# The Role of the FDG-PET in the Staging of Patients with Differentiated Thyroid Cancer

## Authors

- Ebuzer Kalender ([ORCID](https://orcid.org/0000-0001-8472-3174)) — Department of Nuclear Medicine, University of Gaziantep, School of Medicine, Gaziantep, Turkey

## Article information

- **Journal:** The Ulutas Medical Journal (Ulutas Med J), ISSN 2149-388X
- **Issue:** Volume 9, Issue 3 (2023), pages 178–184
- **Article type:** Original Article
- **Published online:** 2023-09-13
- **DOI:** [10.5455/umj.20230901081616](https://doi.org/10.5455/umj.20230901081616)
- **Licence:** [CC BY-NC 4.0](https://creativecommons.org/licenses/by-nc/4.0/)
- **Article page:** https://www.ulutasmedicaljournal.com/?mno=167883
- **PDF:** https://www.ulutasmedicaljournal.com/pdf/167883.pdf

## Abstract

Introduction: This study aims to determine the role of the FDG-PET in the staging of patients with Differentiated Thyroid Cancer (DTC) who have high Tg levels after thyroidectomy. Material and methods: Thirty-three DTC patients who performed FDG-PET scans after thyroidectomy were selected for this retrospective study. All patients had Tg levels over 10 ng/ml. FDG-PET was performed on patients six weeks after surgery. 2 weeks later FDG-PET imaging, patients received 131-I radioiodine treatment (RIT) except those with lymph node involvement. After RIT, post-ablation therapy whole body scan (TWBS) was performed on the patients. Results: Twelve patients (36.4%) without involvement outside the thyroid bed, both on the FDG-PET and TWBS, were remissed completely. In 21 patients (63.4%), there was involvement outside the thyroid bed on the FDG-PET and/or TWBS. Eleven patients (33.3%) had distant organ involvement in the FDG-PET and/or TWBS. Patients with involvement outside the thyroid bed had higher Tg levels than others. The disease was completely or partially regressed in the patients with distant organ involvement who had negative FDG-PET scans and positive TWBS results. The disease tended to progress in patients with distant organ involvement who had higher SUVmax levels on FDG-PET. Conclusion: Our data suggest that the FDG-PET scan, performed on the DTC patients with high Tg levels at the time of staging, would be the right approach. This approach will be useful, especially in demonstrating lymph node involvement and predicting prognosis. The results of FDG-PET may also change the treatment management.

## Keywords

FDG-PET; DTC; Thyroglobulin; Thyroidectomy

## How to cite

Kalender E. The Role of the FDG-PET in the Staging of Patients with Differentiated Thyroid Cancer. Ulutas Med J. 2023;9(3):178-184. doi:10.5455/umj.20230901081616

## References

1. Jemal A, Siegel R, Ward E, et al. Cancer statistics. CA: A Cancer Journal for Clinicians 2006;56:106–130. https://doi.org/10.3322/canjclin.56.2.106
2. Pellegriti G, Frasca F, Regalbuto C, Squatrito S, Vigneri R. Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors. J Cancer Epidemiol. 2013;2013:965212. https://doi.org/10.1155/2013/965212
3. Hundahl SA, Cady B, Cunningham MP, et al. Initial results from a prospective cohort study of 5583 cases of thyroid carcinoma treated in the United States during 1996. US and German Thyroid Cancer Study Group. An American College of Surgeons Commission on Cancer Patient Care Evaluation study. Cancer. 2000;89:202-17. https://doi.org/10.1002/1097-0142(20000701)89:1<202::aid-cncr27>3.0.co;2-a
4. Van Herle AJ, Uller RP, Matthews NI, Brown J. Radio immunoassay for measurement of thyroglobulin in human serum. J Clin Invest 1973; 52: 1320-7. https://doi.org/10.1172/jci107303
5. Bernier MO, Morel O, Rodien P, et al. Prognostic value of an increase in the serum thyroglobulin level at the time of the first ablative radioiodine treatment in patients with differentiated thyroid cancer. Eur J Nucl Med Mol Imaging 2005; 32: 1418-21. https://doi.org/10.1007/s00259-005-1866-0
6. Lima N, Cavaliere H, Tomimori E, Knobel M, Neto GM. Prognostic value of serial serum thyroglobulin determinations after total thyroidectomy for differentiated thyroid cancer. J Endocrinol Invest 2002; 25: 110-5. https://doi.org/10.1007/bf03343973
7. Ronga G, Filesi M, Ventroni G, Vestri AR, Signore A. Value of the first serum thyroglobulin level after total thyroidectomy for the diagnosis of metastases from differentiated thyroid carcinoma. Eur J Nucl Med 1999; 26: 1448-52. https://doi.org/10.1007/s002590050477
8. Kalender E, Celen YZ, Elboga U, Demir HD, Karaoglan H, Yilmaz M. The relationship between thyroglobulin (Tg) levels and distant metastases before radioiodine (RAI) treatment in differentiated thyroid carcinoma. Gaziantep Med J 2012;18:11-13. https://doi.org/10.5455/gmj-30-2011-58
9. Liu M, Cheng L, Jin Y, Ruan M, Sheng, S, Chen L. Predicting 131 I-avidity of metastases from differentiated thyroid cancer using 18F-FDG PET/CT in postoperative patients with elevated thyroglobulin. Sci Rep 2018;8:4352. https://doi.org/10.1038/s41598-018-22656-4
10. Iwano S, Kato K, Ito S, Tsuchiya K, Naganawa S. FDG PET performed concurrently with initial I-131 ablation for differentiated thyroid cancer. Ann Nucl Med 2012; 26: 207–13. https://doi.org/10.1007/s12149-011-0559-y
11. Nascimento C, Borget I, Al Ghuzlan A, et al. Postoperative fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography: an important imaging modality in patients with aggressive histology of differentiated thyroid cancer. Thyroid 2015;25:437–44. https://doi.org/10.1089/thy.2014.0320
12. Alzahrani AS, Abouzied ME, Salam SA, et al. The role of F-18-fluorodeoxyglucose positron emission tomography in the postoperative evaluation of differentiated thyroid cancer. Eur J Endocrinol 2008; 158: 683–9. https://doi.org/10.1530/eje-07-0903e
13. Gaertner FC, Okamoto S, Shiga T, et al. FDG PET performed at thyroid remnant ablation has a higher predictive value for 184 77 FDG-PET in Differentiated Thyroid Cancer Ebuzer Kalender longg term survival of high-risk patients with well-differentiated thyroid cancer than radioiodine uptake. Clin Nucl Med 2015; 40: 378–83. https://doi.org/10.1097/rlu.0000000000000699
14. Mazzaferri EL: NCCN thyroid carcinoma practice guidelines. Oncology. 1999; 13: 391–442.
15. Schlumberger MJ: Papillary and follicular thyroid carcinoma. N Engl J Med 1998; 338: 297-306. https://doi.org/10.1056/nejm199801293380506
16. Mazzaferri EL, Kloos RT. Current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab. 2001; 86: 1447-63. https://doi.org/10.1210/jcem.86.4.7407
17. Schlumberger M, Mancusi F, Baudin E, Pacini F. 131-I therapy for elevated thyroglobulin levels. Thyroid 1997; 7: 273-6. https://doi.org/10.1089/thy.1997.7.273
18. Lind P, Kresnik E, Kumnig G, et al. 18F-FDG-PET in the follow-up of thyroid cancer. Acta Med Austriaca 2003; 30: 17-21. https://doi.org/10.1046/j.1563-2571.2003.02046.x
19. Wang W, Larson SM, Tuttle RM, et al. Resistance of [18f]- fluorodeoxyglucose-avid metastatic thyroid cancer lesions to treatment with high-dose radioactive iodine. Thyroid 2001; 11: 1169-75. https://doi.org/10.1089/10507250152741028
