Positron emission tomography for the detection of metastases of differentiated thyroid carcinoma

Objective: To show the value of positron emission tomography (PET) with 18- F-fluorodeoxyglucose (18-FDG) for the detection of metastases of differenti ated thyroid carcinoma in selected patients. Patient histories: There were four patients, who had undergone total thyroi dectomy for papillary (two) or follicular thyroid carcinoma (two). All pati ents had subsequent treatment with (131)iodine. Three patients had an incre asing serum concentration of thyroglobulin, one patient had antibodies agai nst thyroglobulin. A diagnostic (131)iodine scintigraphy was negative in tw o patients, and uncertain in two patients. Positron emission tomography was performed about 45 min after administration of 10 mCi 18-F-fluorodeoxygluc ose. In three patients PET showed uptake in the cervical region, caused by lymph node metastases in two (confirmed by neck dissection) and recurrent t umor on the trachea in one patient (confirmed by surgery). In the fourth pa tient uptake of 18-FDG was seen in the neck and in both lungs. This led to discontinuation of treatment with (131)iodine because the lung metastases d id not accumulate (131)iodine. Discussion: In selected patients with differentiated thyroid carcinoma with an increasing serum concentration of thyroglobulin, PET is an important di agnostic option when scintigraphy with (131)iodine is negative or uncertain . In the four presented case histories, the results of PET led to a therape utic decision: surgery in three patients and discontinuation of (131)iodine in one patient. The development of guidelines for the use of PET in the di agnosis of recurrent thyroid cancer is discussed. (C) 2000 Elsevier Science B.V. All rights reserved.