Implication of 18F-fluorodeoxyglucose uptake by affected lymph nodes in cases with differentiated thyroid cancer

Fujii,Takaaki; Yajima,Reina; Tatsuki,Hironori; Kuwano,Hiroyuki

doi:10.3892/mco.2016.958

Implication of 18F-fluorodeoxyglucose uptake by affected lymph nodes in cases with differentiated thyroid cancer

Authors:
- Takaaki Fujii
- Reina Yajima
- Hironori Tatsuki
- Hiroyuki Kuwano
View Affiliations

Affiliations: Department of General Surgical Science, Graduate School of Medicine, Gunma University, Maebashi, Gunma 371‑8511, Japan
Published online on: July 12, 2016 https://doi.org/10.3892/mco.2016.958
Pages: 247-251

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

In this study, we evaluated the usefulness of positron emission tomography using 18F-fluorodeoxyglucose (FDG-PET) to detect metastatic lymph nodes in differentiated thyroid cancer. We also investigated whether certain factors, including the size of the metastasis to the lymph nodes, are associated with FDG avidity. A total of 22 consecutive patients with differentiated thyroid cancer who underwent FDG‑PET preoperatively were enrolled in this study. Lymph node metastasis was diagnosed in the final pathology in 10 of the 22 patients (45.5%). The mean maximum standardized uptake value of the metastatic lymph nodes was 4.53 (range, 0‑23.5). The 22 cases with differentiated thyroid cancer were divided into two groups based on lymph node metastasis. Clinicopathological variables other than FDG uptake of metastatic lymph nodes were not predictors of lymph node metastasis of thyroid cancer. The sensitivity, specificity, overall accuracy and false‑negative rates of preoperative FDG‑PET in the prediction of lymph node status were 40.0, 100, 72.7 and 60.0%, respectively. The false‑positive rate of FDG‑PET evaluation was 0%. The mean largest dimension of metastasis was 23.0 mm for FDG‑positive cases and 10.9 mm for FDG‑negative cases. There was a marked difference in the size of metastases between FDG‑positive and ‑negative cases; however, even in patients with node metastasis >10 mm, the false‑negative rate was 50.0%. Therefore, FDG‑PET imaging was not found to be sufficient for the evaluation of lymph node status, particularly in cases with small metastases. Our findings indicate that preoperative FDG‑PET evaluation of the lymph nodes cannot be considered predictive of the final pathology.

View Figures

View References

1	Byun BH, Jeong UG, Hong SP, Min JJ, Chong A, Song HC and Bom HS: Prediction of central lymph node metastasis from papillary thyroid microcaprcinoma by ¹⁸F-fluorodeoxyglucose PET/CT and ultrasonography. Ann Nucl Med. 26:471–477. 2012. View Article : Google Scholar : PubMed/NCBI
2	Yeh MW, Bauer AJ, Bernet VA, Ferris RL, Loevner LA, Mandel SJ, Orloff LA, Randolph GW and Steward DL: American Thyroid Association Surgical Affairs Committee Writing Task Force: American Thyroid Association statement on preoperative imaging for thyroid cancer surgery. Thyroid. 25:3–14. 2015. View Article : Google Scholar : PubMed/NCBI
3	Pak K, Kim SJ, Kim IJ, Kim BH, Kim SS and Jeon YK: The role of 18F-fluorodeoxyglucose positron emission tomography in differentiated thyroid cancer before surgery. Endocr Relat Cancer. 20:R203–R213. 2013. View Article : Google Scholar : PubMed/NCBI
4	Kresnik E, Gallowitsch HJ, Mikosch P, Stettner H, Igerc I, Gomez I, Kumnig G and Lind P: Fluorine-18-fluorodeoxyglucose positron emission tomography in the preoperative assessment of thyroid nodules in an endemic goiter area. Surgery. 133:294–299. 2003. View Article : Google Scholar : PubMed/NCBI
5	Fujii T, Yajima R, Yamaguchi S, Tsutsumi S, Asao T and Kuwano H: Is it possible to predict malignancy in cases with focal thyroid incidentaloma identified by ¹⁸F-fluorodeoxyglucose positron emission tomography? Am Surg. 78:141–143. 2012.PubMed/NCBI
6	Wu YJ, Wu HS, Yen RF, Shen YY and Kao CH: Detecting metastatic neck lymph nodes in papillary thyroid carcinoma by ¹⁸F-2-deoxyglucose positron emission tomography and Tc-99m tetrofosmin single photon emission computed tomography. Anticancer Res. 23:2973–2976. 2003.PubMed/NCBI
7	Marcus C, Whitworth PW, Surasi DS, Pai SI and Subramaniam RM: PET/CT in the management of thyroid cancers. AJR Am J Roentgenol. 202:1316–1329. 2014. View Article : Google Scholar : PubMed/NCBI
8	Liu Y: Clinical significance of thyroid uptake on F18-fluorodeoxyglucose positron emission tomography. Ann Nucl Med. 23:17–23. 2009. View Article : Google Scholar : PubMed/NCBI
9	Fletcher JW, Djulbegovic B, Soares H, Siegel BA, Lowe VJ, Lyman GH, Coleman RE, Wahl R, Paschold JC, Avril N, et al: Recommendations on the use of ¹⁸F-FDG PET in oncology. J Nucl Med. 49:480–508. 2008. View Article : Google Scholar : PubMed/NCBI
10	Urhan M, Velioglu M, Rosenbaum J, Basu S and Alavi A: Imaging for the diagnosis of thyroid cancer. Expert Opin Med diagn. 3:237–249. 2009. View Article : Google Scholar : PubMed/NCBI
11	Choi JW, Yoon YH, Yoon YH, Kim SM and Koo BS: Characteristics of primary papillary thyroid carcinoma with false-negative findings on initial ¹⁸F-FDG PET/CT. Ann Surg Oncol. 18:1306–1311. 2011. View Article : Google Scholar : PubMed/NCBI
12	Jeong HS, Baek CH, Son YI, Choi JY, Kim HJ, Ko YH, Chung JH and Baek HJ: ¹⁸F-FDG PET/CT for the initial evaluation of cervical node level of patients with papillary thyroid carcinoma: comparison with ultrasound and contrast-enhanced CT. Clin Endocrinol (Oxf). 65:402–407. 2006. View Article : Google Scholar : PubMed/NCBI
13	Morita S, Mizoguchi K, Suzuki M and Iizuka K: The accuracy of [¹⁸ F]-fluoro-2-deoxy D-glucose-positron emission tomography/computed tomography, ultrasonography, and enhanced computed tomography alone in the preoperative diagnosis of cervical lymph node metastasis in patients with papillary thyroid carcinoma. World J Surg. 34:2564–2569. 2010. View Article : Google Scholar : PubMed/NCBI
14	Ohba K, Nishizawa S, Matsushita A, Inubushi M, Nagayama K, Iwaki H, Matsunaga H, Suzuki S, Sasaki S, Oki Y, et al: High incidence of thyroid cancer in focal thyroid incidentaloma detected by ¹⁸F-fluorodeoxyglucose [corrected] positron emission tomography in relatively young healthy subjects: Results of 3-year follow-up. Endocr J. 57:395–401. 2010. View Article : Google Scholar : PubMed/NCBI
15	Bae JS, Chae BJ, Park WC, Kim JS, Kim SH, Jung SS and Song BJ: Incidental tyroid lesions detected by FDG-PET/CT: Prevalence and risk of thyroid cancer. World J Surg Oncol. 7:632009. View Article : Google Scholar : PubMed/NCBI
16	Choi JY, Lee KS, Kim HJ, Shim YM, Kwon OJ, Park K, Baek CH, Chung JH, Lee KH and Kim BT: Focal thyroid lesions incidentally identified by integrated ¹⁸F-FDG PET/CT: Clinical significance and improved characterization. J Nucl Med. 47:609–615. 2006.PubMed/NCBI
17	Matsuzu K, Segade F, Matsuzu U, Carter A, Bowden DW and Perrier ND: Differential expression of glucose transporters in normal and pathologic thyroid tissue. Thyroid. 14:806–812. 2004. View Article : Google Scholar : PubMed/NCBI
18	Hoffman EJ, Huang SC and Phelps ME: Quantitation in positron emission computed tomography: 1. Effect of object size. J Comput Assist Tomogr. 3:299–308. 1979. View Article : Google Scholar : PubMed/NCBI
19	Deichen JT, Schmidt C, Prante O, Maschauer S, Papadopoulos T and Kuwert T: Influence of TSH on uptake of [¹⁸F]fluorodeoxyglucose in human thyroid cells in vitro. Eur J Nucl Med Mol Imaging. 31:507–512. 2004. View Article : Google Scholar : PubMed/NCBI