Background
Fluorine 18–fluoro-2-deoxyglucose (FDG) positron emission tomography (18F-FDG PET) can be used to visualize metastases in patients with differentiated thyroid
carcinoma that does not take up radioiodine (131I). This study was aimed at evaluating the feasibility of 18F-FDG radio-guided surgery in patients with radioiodine-negative differentiated thyroid
cancer.
Methods
Ten patients received a mean activity of 265 MBq of 18F-FDG 30 minutes before operation. Radioactivity uptake (counts per second [cps],
with a pretime of 10 seconds) in tumor and normal tissues was measured before and
after resection.
Results
Patients with 1 to 5 foci detected by FDG-PET were included in the study. Six of these
patients were injected with recombinant human thyroid-stimulating hormone (TSH) preoperatively.
Abnormal findings detected by preoperative 18F-FDG PET were also detected with the gamma probe in all patients. The mean tumor
activity in vivo was 3,272 cps, and tumor-to-neck and tumor-to-shoulder ratios were,
respectively, 1.40 and 1.73. Tumor resection was incomplete in 3 patients. When resection
was complete, mean radioactivity at the tumor site was decreased by 22%. The ex vivo
mean tumor-to-normal tissue ratio was 2.4. All positive tissues detected with the
probe were confirmed histologically to be differentiated thyroid cancer. The surgeon's
hands were exposed to 90 to 270 μSv.
Conclusions
These results show the feasibility and benefit of 18F-FDG radio-guided surgery with a gamma probe in the management of differentiated
thyroid cancer patients with radioiodine-negative recurrence.
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Article info
Publication history
Accepted:
August 27,
2005
Nantes and Lille, FranceIdentification
Copyright
© 2005 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
