68 Ga-DOTANOC and 18 F-FDG PET/CT in metastatic medullary thyroid carcinoma: novel correlations with tumoral biomarkers
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ORIGINAL ARTICLE
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Ga-DOTANOC and 18F-FDG PET/CT in metastatic medullary thyroid carcinoma: novel correlations with tumoral biomarkers
Pedro Souteiro 1,2,3 Patrícia Gouveia4 Gonçalo Ferreira5 Sandra Belo1 Cláudia Costa6 Davide Carvalho1,2,3 Hugo Duarte5 Inês Lucena Sampaio5,7 ●
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Received: 12 December 2018 / Accepted: 14 January 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Objective Metastatic disease is common in medullary thyroid carcinoma (MTC) and it is usually detected by raising calcitonin and carcinoembryonic antigen (CEA) levels. Nuclear medicine imaging has an important role in lesion identification/characterisation. We aim to compare 68Ga-DOTANOC PET/CT and 18F-FDG PET/CT performance and to explore the correlations between tumoral markers and functional imaging. Methods This a retrospective cross-sectional study including 13 patients with MTC and high calcitonin/CEA levels that underwent both 68Ga-DOTANOC PET/CT and 18F-FDG PET/CT. Results 68Ga-DOTANOC PET/CT identified MTC metastases in 2twopatients that were 18F-FDG-negative (sensitivity of 69.2% vs. 53.9%, respectively). 68Ga-DOTANOC PET/CT also detected a higher number of lesions than 18F-FDG PET/CT in seven patients, with only one patient showing the opposite pattern. Both differences lacked statistical significance (p = 0.50 and p = 0.86, respectively) but 68Ga-DOTANOC PET/CT better performance allowed changes in patients’ management. 68Ga-positive/18F-FDG-negative patients were the ones with the lowest calcitonin doubling time and presented a CEA doubling time >24 months, while the patient with more 18F-FDG-positive lesions was the one with the highest CEA/ calcitonin ratio. The number of lesions found in 68Ga-DOTANOC PET/CT were correlated with calcitonin levels (r = 0.73; p < 0.01) but not with CEA ones (r = 0.42; p = 0.15). The number of 18F-FDG hypermetabolic focus were correlated with CEA levels (r = 0.60; p < 0.05) but not with calcitonin (r = 0.48; p = 0.09). Conclusions This is the first study to describe a positive correlation between 68Ga-positive lesions and calcitonin levels and between 18F-FDG-positivity and CEA levels. Tumoral markers pattern in metastatic MTC could help clinicians to decide which exam to perform first. Keywords Thyroid cancer, medullary PET-CT Scan Calcitonin Carcinoembryonic antigen ●
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* Pedro Souteiro [email protected] 1
Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal
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Faculty of Medicine of University of Porto, Porto, Portugal
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Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
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Nuclear Medicine Department, Centro Hospitalar do Porto, Porto, Portugal
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Nuclear Medicine Department, Instituto Português de Oncologia do Porto, Porto, Portugal
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Department of Endocrinology, Instituto Português de Oncologia do Porto, Porto, Portugal
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Medical Physics, Radiobiology and Radiological Protection Group, Centro de Investigação do I
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