Fluorodeoxyglucose-positron emission tomography scan-positive recurrent papillary thyroid cancer and the prognosis and i
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RESEARCH
WORLD JOURNAL OF SURGICAL ONCOLOGY
Open Access
Fluorodeoxyglucose-positron emission tomography scan-positive recurrent papillary thyroid cancer and the prognosis and implications for surgical management Jennifer MJ Schreinemakers1,2, Menno R Vriens1,2, Nuria Munoz-Perez1,3, Marlon A Guerrero1,4, Insoo Suh1, Inne HM Borel Rinkes2, Jessica Gosnell1, Wen T Shen1, Orlo H Clark1 and Quan-Yang Duh1*
Abstract Background: To compare outcomes for patients with recurrent or persistent papillary thyroid cancer (PTC) who had metastatic tumors that were fluorodeoxyglucose-positron emission tomography (FDG-PET) positive or negative, and to determine whether the FDG-PET scan findings changed the outcome of medical and surgical management. Methods: From a prospective thyroid cancer database, we retrospectively identified patients with recurrent or persistent PTC and reviewed data on demographics, initial stage, location and extent of persistent or recurrent disease, clinical management, disease-free survival and outcome. We further identified subsets of patients who had an FDG-PET scan or an FDG-PET/CT scan and whole-body radioactive iodine scans and categorized them by whether they had one or more FDG-PET-avid (PET-positive) lesions or PET-negative lesions. The medical and surgical treatments and outcome of these patients were compared. Results: Between 1984 and 2008, 41 of 141 patients who had recurrent or persistent PTC underwent FDG-PET (n = 11) or FDG-PET/CT scans (n = 30); 22 patients (54%) had one or more PET-positive lesion(s), 17 (41%) had PET-negative lesions, and two had indeterminate lesions. Most PET-positive lesions were located in the neck (55%). Patients who had a PET-positive lesion had a significantly higher TNM stage (P = 0.01), higher age (P = 0.03), and higher thyroglobulin (P = 0.024). Only patients who had PET-positive lesions died (5/22 vs. 0/17 for PET-negative lesions; P = 0.04). In two of the seven patients who underwent surgical resection of their PET-positive lesions, loco-regional control was obtained without evidence of residual disease. Conclusion: Patients with recurrent or persistent PTC and FDG-PET-positive lesions have a worse prognosis. In some patients loco-regional control can be obtained without evidence of residual disease by reoperation if the lesion is localized in the neck or mediastinum.
Background Papillary thyroid cancer (PTC) accounts for 80 to 85% of all thyroid cancers. Although most patients with PTC have a good prognosis, recurrent disease develops in about 20 to 30%, and about 7% of patients die from progressive disease within 10 years of diagnosis [1]. After initial surgery for PTC, follow-up consists of regular * Correspondence: [email protected] 1 Department of Surgery, University of California, 1600 Divisadero Street, Box 1711, San Francisco, CA 94115, USA Full list of author information is available at the end of the article
ultrasound examination of the neck, measurements of serum thyroglobulin (Tg) and Tg antibodies, and wholebody iodine scans (W
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