Download PDF
Der Nuklearmediziner 2010; 33(4): 233-241
DOI: 10.1055/s-0030-1267190
Schilddrüsemkarzinom – neue Aspekte in Diagnostik und Therapie

© Georg Thieme Verlag KG Stuttgart · New York

Die chirurgische Perspektive: Bedeutung der FDG-PET/CT-Diagnostik in der Rezidivchirurgie der differenzierten Schilddrüsenkarzinome

The Surgical Perspective: Impact of PET/CT Diagnostic for Surgery of Recurrent Differentiated Thyroid CarcinomaK. Lorenz1 , T. Weber2
  • 1Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Halle, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Halle(Saale)
  • 2Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Ulm
Further Information

Publication History

Publication Date:
16 December 2010 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Die PET-Bildgebung hat im diagnostischen und therapeutischen Management der differenzierten Schilddrüsenkarzinome (DTC) eine wichtige Rolle eingenommen. Insbesondere in der Rezidivsituation, bei residuellem Tumor und in der Nachsorge bei ansteigendem Tumormarker Thyreoglobulin und fehlender Iodspeicherung des Karzinoms ist die PET/CT-Lokalisation der Tumorläsionen wesentlich. Eine exakte Tumorlokalisation ist gerade aus chirurgischer Perspektive von entscheidender Bedeutung, um die chirurgisch therapeutischen Optionen zu prüfen und in ihrem Umfang abschätzen zu können. Dabei sind die Identifikation der Tumorläsionen und die sichere Abgrenzung gegenüber nicht-tumorigenen Läsionen der PET, aber auch die anatomisch-topografische Korrelation mit der CT für den Chirurgen gleichermaßen wichtig. Mithilfe der FDG-PET/CT-Diagnostik können die Lokalisation iodnegativer Rezidive verbessert und Rezidivoperationen befundgerecht ausgerichtet werden, Lymphknoten- und Weichteilrezidive gezielt angegangen und Fernmetastasen identifiziert werden.

Key words

PET imaging evolved to be an important tool in the diagnostic and therapeutic management of differentiated thyroid cancer (DTC). Mainly in the situation of residual or recurrent tumor with rising thyroglobulin levels and iodine negative DTC, PET/CT-localization of tumor lesions seems to be an important diagnostic tool. From the surgical perspective accurate localization of recurrent DTC plays a key role in order to evaluate therapeutic surgical options and to plan the extent of necessary surgical interventions. Moreover, for the surgeon it is not only important to identify tumor lesions with PET scan but also to differentiate these from benign lesions. In addition, PET/CT scans allow for perceiving a detailed anatomical correlation. The advantage of FDG-PET/CT-diagnostic is an improved localization of iodine-negative tumor recurrence, guiding remedial surgery according to the relevant PET-findings, a selective approach to lymph node and soft tissue recurrences and enabling identification of distant metastases.

Schlüsselwörter

differenzierte Schilddrüsenkarzinome - chirurgische Therapie - Schilddrüsenkarzinomrezidiv - PET/CT-Diagnostik - Rezidivchirurgie

Key words

differentiated thyroid carcinoma - surgical therapy - thyroid carcinoma recurrence - PET/CT diagnostic - recurrent surgery

Literatur

  • 1 Dietlein M. Follow-up of differentiated thyroid cancer: what is the value of FDG and Sestamibi in the diagnostic algorithm?.  Nuklearmedizin. 1998;  37 12-17
    PubMedGoogle Scholar
  • 2 Hooft L, Hoekstra OS, Deville W. et al . Diagnostic accuracy of 18F-Fluorodeoxyglucose positron emission tomography in the follow-up of papillary or follicular thyroid cancer.  J Clin Endocrinol Metab. 2001;  86 3779-3786
    CrossrefPubMedGoogle Scholar
  • 3 Choi MY, Chung JK, Lee HY. et al . The clinical impact of 18F-FDG PET in papillary thyroid carcinoma with a negative 131I whole body scan: a single-center study in 108 patients.  Ann Nucl Med. 2006;  20 547-552
    CrossrefPubMedGoogle Scholar
  • 4 Mirallie E, Guillan T, Bridji B. et al . Therapeutic impact of 18FDG-PET/CT in the management of iodine negative recurrence of differentiated thyroid carcinoma.  Surgery. 2007;  142 952-958
    CrossrefPubMedGoogle Scholar
  • 5 Freudenberg LS, Antoch G, Jentzen W. et al . Value of 124J-PET/CT in staging of patients with differentiated thyroid cancer.  Eur Radiol. 2004;  14 2092-2098
    CrossrefPubMedGoogle Scholar
  • 6 Grünwald F, Menzel C, Bender H. et al . Comparison of 18-FDG-PET with 131J-iodine and 99mTc-sestamibi scintigraphy in differentiated thyroid cancer.  Thyroid. 1997;  7 327-335
    CrossrefPubMedGoogle Scholar
  • 7 Dadparvar S, Krishna L, Brady LW. et al . The role of iodine-131 and thallium-201 imaging and serum thyroglobulin in the management of differentiated thyroid carcinoma.  Cancer. 1993;  71 3767-3773
    CrossrefPubMedGoogle Scholar
  • 8 Teunissen JJ, Kewkkeboom Dj, Krenning E. Staging and treatment of differentiated thyroid carcinoma with radiolabeled somatostatin analogs.  Trends Endocrinol Metab. 2006;  17 19-25
    CrossrefPubMedGoogle Scholar
  • 9 Dong MJ, Liu ZF, Ruan LX. et al . Value of 18F-FDG-PET/PET-CT in differentiated thyroid carcinoma with radioiodine-negative whole-body scan: a meta analysis.  Nucl Med Comm. 2009;  30 639-650
    CrossrefPubMedGoogle Scholar
  • 10 Palmedo H, Bucerius J, Joe A. et al . Integrated PET/CT in differentiated thyroid cancer: Diagnostic accuracy and impact on patient management.  J Nucl Med. 2006;  47 616-624
    PubMedGoogle Scholar
  • 11 Sisson JC, Ackermann RJ, Meyer MA. et al . Uptake of 18-fluoro-2-desoxy-D-glucose by thyroid cancer: implications for diagnosis and therapy.  J Clin Endocrinol Metab. 1993;  77 1090-1094
    CrossrefPubMedGoogle Scholar
  • 12 Muros MA, Llamas-Elvira JM, Ramirez-Navarro A. et al . Utility of fluorine-18-fluorodeoxyglucose positron emission tomography in differentiated thyroid carcinoma with negative radioiodine scans and elevated serum thyroglobulin levels.  Am J Surg. 2000;  179 457-461
    CrossrefPubMedGoogle Scholar
  • 13 Feine U, Lietzenmayer R, Hanke JP. et al . Fluorine 18-FDG- and iodine 131-iodide uptake in thyroid cancer.  J Nucl Med. 1996;  37 1468-1472
    PubMedGoogle Scholar
  • 14 Dietlein M, Scheidhauer K, Voth E. et al . Fluorine-18-fluorodeoxyglucose positron emission tomography and iodine -131 whole-body scintigraphy in the follow-up of differentiated thyroid cancer.  Eur J Nucl Med. 1997;  24 1342-1348
    CrossrefPubMedGoogle Scholar
  • 15 Altenvoerde G, Lerch H, Kuwert T. et al . Positron emission tomography with F-18-deoxyglucose in patients with differentiated thyroid carcinoma, elevated thyroglobulin levels, and negative iodine scans.  Langenbecks Arch Surg. 1998;  383 160-163
    PubMedGoogle Scholar
  • 16 Frilling A, Tecklenborg K, Görges R. et al . Preoperative diagnostic value of [18F] fluorodeoxyglucose positron emission tomography in patients with radioiodine-negative recurrent well-differentiated thyroid carcinoma.  Ann Surg. 2001;  234 804-811
    CrossrefPubMedGoogle Scholar
  • 17 Zimmer LA, McCook B, Meltzer C. et al . Combined positron emission tomography/computed tomography imaging of recurrent thyroid cancer.  Otolaryngol Head Neck Surg. 2003;  128 178-184
    CrossrefPubMedGoogle Scholar
  • 18 Miller ME, Chen Q, Elashoff D. et al . Positron emission tomography and positron emission tomography-CT evaluation for recurrent papillary thyroid carcinoma: meta-analysis and literature review.  Head Neck. 2010;  July 27th (Epub ahead of print)
    PubMedGoogle Scholar
  • 19 Finkelstein SE, Grigsby PW, Siegel BA. et al . Combined [18F]Fluorodeoxyglucose positron emission tomography and computed tomography (FDG-PET/CT) for detection of recurrent 131I-negative thyroid cancer.  Ann Surg Oncol. 2007;  15 286-292
    PubMedGoogle Scholar
  • 20 Ito S, Kato K, Ikeda M. et al . Comparison of 18F-FDG PET and bone scintigraphy in detection of bone metastases of thyroid cancer.  J Nucl Med. 2007;  48 889-895
    CrossrefPubMedGoogle Scholar
  • 21 Shammas A, Degirmenci B, Mountz JM. et al . 18F-FDG PET/CT in patients with suspected recurrent or metastatic well-differentiated thyroid cancer.  J Nucl Med. 2007;  48 221-226
    PubMedGoogle Scholar
  • 22 Bertagna F, Bosio G, Biasiotto G. et al . F-18 FDG-PET/CT evaluation of patients with differentiated thyroid cancer with negative I-131 total body scan and high thyroglobulin level.  Clin Nucl Med. 2009;  34 756-761
    CrossrefPubMedGoogle Scholar
  • 23 Esteva D, Muros MA, Llamas-Elvira JM. et al . Clinical and Pathological factors related to 18F-FDG-PET positivity in the diagnosis of recurrence and/or metastasis in patients with differentiated thyroid cancer.  Ann Surg Oncol. 2009;  16 2006-2013
    CrossrefPubMedGoogle Scholar
  • 24 Van Tol KM, Jager PL, Piers DA. et al . Better yield of (18)fluorodeoxyglucose-positron emission tomography in patients with metastatic differentiated thyroid carcinoma during thyrotropin stimulation.  Thyroid. 2002;  12 381-387
    CrossrefPubMedGoogle Scholar
  • 25 Leboulleux S, Schroeder PR, Busaidy NL. et al . Assessment of the incremental value of recombinant thyrotropin stimulation before 2-[18F]-Fluoro-2-Deoxy-D-Glucose positron emission tomography imaging to localize residual differentiated thyroid cancer.  J Clin Endocrinol Metab. 2009;  94 1310-1316
    CrossrefPubMedGoogle Scholar
  • 26 Vera P, Kuhn-Lansoy C, Edet-Sanson A. et al . Does recombinant human thyrotropin-stimulated positron emission tomography with [18]Fluoro-2-Deoxy-D-Glucose improve detection of recurrence of well-differentiated thyroid carcinoma in patients with low serum thyroglobulin?.  Thyroid. 2010;  1 15-23
    PubMedGoogle Scholar
  • 27 Boerner AR, Petrich T, Weckesser E. et al . Monitoring isotretinoin therapy in thyroid cancer using 18F-FDG PET.  Eur J Nucl Med. 2002;  29 231-236
    CrossrefPubMedGoogle Scholar

Korrespondenzadresse

PD Dr. Kerstin Lorenz

Klinik für Allgemein-, Viszeralund-

Gefäßchirurgie

Universitätsklinikum Halle

Medizinische Fakultät

Martin-Luther-Universität

Halle-Wittenberg

Ernst-Grube-Straße 40

06120 Halle/ Saale

Phone: +49/345/557 2060

Fax: +49/345/557 2120

Email: kerstin.lorenz@medizin.uni-halle.de

      >