<sup>18</sup>F-FDG-PET SUV AS A PROGNOSTIC MARKER OF INCREASING SIZE IN THYROID CANCER TUMORS.

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Citation: Endocrine Practice. 23(2):182-189, 2017 FebPMID: 27849386Institution: MedStar Heart & Vascular Institute | MedStar Washington Hospital Center | MedStar Washington Hospital CenterDepartment: Medicine/Endocrinology | Medicine/Nuclear MedicineForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Positron-Emission Tomography/mt [Methods] | *Thyroid Neoplasms/dg [Diagnostic Imaging] | Adult | Aged | Aged, 80 and over | Biomarkers, Tumor | Disease Progression | Female | Fluorodeoxyglucose F18 | Humans | Male | Middle Aged | Neoplasm Metastasis | Pilot Projects | Prognosis | Radiopharmaceuticals | Retrospective Studies | Thyroglobulin/bl [Blood] | Thyroid Neoplasms/pa [Pathology] | Whole Body ImagingYear: 2017ISSN:
  • 1530-891X
Name of journal: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical EndocrinologistsAbstract: ABBREVIATIONS: DTC = differentiated thyroid cancer EORTC = European Organization for Research and Treatment of Cancer <sup>18</sup>F-FDG = 2-[fluorine-18] fluoro-2-deoxy-D-glucose FNA = fine-needle aspiration MTC = medullary thyroid cancer PET/CT = positron emission tomography/computed tomography PVE = partial volume effect RAI = radioactive iodine SUV = standardized uptake value Tg = thyroglobulin TSH = thyroid-stimulating hormone.CONCLUSIONS: A significant positive correlation was noted between the increase in lesional SUV and subsequent increase in lesion area. An increase in lesional SUV in subsequent scans may portend tumor growth and could prompt consideration for earlier or more aggressive intervention.METHODS: A retrospective chart review of patients with histologically confirmed thyroid cancer who were monitored with serial <sup>18</sup>F-FDG-PET/CT scans from 2008 to 2013 was performed. Forty-seven patients were selected for analysis. A mixed-effects statistical model was used after data normalization.OBJECTIVE: Positron emission tomography/computed tomography (PET/CT) scans with 2-[fluorine-18] fluoro-2-deoxy-D-glucose (<sup>18</sup>F-FDG) are used in high-risk thyroid cancer patients to identify metastasis. The prognostic significance of increases in standardized uptake values (SUVs) has not been clearly defined. This pilot study investigated the correlation between SUV increases and subsequent changes in individual lesion size.RESULTS: For a 10% increase in SUV, a 6% increase in tumor area was observed (P<.0001). Analysis on cube root-transformed data from serial scans was significant in 4 of 5 groups: scans 1 to 2 (P = .0001), scans 2 to 3 (P = .0005), scans 3 to 4 (P = .008), scans 4 to 5 (P = .66), and overall (P<.0001). After exclusion of outliers, for a 10% increase in SUV, the expected percentage increases in area on subsequent scans were found to be 3.4% (P = .0006), 2.6% (P = .005), 4% (P = .074), and 4.1% (P = .27) for the second, third, fourth, and fifth scans, respectively. The association was similarly significant in cases with a >=25% increase in SUV. Secondary analysis showed a significant association of SUV with thyroglobulin (Tg) level (P = .035) but not with thyroid-stimulating hormone (TSH) level (P = .85).All authors: Bikas A, Burman KD, Desale S, Garcia CA, Singh I, Wartofsky LFiscal year: FY2017Digital Object Identifier: Date added to catalog: 2017-08-22
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Journal Article MedStar Authors Catalog Article 27849386 Available 27849386

ABBREVIATIONS: DTC = differentiated thyroid cancer EORTC = European Organization for Research and Treatment of Cancer <sup>18</sup>F-FDG = 2-[fluorine-18] fluoro-2-deoxy-D-glucose FNA = fine-needle aspiration MTC = medullary thyroid cancer PET/CT = positron emission tomography/computed tomography PVE = partial volume effect RAI = radioactive iodine SUV = standardized uptake value Tg = thyroglobulin TSH = thyroid-stimulating hormone.

CONCLUSIONS: A significant positive correlation was noted between the increase in lesional SUV and subsequent increase in lesion area. An increase in lesional SUV in subsequent scans may portend tumor growth and could prompt consideration for earlier or more aggressive intervention.

METHODS: A retrospective chart review of patients with histologically confirmed thyroid cancer who were monitored with serial <sup>18</sup>F-FDG-PET/CT scans from 2008 to 2013 was performed. Forty-seven patients were selected for analysis. A mixed-effects statistical model was used after data normalization.

OBJECTIVE: Positron emission tomography/computed tomography (PET/CT) scans with 2-[fluorine-18] fluoro-2-deoxy-D-glucose (<sup>18</sup>F-FDG) are used in high-risk thyroid cancer patients to identify metastasis. The prognostic significance of increases in standardized uptake values (SUVs) has not been clearly defined. This pilot study investigated the correlation between SUV increases and subsequent changes in individual lesion size.

RESULTS: For a 10% increase in SUV, a 6% increase in tumor area was observed (P<.0001). Analysis on cube root-transformed data from serial scans was significant in 4 of 5 groups: scans 1 to 2 (P = .0001), scans 2 to 3 (P = .0005), scans 3 to 4 (P = .008), scans 4 to 5 (P = .66), and overall (P<.0001). After exclusion of outliers, for a 10% increase in SUV, the expected percentage increases in area on subsequent scans were found to be 3.4% (P = .0006), 2.6% (P = .005), 4% (P = .074), and 4.1% (P = .27) for the second, third, fourth, and fifth scans, respectively. The association was similarly significant in cases with a >=25% increase in SUV. Secondary analysis showed a significant association of SUV with thyroglobulin (Tg) level (P = .035) but not with thyroid-stimulating hormone (TSH) level (P = .85).

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