Tedaviye biyokimyasal tam olmayan yanıtlı diferansiye tiroid kanserli hastalarda FDG PET/BT'nin tanısal değeri ve hasta yönetimine katkısı
Küçük Resim Yok
Tarih
2024
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Çalışmamızda izlemde yüksek tiroglobulin (Tg) değerlerine sahip olan, ancak I-131 tarama sintigrafisinde nüks veya metastaz açısından anlamlı bulgu saptanmayan I-131 tedavisi uygulanmış Diferansiye Tiroid Kanser (DTK) hasta grubunda F-18 FDG PET/BT görüntülemenin, tanısal değerini ve hasta yönetimine katkısını değerlendirmek amaçlandı. Gereç ve Yöntem: Çalışmamızda Ocak 2015 ile Kasım 2022 tarihleri arasında kurumumuzda izlemleri yapılan, total tiroidektomi operasyonu öyküsüne sahip ve en az 1 kez 30-200 mCi I-131 tedavisi almış, takipte TSH stimule Tg değerleri yüksek saptanan (>10 ng/mL) ve I-131 tarama sintigrafileri negatif, radyolojik yöntemlerle metastaz/nüks lezyon saptanamayan veya şüpheli bulgulara sahip olan 102 DTK hastasının F-18 FDG PET/BT görüntüleri, hastaların patolojik bulguları, radyolojik verileri ve klinik takipleri retrospektif olarak incelendi. Bulgular: 102 DTK hastasında yapılmış 136 F-18 FDG PET/BT çalışmasının sonuçları 43 hastada gerçek pozitif, 40 hastada gerçek negatif, 13 hastada yanlış pozitif, 6 hastada yanlış negatif olarak değerlendirildi. Çalışmamızda F-18 FDG PET/BT görüntülemenin nüks/ metastaz odaklarını saptamadaki duyarlılığı: % 87.7, özgüllüğü: % 75.4, pozitif tahmin değeri: % 76.7, negatif tahmin değeri: % 86.9 ve doğruluğu: %81.3 şeklinde saptandı. Ayrıca FDG PET/BT görüntüleme sonrasında izlemde nüks veya metastaz saptanan hasta grubu (GP ve YN) ile hastalık saptanmayan (GN ve YP) gruplarda yapılan ROC analizinde Tg cut-off değeri 17.9 ng/mL için sensitivite %73.5, spesifite %71.7 şeklinde bulundu (AUC: 0.812, p < 0.001). FDG PET/BT görüntülemede bulgu saptanan ve sonrasında bu lezyona yönelik operasyon gerçekleştirilen 18 hastada, operasyon öncesi ve sonrası Tg değerleri karşılaştırıldığında istatistiksel olarak anlamlı farklılık mevcuttu (p: 0.002). Çalışma grubundaki hastaların % 31.3'ünde F-18 FDG PET/BT görüntüleme ile tedavi stratejilerinde değişiklik oldu. Sonuç: Stimüle Tg yüksekliği nedeniyle nüks/ metastaz kuşkusu bulunan, ancak I-131 tarama sintigrafisi negatif ve radyolojik yöntemlerle metastaz/nüks lezyon saptanmayan veya şüpheli bulgulara sahip olan hastalarda F-18 FDG PET/BT görüntülemenin tanısal değeri yüksek, hasta yönetimine katkısı olan bir teknik olduğu sonucuna varıldı.
The aim of our study was to evaluate the diagnostic value and contribution to patients management of F-18 FDG PET/CT imaging in a group of patients with Differentiated Thyroid Cancer (DTC) who had high Thyroglobulin (Tg) levels on follow up but no significant findings indicating recurrence or metastasis on I-131 post-therapy scan. Materials and Methods: In our study, we retrospectively reviewed the F-18 FDG PET/CT images, pathological findings, radiological data, and clinical follow-up records of 102 patients with Differentiated Thyroid Cancer (DTC) who had undergone total thyroidectomy, received at least one I-131 therapy dose between January 2015 and November 2022, and had elevated TSH-stimulated Thyroglobulin (Tg) levels (>10 ng/mL) during follow-up. These patients had negative I-131 post-therapy scans and showed no evidence of metastasis or recurrence lesions through radiological methods or presented suspicious findings. Results: The results of 136 FDG PET/CT studies in 102 patients with Differentiated Thyroid Cancer (DTC) revealed that 43 patients were true positive, 40 were true negative, 13 were false positive, and 6 were false positive. In our study, the sensitivity of F-18 FDG PET/CT imaging in detecting recurrence/metastasis lesions was found to be 87.7%, with a specificity of 75.4%, a positive predictive value of 76.7%, a negative predictive value of 86.9%, and an accuracy of 81.3%. In the Receiver operating characteristic analiysis (ROC) cut-off Tg value was calculated as 17.9 ng/mL with 73.5% sensitivity and 71.7% specificity (AUC: 0.812, p < 0.001). In the 18 patients with detected findings on FDG PET/CT imaging who subsequently underwent surgery targeted at the lesion, there was a statistically significant difference in Tg values before and after the operation (p: 0.002). In 31.3% of the patients in the study group, there were alterations in their treatment strategies based on F-18 FDG PET/CT imaging. Conclusion: It was concluded that F-18 FDG PET/CT imaging is a valuable and contributing diagnostic tool in patients with elevated TSH-stimulated Thyroglobulin (Tg) levels, raising suspicions of recurrence or metastasis, but with negative I-131 post-therapy scans and no evidence of metastatic or recurrent lesions through radiological methods or presenting with suspicious findings in follow-up.
The aim of our study was to evaluate the diagnostic value and contribution to patients management of F-18 FDG PET/CT imaging in a group of patients with Differentiated Thyroid Cancer (DTC) who had high Thyroglobulin (Tg) levels on follow up but no significant findings indicating recurrence or metastasis on I-131 post-therapy scan. Materials and Methods: In our study, we retrospectively reviewed the F-18 FDG PET/CT images, pathological findings, radiological data, and clinical follow-up records of 102 patients with Differentiated Thyroid Cancer (DTC) who had undergone total thyroidectomy, received at least one I-131 therapy dose between January 2015 and November 2022, and had elevated TSH-stimulated Thyroglobulin (Tg) levels (>10 ng/mL) during follow-up. These patients had negative I-131 post-therapy scans and showed no evidence of metastasis or recurrence lesions through radiological methods or presented suspicious findings. Results: The results of 136 FDG PET/CT studies in 102 patients with Differentiated Thyroid Cancer (DTC) revealed that 43 patients were true positive, 40 were true negative, 13 were false positive, and 6 were false positive. In our study, the sensitivity of F-18 FDG PET/CT imaging in detecting recurrence/metastasis lesions was found to be 87.7%, with a specificity of 75.4%, a positive predictive value of 76.7%, a negative predictive value of 86.9%, and an accuracy of 81.3%. In the Receiver operating characteristic analiysis (ROC) cut-off Tg value was calculated as 17.9 ng/mL with 73.5% sensitivity and 71.7% specificity (AUC: 0.812, p < 0.001). In the 18 patients with detected findings on FDG PET/CT imaging who subsequently underwent surgery targeted at the lesion, there was a statistically significant difference in Tg values before and after the operation (p: 0.002). In 31.3% of the patients in the study group, there were alterations in their treatment strategies based on F-18 FDG PET/CT imaging. Conclusion: It was concluded that F-18 FDG PET/CT imaging is a valuable and contributing diagnostic tool in patients with elevated TSH-stimulated Thyroglobulin (Tg) levels, raising suspicions of recurrence or metastasis, but with negative I-131 post-therapy scans and no evidence of metastatic or recurrent lesions through radiological methods or presenting with suspicious findings in follow-up.
