Detection Of Recurrent Thyroid Carcinoma Research Articles

Utility of PET/Neck MRI Digital Fusion Images in the Management of Recurrent or Persistent Thyroid Cancer

Approximately 30% of thyroid cancer patients present with reappearing disease within 40 years of initial diagnosis. Hence, sensitive postsurgical monitoring techniques are imperative to successful long-term care. The objective of this study was to assess the added clinical utility of a combined positron emission tomography/magnetic resonance imaging (PET/MRI) of the neck in conjunction with standard imaging in the detection of recurrent thyroid carcinoma. We define standard imaging as a neck sonogram, 131I scan, computed tomography, and MRI. This study included 34 patients treated for thyroid cancer at Washington Hospital Center. All patients had previously undergone near-total or total thyroidectomy, standard follow-up imaging studies, and laboratory studies. Twenty-nine of thirty-four patients had received at least one 131I treatment prior to the study. Each patient received a PET and MRI scan, and these images were subsequently digitally fused. Individually and blinded, four endocrinologists retrospectively reviewed all information in patient charts prior to PET and PET/MRI coregistration. A clinical assessment and treatment plan were devised with these data. Following the initial assessment, the endocrinologists were provided results from the PET and PET/MRI fusion studies and asked to make a revised assessment and treatment plan. For each patient, the physicians categorized PET/MRI fusion results as providing new information that altered the initial treatment plan, providing new information that confirmed the initial treatment plan, or providing no additional information. On average, PET/MRI coregistration provided additional information that altered the treatment plan in 46% of the cases, provided additional information that confirmed the treatment plan in 36% of cases, and did not provide any additional information in 18% of cases. The combination of structural and functional data that PET/neck MRI fusion offers provided further information in an overwhelming majority of thyroid cancer patients in this study. Thus PET/MRI can be a useful tool in surgical planning, radioactive iodine therapy decisions, and determining the level of follow-up necessary for each patient.

Clinical evaluation of serum thyroglobulin measurement using a commercial kit in the diagnosis of recurrent thyroid cancer

The value of serum thyroglobulin assay employing a kit manufactured by Diagnostic Products Corporation in the detection of recurrence of thyroid carcinoma in patients treated by thyroidectomy and ablative therapy was assessed by clinical follow-up and radioiodine scanning of 122 patients over a 2-year period. A total of 204 specimens were analysed. The assay was found to be sensitive and highly specific for the detection of recurrent thyroid carcinoma provided that lipemic sera are clarified by ultracentrifugation prior to measurement and that results from those patients who demonstrate positive serum antithyroglobulin antibodies are excluded. The predictive value of a serum thyroglobulin level above 20 pmol/L was 96% for recurrence of thyroid carcinoma. The predictive value for non-recurrence was 98% for serum thyroglobulin levels below 10 pmol/L. The specificity and sensitivity of the assay were poor for serum thyroglobulin levels between 10 and 20 pmol/L. In recurrence-free patients, the serum thyroglobulin levels were not changed by withdrawal of thyroid replacement therapy 4-7 weeks prior to sampling.