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  • Review Article
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The role of PET in follow-up of patients treated for differentiated epithelial thyroid cancers

Nature Clinical Practice Endocrinology & Metabolism volume 3, pages 112–121 (2007)Cite this article

Abstract

This article provides an update on the use of 2-[18F]-fluoro-2-deoxyglucose PET in the follow-up of patients treated for differentiated thyroid carcinoma (DTC). Although DTC recurrence is principally identified by a detectable basal or TSH-stimulated thyroglobulin level, PET helps to localize recurrent disease in patients with normal 131I total-body scans and other normal anatomic imaging studies. The sensitivity of PET for localization of recurrence ranges from 45% to 100% according to tumor burden and differentiation. Whether PET should be performed after TSH stimulation is unclear, but several studies have reported an increase in the number of lesions detected by uptake of 2-[18F]-fluoro-2-deoxyglucose in this setting. Dependent on a center's approach, PET can alter therapeutic management in 9–51% of cases. Furthermore, PET might have a prognostic impact on survival in patients with metastatic disease and aid clinicians in selecting patients who need closer follow-up or aggressive treatment. PET can, therefore, be used advantageously in the follow-up of patients with DTC and can localize disease in patients with elevated thyroglobulin levels, normal total-body scans, and normal findings on conventional imaging modalities. In patients in whom local treatment is planned, especially those with aggressive pathologic variants of thyroid cancer, PET can exclude distant metastases. In patients with metastatic disease, PET can help to identify patients needing closer follow-up.

Key Points

  • 2-[18F]-fluoro-2-deoxyglucose (FDG)-PET is an important imaging modality in thyroid cancer patients, with sensitivity of 45–100% and specificity of 90–100% for the diagnosis of recurrence

  • FDG-PET should be performed in patients with an elevated thyroglobulin level, normal 131I scan and normal conventional imaging results

  • FDG-PET plus CT is superior to FDG-PET alone

  • Whether or not stimulation with recombinant human TSH is necessary before FDG-PET scanning has not yet been determined

  • In patients with aggressive differentiated thyroid cancer variants, FDG-PET should be performed before aggressive treatment is started

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Figure 1: Potential causes of false-positive PET scans.
Figure 2: Diagnosis of a retropharyngeal lymph-node metastasis.

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Authors and Affiliations

  1. and M Schlumberger is Chairman in the Department of Nuclear Medicine and Endocrine Tumors at the Institut Gustave Roussy, S Leboulleux is an Assistant Professor, Villejuif, France; M Schlumberger is also Professor of Oncology at the University Paris Sud, Paris.,

    Sophie Leboulleux & Martin Schlumberger

  2. M Schlumberger is also Professor of Oncology at the University Paris Sud, Paris.,

    Sophie Leboulleux & Martin Schlumberger

  3. in the Division of Endocrinology and Metabolism of the Department of Medicine at the Johns Hopkins University School of Medicine, PR Schroeder is a Fellow, and PW Ladenson is a Director and Professor of Endocrinology, Baltimore, MD, USA.,

    Pamela R Schroeder & Paul W Ladenson

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Correspondence to Sophie Leboulleux.

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Competing interests

PW Ladenson is a consultant to the Genzyme Corporation, and M Schlumberger and PW Ladenson have received grants from Genzyme corporation. The other authors declared they have no competing interests.

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Leboulleux, S., Schroeder, P., Schlumberger, M. et al. The role of PET in follow-up of patients treated for differentiated epithelial thyroid cancers. Nat Rev Endocrinol 3, 112–121 (2007). https://doi.org/10.1038/ncpendmet0402

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