Ontology type: schema:ScholarlyArticle Open Access: True
2018-10-10
AUTHORSLindsay Brammen, Martin B. Niederle, Philipp Riss, Christian Scheuba, Andreas Selberherr, Georgios Karanikas, Gerd Bodner, Oskar Koperek, Bruno Niederle
ABSTRACTBackgroundAt the time of diagnosis, one-third of medullary thyroid carcinoma (MTC) patients show lymph node (LN) or distant metastasis. A metastasized MTC requires different surgical strategies.ObjectiveThis study aimed to determine the value of ultrasound and [18F]fluoro-dihydroxyphenylalanine positron emission tomography with computed tomography (F-DOPA-PET-CT) in localizing MTC, as well as LN and distant metastasis.MethodsThe study included 50 patients (24 males/26 females) with preoperative ultrasound, F-DOPA-PET-CT, and histologically proven MTC. Imaging results were correlated with both preoperative basal calcitonin (bCt) levels and final histology.ResultsTumors were classified as pT1a:17 (diameter, mean ± standard deviation: 5.8 ± 3.0 mm), pT1b:15 (15.0 ± 3.2 mm), pT2:9 (27.3 ± 7.0 mm), and pT3:9 (38.3 ± 24.2 mm). The median bCt level was 202 pg/mL (lower/upper quartile: 82/1074 pg/mL). Ultrasound was positive for tumor in 45/50 (92%) patients (20.0 ± 16.0 mm) and negative in 5 patients (3.2 ± 2.2 mm). Overall, 43/50 (86%) patients had positive F-DOPA local scans (20.0 ± 16.4 mm), while 7 (14%) patients were negative (7.7 ± 8.1 mm). Lastly, 21/50 (42%) patients had LN metastasis; 8/21 (38%) patients had positive LNs suspected with ultrasound, and 12/21 (57%) patients had positive LNs suspected with F-DOPA. Tumor and LN sensitivity of ultrasound was 92% and 43%, respectively, and 86% and 57% of F-DOPA-PET-CT, respectively. In 3/50 (6%) patients and 3/50 (6%) patients, mediastinal LN metastasis and distant metastasis, respectively, were diagnosed only by F-DOPA-PET-CT.ConclusionUltrasound and F-DOPA-PET-CT are sensitive for the localization of MTC but not for the presence and location of LN metastasis (limitations: size/number). Only F-DOPA ensures the diagnosis of distant metastasis and influences the extent of LN surgery. Surgical strategy cannot be predicted based on neither ultrasound nor F-DOPA-PET-CT. More... »
PAGES3919-3927
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DOIhttp://dx.doi.org/10.1245/s10434-018-6829-3
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"description": "BackgroundAt the time of diagnosis, one-third of medullary thyroid carcinoma (MTC) patients show lymph node (LN) or distant metastasis. A metastasized MTC requires different surgical strategies.ObjectiveThis study aimed to determine the value of ultrasound and [18F]fluoro-dihydroxyphenylalanine positron emission tomography with computed tomography (F-DOPA-PET-CT) in localizing MTC, as well as LN and distant metastasis.MethodsThe study included 50 patients (24 males/26 females) with preoperative ultrasound, F-DOPA-PET-CT, and histologically proven MTC. Imaging results were correlated with both preoperative basal calcitonin (bCt) levels and final histology.ResultsTumors were classified as pT1a:17 (diameter, mean\u2009\u00b1\u2009standard deviation: 5.8\u2009\u00b1\u20093.0\u00a0mm), pT1b:15 (15.0\u2009\u00b1\u20093.2\u00a0mm), pT2:9 (27.3\u2009\u00b1\u20097.0\u00a0mm), and pT3:9 (38.3\u2009\u00b1\u200924.2\u00a0mm). The median bCt level was 202\u00a0pg/mL (lower/upper quartile: 82/1074\u00a0pg/mL). Ultrasound was positive for tumor in 45/50 (92%) patients (20.0\u2009\u00b1\u200916.0\u00a0mm) and negative in 5 patients (3.2\u2009\u00b1\u20092.2\u00a0mm). Overall, 43/50 (86%) patients had positive F-DOPA local scans (20.0\u2009\u00b1\u200916.4\u00a0mm), while 7 (14%) patients were negative (7.7\u2009\u00b1\u20098.1\u00a0mm). Lastly, 21/50 (42%) patients had LN metastasis; 8/21 (38%) patients had positive LNs suspected with ultrasound, and 12/21 (57%) patients had positive LNs suspected with F-DOPA. Tumor and LN sensitivity of ultrasound was 92% and 43%, respectively, and 86% and 57% of F-DOPA-PET-CT, respectively. In 3/50 (6%) patients and 3/50 (6%) patients, mediastinal LN metastasis and distant metastasis, respectively, were diagnosed only by F-DOPA-PET-CT.ConclusionUltrasound and F-DOPA-PET-CT are sensitive for the localization of MTC but not for the presence and location of LN metastasis (limitations: size/number). Only F-DOPA ensures the diagnosis of distant metastasis and influences the extent of LN surgery. Surgical strategy cannot be predicted based on neither ultrasound nor F-DOPA-PET-CT.",
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