Medullary Thyroid Carcinoma: Do Ultrasonography and F-DOPA-PET-CT Influence the Initial Surgical Strategy? View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2018-10-10

AUTHORS

Lindsay Brammen, Martin B. Niederle, Philipp Riss, Christian Scheuba, Andreas Selberherr, Georgios Karanikas, Gerd Bodner, Oskar Koperek, Bruno Niederle

ABSTRACT

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 ± 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... »

PAGES

3919-3927

Identifiers

URI

http://scigraph.springernature.com/pub.10.1245/s10434-018-6829-3

DOI

http://dx.doi.org/10.1245/s10434-018-6829-3

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1107535912

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/30306375


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40 schema: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 ± 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.
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48 CT
49 CT influence
50 ConclusionUltrasound
51 F-DOPA
52 F-DOPA PET
53 LN metastasis
54 LN surgery
55 MTC
56 MethodsThe study
57 ResultsTumors
58 basal calcitonin levels
59 calcitonin levels
60 carcinoma patients
61 computed tomography
62 diagnosis
63 different surgical strategies
64 dihydroxyphenylalanine positron emission tomography
65 distant metastasis
66 emission tomography
67 extent
68 final histology
69 histology
70 imaging results
71 influence
72 initial surgical strategy
73 levels
74 local scan
75 localization
76 location
77 lymph nodes
78 mediastinal LN metastasis
79 medullary thyroid carcinoma patients
80 metastasis
81 nodes
82 one-third
83 patients
84 pg/
85 positive lymph nodes
86 positron emission tomography
87 preoperative basal calcitonin levels
88 preoperative ultrasound
89 presence
90 results
91 scans
92 sensitivity
93 strategies
94 study
95 surgery
96 surgical strategy
97 thyroid carcinoma patients
98 time
99 time of diagnosis
100 tomography
101 tumors
102 ultrasonography
103 ultrasound
104 value of ultrasound
105 values
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