Annals of Surgical Oncology Cite Track
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10.1245/s10434-007-9611-5
Annals of Surgical Oncology 15:286-292 (2008)
© 2008 Society of Surgical Oncology
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Original Article

Combined [18F]Fluorodeoxyglucose Positron Emission Tomography and Computed Tomography (FDG-PET/CT) for Detection of Recurrent, 131I-Negative Thyroid Cancer

Steven E. Finkelstein, MD1, Perry W. Grigsby, MD2,4, Barry A. Siegel, MD3,4, Farrokh Dehdashti, MD3,4, Jeffrey F. Moley, MD1,4 and Bruce L. Hall, MD, PhD1,4

1 Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
2 Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
3 Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
4 Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA

Correspondence: Address correspondence and reprint requests to: Bruce L. Hall, MD, PhD; E-mail: hallb{at}wustl.edu

Background: Whole-body 131I scintigraphy (WBS) and serial thyroglobulin measurement (Tg) are standard methods for detecting thyroid cancer recurrence after total/near total thyroidectomy and 131I ablation. Some patients develop elevated Tg (Tg-positive) or there is clinical suspicion of recurrence, but WBS are negative (WBS-negative). This may reflect non-iodine-avid recurrence or metastasis. In 2002, the Centers for Medicare and Medicaid Services (CMS) approved positron emission tomography with [18F]fluorodeoxyglucose (FDG-PET) for Tg-positive/WBS-negative patients with follicular-cell-origin thyroid cancer. Limited data are available regarding the performance of combined FDG-PET/computed tomography (FDG-PET/CT) for detecting recurrent thyroid cancer in WBS-neg patients.

Methods: This retrospective review of prospectively collected data analyzed 65 patients who had FDG-PET/CT for suspected thyroid cancer recurrence (April 1998–August 2006). Patients were WBS-negative but were suspected to have recurrence based on Tg levels or clinical grounds. Suspected FDG-PET/CT abnormalities were reported as benign or malignant. Lesions were ultimately declared benign or malignant by surgical pathology or clinical outcome (disease progression).

Results: Of 65 patients who underwent FDG-PET/CT, 47 had positive FDG-PET/CT. Of the positive FDG-PET/CT, 43 studies were true positives, with 21 (49%) confirmed pathologically by surgical resection. The four false positives (3/4 confirmed pathologically) included an infundibular cyst, an inflamed supraclavicular cyst, pneumonitis, and degenerative disc disease. Of the 18 FDG-PET/CT studies that were negative, 17 were true negatives and one was a false negative (metastatic papillary carcinoma). Thus, FDG-PET/CT demonstrated a patient-based sensitivity of 98%, specificity of 81%, positive predictive value of 91%, and negative predictive value of 94%.

Conclusions: FDG-PET/CT is useful for detecting thyroid cancer recurrence in WBS-negative patients, and can assist decision making.

Key Words: Thyroid cancer • 131I Scintigraphy • FDG-PET • FDG-PET/CT






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