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Incidental Thyroid Carcinoma Identified by Positron Emission Tomography Scanning Obtained for Metastatic Evaluation

Incidental Thyroid Carcinoma Identified by Positron Emission Tomography Scanning Obtained for Metastatic Evaluation. The American Surgeon, Vol 67:p582-584, June 2001 Peyton W. Davis, Nancy D. Perrier, Lee Adler, and Edward A. Levine. Speaker: 8700021 陳修弘. Introduction.

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Incidental Thyroid Carcinoma Identified by Positron Emission Tomography Scanning Obtained for Metastatic Evaluation

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  1. Incidental Thyroid Carcinoma Identified by Positron Emission Tomography Scanning Obtained for Metastatic Evaluation The American Surgeon, Vol 67:p582-584, June 2001 Peyton W. Davis, Nancy D. Perrier, Lee Adler, and Edward A. Levine. Speaker: 8700021 陳修弘

  2. Introduction

  3. Positron Emission Tomography (PET) ~ I • Tracer: [18F]fluorodeoxyglucose (FDG) • Cells with higher glucose requirements

  4. Positron Emission Tomography (PET) ~ II • Evaluation of patients at risk of having metastatic disease • Staging of malignant melanoma • Therapeutic management of patients with recurrent colorectal carcinoma • Identification of esophageal and gastric carcinoma • Evaluating patients with suspicious thyroid nodules

  5. The Purpose of this Study • To review for cases in which an abnormality was identified by PET in the region or the thyroid

  6. Methods

  7. Methods ~ I • Patients were for scanning as part of a metastatic workup • PET scans or the chest or torso for known or suspected extrathyroidal malignancy • 1284 consecutive patients at Wake Forest University Baptist Medical Center • ECAT 951 scanner (CTI, Knoxville, TN) • Between April 1998 and May 2000

  8. Methods ~ II • PET procedure • Patients received a 4-minute-per-bed position transmission scan • Followed by intravenous administration of 15- to 20-mCi FDG • After a 45-min to one-hr delay 7-minute-per-bed position emission imaging was performed

  9. Methods ~ III • The emission scan and the transmission scan were reconstructed and reviewed on a workstation in all three orthogonal planes • The peak activity per cubic centimeter in suspicious areas was corrected for • the dose administered • lean body weight • radioactive decay • blood glucose level to produce a standardized uptake value (SUV).

  10. Methods ~ IV • Four patients with a suspicious area in the thyroid region who were followed up with a fine-needle aspiration (FNA) biopsy under ultrasound guidance. • Two malignant melanoma • One gastric adenocarcinoma • One colon adenocarcinoma

  11. Methods ~ V • They subsequently underwent surgical resection and appropriate adjuvant therapies for their original malignancy • At a later date all cases underwent a definitive resection for the thyroid FNA findings.

  12. Results

  13. Results ~ I

  14. Results ~ II

  15. Results ~ III • PET scan results: • P1: No other abnormalities • P2: Hilum of the right lung • P3: Gastroesophageal junction and left lung • P4: Suspicious area in the liver • P5: Rectal and thyroid uptake only

  16. Results ~ IV • FNA results • Revealed papillary carcinoma of the thyroid in the five cases • Case five underwent surgery based on uncertainty of a negative ultrasound guided FNA • Histology: supported the diagnosis of papillary carcinoma without any evidence of metastatic disease from the original malignancy. • No patients has suffered a recurrence of the thyroid lesion.

  17. Discussion

  18. Discussion ~ I • Current methods of detecting thyroid malignancy and recurrence • Sonography • 131I • 123I whole-body scan • Serum thyroglobulin levels • Thallium-201 scintigraphy

  19. Discussion ~ II • PET V.S these other modalities • Superior to scintigraphy in the identification of benign versus malignant thyroid tumors • In one study of six patienst with positive PET and negative 131I scans five had positive histology for carcinoma • PET has a sensitivity of 94% and specificity of 95% fir metastatic disease in patients with negative 131I scan

  20. Discussion ~ III • Other studies have supported the usefulness of PET in evaluating metastatic thyroid disease in patients with negative thallium scans. • FDG PET can stratify these patients into high- and low-risk subsets • FDG PET has definite usefulness in treating patients with known thyroid malignancy or metastases

  21. Discussion ~ IV • In this report, authors address cases in which PET identified an area of occult thyroid carcinoma • These scans were useful in the management of these patients in that metastatic disease was not the cause of their PET abnormality.

  22. Conclusion • These incidental findings suggest • The diagnosis of a primary thyroid malignancy should be entertained for abnormalities of the thyroid observed on PET • Support a potential role for FDG-PET as a component of the evaluation of primary thyroid malignancies

  23. Thanks!

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