Medical/organization & administration , Societies, Medical/standards , Molecular Biology/instrumentation , Molecular Biology/methods , Molecular Biology/trends , Biomarkers/analysis , Biomarkers, Tumor/analysisABSTRACT
No disponible
Subject(s)
Humans , Female , Aged , Fluorodeoxyglucose F18/analysis , Positron-Emission Tomography/instrumentation , Positron-Emission Tomography/methods , Positron-Emission Tomography , Thyroid Neoplasms/surgery , Thyroid Neoplasms , Thyroid Nodule/pathology , Thyroid Nodule , Thyroid Gland/pathology , Thyroid Gland/surgery , Thyroid Gland , Carcinoma/complications , Carcinoma/surgery , Carcinoma , Neoplasm Metastasis/pathology , Neoplasm MetastasisSubject(s)
Fluorodeoxyglucose F18 , Radiopharmaceuticals , Thyroid Neoplasms/diagnostic imaging , Fluorodeoxyglucose F18/pharmacokinetics , Humans , Positron Emission Tomography Computed Tomography , Prognosis , Radiopharmaceuticals/pharmacokinetics , Sensitivity and Specificity , Thyroid Neoplasms/metabolism , Thyroid Nodule/diagnostic imaging , Thyroid Nodule/metabolismABSTRACT
BACKGROUND: Of all thyroid cancers, <5 % are medullary (MTC). It is a well-characterized neuroendocrine tumor arising from calcitonin-secreting C cells, and RET gene plays a central role on its pathogeny. METHODS: The electronic search was conducted using MEDLINE (PubMed), EMBASE and Cochrane Central Register of Controlled Trials. Quality assessments of selected current articles, guidelines and reviews of MTC were performed. RESULTS: This consensus updates and summarizes biology, treatment and prognostic considerations of MTC. CONCLUSIONS: Multidisciplinary teams and specialized centers are recommended for the management of MTC patients. In the metastatic setting, those patients with large volume of disease are candidates to start systemic treatment mainly if they are symptomatic and the tumor has progressed in the last 12-14 months. Wait and see strategy should be offered to patients with: disseminated disease with only high levels of calcitonin and no macroscopic structural disease, low burden and absence of progression.
Subject(s)
Carcinoma, Neuroendocrine/pathology , Carcinoma, Neuroendocrine/therapy , Thyroid Neoplasms/pathology , Thyroid Neoplasms/therapy , HumansABSTRACT
En nombre de la Sociedad Andaluza de Endocrinología y Nutrición (SAEN) se ha elaborado un consenso sobre la atención a la mujer gestante que presenta algún tipo de disfunción tiroidea, basándose en la revisión de la bibliografía actualizada y sobre todo de las guías de buena práctica clínica. Se desarrolla bajo distintos epígrafes o apartados en los que se contempla tanto el diagnóstico como el tratamiento del hipotiroidismo clínico y subclínico, el hipertiroidismo franco y subclínico, la hipotiroxinemia y la tiroiditis posparto, así como la justificación de la realización de cribado universal de la disfunción tiroidea durante la gestación, proporcionando a los profesionales que asisten a estas pacientes un arma de toma de decisiones razonada (AU)
A position statement on the diagnosis and treatment of thyroid dysfunction in pregnancy has been agreed on behalf of The Sociedad Andaluza de Endocrinología y Nutrición (SAEN), based on a review of the literature to date and all good clinical practice guidelines. The document is set out in different sections as regards the diagnosis and treatment of, overt and subclinical hypo- and hyperthyroidism, isolated hypothyroxinaemia and postpartum thyroiditis. It also justifies the implementation of universal screening for thyroid dysfunction in pregnancy, and provides practitioners who care for these patients with tool for rational decision making (AU)
Subject(s)
Adult , Female , Humans , Infant, Newborn , Pregnancy , Thyroid Diseases/complications , Thyroid Diseases/diagnosis , Societies, Medical/organization & administration , Societies, Medical/standards , Pregnancy Complications/epidemiology , Pregnancy Complications/prevention & control , Hypothyroidism/complications , Postpartum Thyroiditis/diagnosis , Postpartum Thyroiditis/epidemiology , Thyroiditis/complications , Mass Screening/methods , Hyperthyroidism/complications , Hyperthyroidism/diagnosis , Thyroxine/therapeutic use , Iron/therapeutic use , Immunoenzyme Techniques , Postpartum Period , Postpartum Period/metabolism , Postpartum Thyroiditis/drug therapyABSTRACT
A position statement on the diagnosis and treatment of thyroid dysfunction in pregnancy has been agreed on behalf of The Sociedad Andaluza de Endocrinología y Nutrición (SAEN), based on a review of the literature to date and all good clinical practice guidelines. The document is set out in different sections as regards the diagnosis and treatment of, overt and subclinical hypo- and hyperthyroidism, isolated hypothyroxinaemia and postpartum thyroiditis. It also justifies the implementation of universal screening for thyroid dysfunction in pregnancy, and provides practitioners who care for these patients with tool for rational decision making.
Subject(s)
Hyperthyroidism/therapy , Hypothyroidism/therapy , Postpartum Thyroiditis/therapy , Pregnancy Complications/therapy , Female , Humans , Hyperthyroidism/complications , Hyperthyroidism/diagnosis , Hypothyroidism/complications , Hypothyroidism/diagnosis , Postpartum Thyroiditis/diagnosis , Pregnancy , Pregnancy Complications/diagnosis , Pregnancy Complications/physiopathology , Spain , Thyroxine/bloodABSTRACT
El feocromocitoma es un tumor poco frecuente localizado en la médula de la glándula adrenal y caracterizado por una elevada síntesis de catecolaminas. La cirugía es el tratamiento de elección y es potencialmente curativa si se diagnostica y reseca adecuadamente. Los métodos de diagnóstico por imagen, tanto morfológica como funcional, son de gran importancia en la evaluación prequirúrgica. Se presenta el caso de una paciente con síndrome de neoplasia endocrina múltiple tipo 2 con suprarrenalectomía bilateral por sendos feocromocitomas y elevación progresiva de la metanefrina urinaria. En la resonancia magnética realizada se observó una imagen nodular en la fosa suprarrenal derecha, por lo que se remitió a nuestra unidad con el objetivo de confirmar la sospecha de recidiva. Dada la ausencia de hallazgos patológicos en la gammagrafía con 123I-MIBG y ante la alta sospecha de recidiva se realizaron estudios PET/TAC con 18F-DOPA y 18F-FDG que confirmaron el diagnóstico(AU)
Pheochromocytoma is a rare tumor located in the medulla of the adrenal gland that is characterized by high catecholamine synthesis. Surgery is the treatment of choice and is usually curative if appropriately diagnosed and excised. Imaging methods, both morphological and functional, are of great importance in presurgical evaluation. We report the case of a female patient with multiple endocrine neoplasia syndrome type 2, with bilateral adrenalectomy due to two pheochromocytomas and progressive elevation of urinary metanephrine. Magnetic resonance imaging showed a nodular image in the right adrenal fossa. The patient was referred to our unit in order to confirm suspicion of recurrence. Due to the absence of pathological findings in the 123I-MIBG scintigraphy and high suspicion of recurrence, PET/CT imaging with 18F-DOPA and 18F-FDG were performed, and the diagnosis was confirmed(AU)
Subject(s)
Humans , Female , Adult , 3-Iodobenzylguanidine , Fluorodeoxyglucose F18 , Pheochromocytoma/complications , Pheochromocytoma/diagnosis , Pheochromocytoma , Multiple Endocrine Neoplasia/diagnosis , Multiple Endocrine Neoplasia , Endocrine Gland Neoplasms/diagnosis , Endocrine Gland Neoplasms , Positron-Emission Tomography/instrumentation , Positron-Emission Tomography/methods , Positron-Emission Tomography , Positron Emission Tomography Computed Tomography/methods , AdrenalectomyABSTRACT
Pheochromocytoma is a rare tumor located in the medulla of the adrenal gland that is characterized by high catecholamine synthesis. Surgery is the treatment of choice and is usually curative if appropriately diagnosed and excised. Imaging methods, both morphological and functional, are of great importance in presurgical evaluation. We report the case of a female patient with multiple endocrine neoplasia syndrome type 2, with bilateral adrenalectomy due to two pheochromocytomas and progressive elevation of urinary metanephrine. Magnetic resonance imaging showed a nodular image in the right adrenal fossa. The patient was referred to our unit in order to confirm suspicion of recurrence. Due to the absence of pathological findings in the (123)I-MIBG scintigraphy and high suspicion of recurrence, PET/CT imaging with (18)F-DOPA and (18)F-FDG were performed, and the diagnosis was confirmed.
Subject(s)
3-Iodobenzylguanidine , Adrenal Gland Neoplasms/diagnostic imaging , Dihydroxyphenylalanine/analogs & derivatives , Fluorodeoxyglucose F18 , Multiple Endocrine Neoplasia Type 2a/diagnostic imaging , Neoplasm Recurrence, Local/diagnostic imaging , Neoplasms, Multiple Primary/diagnostic imaging , Pheochromocytoma/diagnostic imaging , Radiopharmaceuticals , Adult , Female , Humans , Multiple Endocrine Neoplasia Type 2a/complications , Radionuclide ImagingABSTRACT
Objetivo. Pretendemos analizar la evolución de los pacientes diagnosticados de carcinoma diferenciado de tiroides (CDT) con un rastreo de cuerpo completo con 131I-Na (RCC) negativo, una tiroglobulina sérica (Tg) elevada y una tomografía por emisión de positrones con 18F-fluordeoxiglucosa (PET-FDG) negativa. Material y métodos. Se estudiaron retrospectivamente a 23 pacientes diagnosticados y tratados de CDT, con edades comprendidas entre los 23 y 83 años, que entre enero de 2001 y diciembre de 2002 presentaron, un RCC negativo con valores de Tg en un rango de sospecha de recurrencia o metástasis (Tg > 2 ngr/mL con supresión de tratamiento hormonal) y una PET-FDG negativa. Tras un seguimiento clínico, radiológico y analítico de estos pacientes durante un periodo mínimo de 4 años, se vuelve a evaluar el estado de enfermedad con un RCC de control, observando a su vez la evolución de la Tg. Todos los RCC se realizaron con dosis diagnósticas de 185 MBq de 131I-Na. Resultados. En 18 de los 23 pacientes la Tg descendió y en 5 ascendió. Cuatro pacientes (17%) estaban libres de enfermedad (RCC negativo y Tg < 2 ngr/mL). Dieciséis pacientes (70%) estaban libres de enfermedad según el RCC pero con cifras elevadas de Tg. En 3 pacientes (13%) se observó enfermedad y cifras elevadas de Tg, 2 con RCC positivo y el tercero con 99mTc-MIBI y TC positivos. Conclusiones. La mayoría de los pacientes con RCC negativo, Tg elevada y PET-FDG negativa muestran una buena evolución, descendiendo los niveles de Tg e incluso alcanzando valores de normalidad en un porcentaje significativo de ellos(AU)
Objective. This study has aimed to analyze the evolution of patients diagnosed with differentiated thyroid carcinoma (DTC) with a negative 131I-Na whole body scan (WBS), high levels of serum thyroglobulin (Tg) and negative 18Ffluorodeoxyglucose positron emission tomography (PET-FDG) study. Material and methods. Twenty-three patients diagnosed and treated for DTC were studied retrospectively. Patients were aged between 23 and 83 and had shown, between January 2001 and December 2002, negative WBS, Tg values in a range of suspected recurrence or metastasis (Tg>2 ng / mL with thyroid hormone withdrawal) and a negative PET-FDG study. The patients were monitored clinically, radiologically and analytically for a minimum period of 4 years. After this, a new evaluation was made of their state of disease with a control WBS, also observing the evolution of Tg. All WBS were performed with a 185 MBq diagnostic dose of 131I-Na. Results. In 18/23 patients, Tg decreased and in 5 it increased. Four patients (17%) were free of active disease (negative WBS Tg<2 ng / mL). A total of 16 patients (70%) were free of disease according to the WBS but had elevated Tg. Three patients (13%) had disease and high levels of Tg, two of them with positive WBS and the third with 99mTc-MIBI scan and CT positive. Conclusions. Most patients with a negative WBS, high Tg serum levels and negative FDG PET had good evolution, with descending Tg levels, normal levels even being reached in a significant percentage of them(AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Positron Emission Tomography Computed Tomography/methods , Positron Emission Tomography Computed Tomography , Fluorodeoxyglucose F18 , Carcinoma , Thyroid Neoplasms , 3-Iodobenzylguanidine , Thyroglobulin , Thyroid Gland/pathology , Thyroid Gland , Retrospective Studies , 28599 , Indicators of Morbidity and Mortality , Recurrence/prevention & controlABSTRACT
OBJECTIVE: This study has aimed to analyze the evolution of patients diagnosed with differentiated thyroid carcinoma (DTC) with a negative (131)I-Na whole body scan (WBS), high levels of serum thyroglobulin (Tg) and negative (18F)fluorodeoxyglucose positron emission tomography (PET-FDG) study. MATERIAL AND METHODS: Twenty-three patients diagnosed and treated for DTC were studied retrospectively. Patients were aged between 23 and 83 and had shown, between January 2001 and December 2002, negative WBS, Tg values in a range of suspected recurrence or metastasis (Tg>2 ng / mL with thyroid hormone withdrawal) and a negative PET-FDG study. The patients were monitored clinically, radiologically and analytically for a minimum period of 4 years. After this, a new evaluation was made of their state of disease with a control WBS, also observing the evolution of Tg. All WBS were performed with a 185 MBq diagnostic dose of (131)I-Na. RESULTS: In 18/23 patients, Tg decreased and in 5 it increased. Four patients (17%) were free of active disease (negative WBS Tg<2 ng / mL). A total of 16 patients (70%) were free of disease according to the WBS but had elevated Tg. Three patients (13%) had disease and high levels of Tg, two of them with positive WBS and the third with (99m)Tc-MIBI scan and CT positive. CONCLUSIONS: Most patients with a negative WBS, high Tg serum levels and negative FDG PET had good evolution, with descending Tg levels, normal levels even being reached in a significant percentage of them.
Subject(s)
Adenocarcinoma, Follicular/diagnostic imaging , Biomarkers, Tumor/blood , Carcinoma, Papillary/diagnostic imaging , Fluorine Radioisotopes , Fluorodeoxyglucose F18 , Positron-Emission Tomography , Radiopharmaceuticals , Thyroglobulin/blood , Thyroid Neoplasms/diagnostic imaging , Adenocarcinoma, Follicular/blood , Adenocarcinoma, Follicular/secondary , Adenocarcinoma, Follicular/surgery , Adult , Aged , Aged, 80 and over , Autoantibodies/blood , Carcinoma, Papillary/blood , Carcinoma, Papillary/secondary , Carcinoma, Papillary/surgery , Female , Follow-Up Studies , Humans , Iodine Radioisotopes , Lymphatic Metastasis , Male , Middle Aged , Retrospective Studies , Sodium Iodide , Thyroid Neoplasms/blood , Thyroid Neoplasms/surgery , ThyroidectomyABSTRACT
AIM: To evaluate the efficacy and clinical impact of the FDG-PET in the diagnosis of suspicion of recurrence of medullary thyroid cancer (MTC) in patients with elevated serum calcitonin and negative imaging test. MATERIAL AND METHODS: We performed a retrospective study of 31 consecutive cases from february 2001 to october 2007 of 17 women and 14 men, mean age 56.2 years (range: 26-88), with anatomical-pathology diagnosis of medullary thyroid cancer and suspicion of recurrence due to abnormal elevation of calcitonin and negative imaging tests. All of the patients underwent whole body FDG-PET scan with a dedicated PET or PET-CT 60 minutes after intravenous injection of 333-434 MBq of (18)F-FDG. Results were confirmed by pathology study in 45.2% of the patients and by clinical follow-up with a mean of 4 years (range: 16 m-8 years) RESULTS: Sensitivity was 88%, specificity 84.6%, positive predictive value 88%, negative predictive value 84.6% and diagnostic accuracy 87%. The results of the FDG PET modified the therapeutic strategy in 14 cases (45.2%). A comparison was made of the mean values of calcitonin using the Student's "t" test between positive PET studies for the disease and negative ones. No significant differences were found (P=.3). CONCLUSIONS: In patients with MTC and suspected recurrence with elevated calcitonin and negative imaging test, the FDG is the best test for the diagnosis of occult recurrence in MTC with elevated calcitonin and negative imaging techniques with elevated clinical impact. It facilitates the therapeutic management of the patients with MTC recurrence, and should be included in the diagnosis algorithm in these patients.
Subject(s)
Biomarkers, Tumor/blood , Calcitonin/blood , Carcinoma, Medullary/secondary , Fluorodeoxyglucose F18 , Radiopharmaceuticals , Thyroid Neoplasms/diagnostic imaging , Bone Neoplasms/blood , Bone Neoplasms/diagnostic imaging , Bone Neoplasms/secondary , Carcinoma, Medullary/blood , Carcinoma, Medullary/diagnostic imaging , Carcinoma, Medullary/surgery , Disease Progression , False Negative Reactions , False Positive Reactions , Female , Humans , Liver Neoplasms/blood , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/secondary , Lung Neoplasms/blood , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/secondary , Lymphatic Metastasis/diagnostic imaging , Male , Middle Aged , Multiple Endocrine Neoplasia Type 2a/diagnostic imaging , Multiple Endocrine Neoplasia Type 2b/diagnostic imaging , Predictive Value of Tests , Radionuclide Imaging , Retrospective Studies , Sensitivity and Specificity , Thyroid Neoplasms/blood , Thyroid Neoplasms/surgery , ThyroidectomyABSTRACT
Objetivo. Evaluar la eficacia y el impacto clínico de la PET-FDG en el diagnóstico de sospecha de recurrencia de carcinoma medular de tiroides (CMT), en pacientes con calcitonina elevada y pruebas de imagen negativas. Material y métodos. Estudiamos retrospectivamente a 31 pacientes consecutivos de febrero de 2001 a octubre de 2007; 17 mujeres y 14 hombres con una edad media de 56,2 años (rango: 26-88), diagnóstico anatomopatológico de carcinoma medular de tiroides y sospecha de recurrencia por elevación patológica de calcitonina y pruebas de imagen negativas. A todos los pacientes se les realizó PET/PET-TAC corporal 60min post-inyección intravenosa de 333-434 MBq de 18F-FDG. Los resultados se confirmaron mediante anatomía patológica en el 45,2% de los pacientes y por seguimiento clínico/radiológico en el 54,8% durante un período de seguimiento medio de 4 años (rango: 16 m-8 años). Resultados. Se obtuvo una sensibilidad del 88%, especificidad del 84,6%, valor predictivo positivo del 88%, valor predictivo negativo del 84,6% y exactitud diagnóstica del 87%. Los resultados de la PET-FDG modificaron la actitud terapéutica en 14 casos (45,2%). Se compararon las medias de los valores de calcitonina entre PET positivos para enfermedad y negativos, mediante la prueba de la «t» de Student no encontrando diferencia significativa (p=0,3). Conclusiones. La PET-18F-FDG es la prueba idónea para el diagnóstico de recurrencia oculta en CMT con calcitonina elevada y técnicas de imagen negativas, con elevado impacto clínico facilitando el manejo terapéutico de los pacientes con recurrencia de CMT, debiendo ser incluida en el algoritmo diagnóstico de estos pacientes(AU)
Aim. To evaluate the efficacy and clinical impact of the FDG-PET in the diagnosis of suspicion of recurrence of medullary thyroid cancer (MTC) in patients with elevated serum calcitonin and negative imaging test. Material and methods. We performed a retrospective study of 31 consecutive cases from february 2001 to october 2007 of 17 women and 14 men, mean age 56.2 years (range: 26-88), with anatomical-pathology diagnosis of medullary thyroid cancer and suspicion of recurrence due to abnormal elevation of calcitonin and negative imaging tests. All of the patients underwent whole body FDG-PET scan with a dedicated PET or PET-CT 60minutes after intravenous injection of 333-434 MBq of 18F-FDG. Results were confirmed by pathology study in 45.2% of the patients and by clinical follow-up with a mean of 4 years (range: 16 m-8 years). Results. Sensitivity was 88%, specificity 84.6%, positive predictive value 88%, negative predictive value 84.6% and diagnostic accuracy 87%. The results of the FDG PET modified the therapeutic strategy in 14 cases (45.2%). A comparison was made of the mean values of calcitonin using the Student's «t» test between positive PET studies for the disease and negative ones. No significant differences were found (P=.3). Conclusions. In patients with MTC and suspected recurrence with elevated calcitonin and negative imaging test, the FDG is the best test for the diagnosis of occult recurrence in MTC with elevated calcitonin and negative imaging techniques with elevated clinical impact. It facilitates the therapeutic management of the patients with MTC recurrence, and should be included in the diagnosis algorithm in these patients(AU)
Subject(s)
Humans , Male , Female , Middle Aged , Evaluation of the Efficacy-Effectiveness of Interventions , Positron Emission Tomography Computed Tomography/instrumentation , Positron Emission Tomography Computed Tomography/methods , Fluorodeoxyglucose F18 , Thyroid Neoplasms , Calcitonin , Predictive Value of Tests , Furosemide , Thyroid Function Tests/trends , Thyroid Gland/pathology , Thyroid Gland , Retrospective Studies , Sensitivity and Specificity , Neoplasm Recurrence, LocalABSTRACT
Objetivo. Valorar la utilidad de los estudios PET-18F-FDG en el seguimiento de los pacientes diagnosticados de carcinoma diferenciado de tiroides que presentan riesgo de enfermedad y niveles de tiroglobulina (Tg) no interpretables por la presencia de anticuerpos antitiroglobulina (AbTg). Material y métodos. Estudio retrospectivo de 7 mujeres con edad media de 40 años y diagnóstico histológico de cáncer diferenciado de tiroides (7 carcinomas papilares) que fueron remitidos a nuestro servicio para la realización de estudio PET-18F-FDG por sospecha de enfermedad, debido a rastreo 131I negativo y niveles de AbTg elevados, entre los años 2002 y 2007. Se les realizaron 11 exploraciones PET tras la inyección de 370-434 MBq de 18F-FDG en condiciones de normoglucemia y previa administración de relajante muscular, hidratación y furosemida. Los resultados de la PET se confirmaron por histología y/o por evolución clínico radiológica, con un período de seguimiento mínimo de 24 meses. Resultados. La prevalencia de la recurrencia de la enfermedad en la población estudiada fue del 57,14%. Todas las pacientes presentaban niveles de Tg inferiores a 3 ng/dl y AbTg superiores a 200 UI/ml. Tres pacientes presentaban antecedentes de tiroiditis. De los 11 estudios realizados la PET fue negativa en tres y positiva en 8. Se descartó la existencia de enfermedad en 3 pacientes mientras que en 4 pacientes la PET permitió localizar con éxito la existencia de recidiva. Conclusión. La PET-18F-FDG es una técnica útil para localizar enfermedad, así como para descartar la existencia de recurrencia con una elevada seguridad diagnóstica, en pacientes con antecedentes de carcinoma diferenciado de tiroides con rastreo 131I negativo, pero con elevación patológica de anticuerpos AbTg(AU)
Aim. To evaluate the utility of 18FFDG-PET for patients diagnosed of differentiated thyroid carcinoma who present risk of disease and invaluable levels of thyroglobulin (Tg) by the presence of antibodies antithyroglobulin (AbTg). Material and methods. Retrospective study of 7 women of 40 years old and histological diagnosis of differentiated thyroid cancer (7 papillary tumours) that were sent to our department for the accomplishment of18FFDG-PET study because of suspicion of disease, due to 131I negative and high levels of AbTg, between the year 2002 and 2007. 11 PET scans were obtained after the intravenous injection of 370-434 MBq of 18FFDG in normoglycemia conditions and previous administration of muscle relaxant, hydration and diuretic. The results of 18FFDG-PET scans were confirmed by pathologic examination or clinical outcome and radiographic examination for more than 24 months. Results. The prevalence of recurrence in our population was 57.14%. All patients presented levels of Tg lower than 3 ng/dl and AbTg superior to 200 UI/ml. Three patients had precedent thyroiditis. Out of 11 scans performed 3 of them were negative and 8 cases were found positive. It ruled out the existence of disease in three patients and localized the presence of recurrence in 4 patients. Conclusion. 18FFDG-PET Conclusion. CONCLUSION: 18F-FDG-PET is a useful diagnostic tool for the detection of recurrence as well as to rule out the existence of disease with a high accuracy, in patients with differentiated thyroid carcinoma with 131I whole body scan negative but with pathological elevation of antithyroglobulin antibodies(AU)
Subject(s)
Humans , Female , Adult , Positron-Emission Tomography/instrumentation , Positron-Emission Tomography/methods , Fluorodeoxyglucose F18 , Neoplasm Recurrence, Local , Thyroid Neoplasms , Thyroglobulin , Carcinoma , Thyroidectomy/methods , Thyroidectomy , Tracheal Neoplasms , Thyroglobulin/administration & dosage , Neoplasm Recurrence, Local/pathology , Thyroglobulin/metabolism , Retrospective Studies , Nuclear Medicine/methods , Nuclear Medicine/trends , Radionuclide Imaging/trends , 28599ABSTRACT
AIM: To evaluate the utility of (18F)FDG-PET for patients diagnosed of differentiated thyroid carcinoma who present risk of disease and invaluable levels of thyroglobulin (Tg) by the presence of antibodies antithyroglobulin (AbTg). MATERIAL AND METHODS: Retrospective study of 7 women of 40 years old and histological diagnosis of differentiated thyroid cancer (7 papillary tumours) that were sent to our department for the accomplishment of(18F)FDG-PET study because of suspicion of disease, due to ¹³¹I negative and high levels of AbTg, between the year 2002 and 2007. 11 PET scans were obtained after the intravenous injection of 370-434 MBq of (18F)FDG in normoglycemia conditions and previous administration of muscle relaxant, hydration and diuretic. The results of (18F)FDG-PET scans were confirmed by pathologic examination or clinical outcome and radiographic examination for more than 24 months. RESULTS: The prevalence of recurrence in our population was 57.14%. All patients presented levels of Tg lower than 3 ng/dl and AbTg superior to 200 UI/ml. Three patients had precedent thyroiditis. Out of 11 scans performed 3 of them were negative and 8 cases were found positive. It ruled out the existence of disease in three patients and localized the presence of recurrence in 4 patients. CONCLUSION: (18F)FDG-PET CONCLUSION: 18F-FDG-PET is a useful diagnostic tool for the detection of recurrence as well as to rule out the existence of disease with a high accuracy, in patients with differentiated thyroid carcinoma with ¹³¹I whole body scan negative but with pathological elevation of antithyroglobulin antibodies.
Subject(s)
Autoantibodies/blood , Carcinoma, Papillary/diagnostic imaging , Carcinoma, Papillary/secondary , Fluorine Radioisotopes , Fluorodeoxyglucose F18 , Iodine Radioisotopes , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/secondary , Lymphatic Metastasis/diagnostic imaging , Neoplasm Recurrence, Local/diagnostic imaging , Positron-Emission Tomography , Radiopharmaceuticals , Thyroid Neoplasms/diagnostic imaging , Adult , Autoantigens/blood , Autoantigens/immunology , Biomarkers, Tumor/blood , Carcinoma, Papillary/blood , Carcinoma, Papillary/surgery , Female , Fluorine Radioisotopes/administration & dosage , Fluorodeoxyglucose F18/administration & dosage , Follow-Up Studies , Humans , Lung Neoplasms/blood , Middle Aged , Neoplasm Recurrence, Local/blood , Prevalence , Radiopharmaceuticals/administration & dosage , Retrospective Studies , Thyroglobulin/blood , Thyroglobulin/immunology , Thyroid Neoplasms/blood , Thyroid Neoplasms/immunology , Thyroid Neoplasms/surgery , Thyroidectomy , Thyroiditis, Autoimmune/blood , Thyroiditis, Autoimmune/diagnostic imaging , Thyroiditis, Autoimmune/immunology , Young AdultABSTRACT
A 60-year-old woman presented with noncardiac chest pain over months and negative laboratory findings. Conventional imaging methods and bone scintigraphy detected bone lesions suggesting metastatic disease from an unknown primary tumor. An 18FDG-PET scan performed to orient the search for the primary tumor found focal lesions suggesting lymphoma and identified a focal thyroid lesion and a cervical lymph node accessible for biopsy. The biopsy of this lymph node incidentally detected a papillary differentiated thyroid cancer (DTC), since the existence of a non-Hodgkin's lymphoma was confirmed after a new biopsy. After confirming the presence of a lymphoma, 18FDG-PET enabled the initial staging of the tumor, the evaluation of the response to treatment, and follow-up for detection of recurrence. On the other hand, 18FDG-PET incidentally detected a DTC.
Subject(s)
Bone Neoplasms/diagnostic imaging , Bone Neoplasms/secondary , Fluorodeoxyglucose F18 , Neoplasms, Multiple Primary/diagnostic imaging , Neoplasms, Unknown Primary/diagnostic imaging , Positron-Emission Tomography , Radiopharmaceuticals , Female , Humans , Middle AgedABSTRACT
Paciente mujer de 60 años con dolor torácico características mecánicas de meses de evolución y determinaciones analíticas dentro de la normalidad. Los estudios morfológicos y la gammagrafía ósea detectaron lesiones óseas sugestivas de afectación metastásica de un tumor de origen desconocido, por lo que se solicitó una exploración con tomografía por emisión de positrones con 2-18F-fluoruro-2-deoxi- D-glucosa (PET-FDG) con el objetivo de orientar la búsqueda del tumor primario. El estudio se informó como lesiones hipermetabólicas sugestivas de linfoma, mencionando la presencia de una lesión tiroidea hipermetabólica y de una adenopatía cervical accesible para la toma de biopsia. Dicha adenopatía detectó de forma incidental un cáncer diferenciado de tiroides (CDT) papilar, ya que posteriormente se confirmó la existencia de un linfoma no-Hodgkin tras la toma de una nueva biopsia. La PET-FDG, tras confirmar la existencia de un linfoma, permitió su estadificación inicial, así como valorar la respuesta al tratamiento y realizar su seguimiento. Por otro lado, detectó de forma incidental la existencia de un CDT
A 60-year-old woman presented with noncardiac chest pain over months and negative laboratory findings. Conventional imaging methods and bone scintigraphy detected bone lesions suggesting metastatic disease from an unknown primary tumor. An 18FDG-PET scan performed to orient the search for the primary tumor found focal lesions suggesting lymphoma and identified a focal thyroid lesion and a cervical lymph node accessible for biopsy. The biopsy of this lymph node incidentally detected a papillary differentiated thyroid cancer (DTC), since the existence of a non-Hodgkins lymphoma was confirmed after a new biopsy. After confirming the presence of a lymphoma, 18FDG-PET enabled the initial staging of the tumor, the evaluation of the response to treatment, and follow-up for detection of recurrence. On the other hand, 18FDG-PET incidentally detected a DTC
