American Association of Endocrine Surgeon| Volume 138, ISSUE 6, P1176-1182, December 2005

Feasibility and benefit of fluorine 18–fluoro-2-deoxyglucose–guided surgery in the management of radioiodine-negative differentiated thyroid carcinoma metastases


      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.


      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.


      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.


      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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Mazzaferri E.L.
        • Kloos R.T.
        Clinical review 128: Current approaches to primary therapy for papillary and follicular thyroid cancer.
        J Clin Endocrinol Metab. 2001; 86: 1447-1463
        • Mirallié E.
        • Hamy A.
        • Floch I.
        • Sagan C.
        • Paineau J.
        • Murat A.
        • et al.
        Outcome in cervical recurrences of papillary or follicular thyroid cancer.
        Ann Chir. 1999; 53: 577-582
      1. Bernier MO, Moisan C, Mansour G, Aurengo A, Ménégaux F, Leenhardt L. Usefulness of fine needle aspiration cytology in the diagnosis of loco-regional recurrence of differentiated thyroid carcinoma. Eur J Surg Oncol 2005;31:288-93.

        • Rouxel A.
        • Hejblum G.
        • Bernier M.O.
        • Boelle P.Y.
        • Menegaux F.
        • Mansour G.
        • et al.
        Prognostic factors associated with the survival of patients developing loco-regional recurrences of differentiated thyroid carcinomas.
        J Clin Endocrinol Metab. 2004; 89: 5362-5368
        • Helal B.O.
        • Merlet P.
        • Toubert M.E.
        • Franc B.
        • Schwartz C.
        • Gauthier-Koelesnikov H.
        • et al.
        Clinical impact of (18)F-FDG PET in thyroid carcinoma patients with elevated thyroglobulin levels and negative (131)I scanning results after therapy.
        J Nucl Med. 2001; 42: 1464-1469
        • Frilling A.
        • Tecklenborg K.
        • Gorges R.
        • Weber F.
        • Clausen M.
        • Broelsch E.C.
        Preoperative diagnostic value of [(18)F] fluorodeoxyglucose positron emission tomography in patients with radioiodine-negative recurrent well-differentiated thyroid carcinoma.
        Ann Surg. 2001; 234: 804-811
        • Pineda J.D.
        • Lee T.
        • Ain K.
        • Reynolds J.C.
        • Robbins J.
        Iodine-131 therapy for thyroid cancer patients with elevated thyroglobulin and negative diagnostic scan.
        J Clin Endocrinol Metab. 1995; 80: 1488-1492
        • Mazzaferri E.L.
        Treating high thyroglobulin with radioiodine: a magic bullet or a shot in the dark?.
        J Clin Endocrinol Metab. 1995; 80: 1485-1487
        • Mazzaferri E.L.
        • Jhiang S.M.
        Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer.
        Am J Med. 1994; 97: 418-428
        • Lin J.D.
        • Kao P.F.
        • Weng H.F.
        • Lu W.T.
        • Huang M.J.
        Relative value of thallium-201 and iodine-131 scans in the detection of recurrence or distant metastasis of well differentiated thyroid carcinoma.
        Eur J Nucl Med. 1998; 25: 695-700
        • Alam M.S.
        • Kasagi K.
        • Misaki T.
        • Miyamoto S.
        • Iwata M.
        • Iida Y.
        • et al.
        Diagnostic value of technetium-99m methoxyisobutyl isonitrile (99mTc-MIBI) scintigraphy in detecting thyroid cancer metastases: a critical evaluation.
        Thyroid. 1998; 8: 1091-1100
        • Valli N.
        • Catargi B.
        • Ronci N.
        • Leccia F.
        • Guyot M.
        • Roger P.
        • et al.
        Evaluation of indium-111 pentetreotide somatostatin receptor scintigraphy to detect recurrent thyroid carcinoma in patients with negative radioiodine scintigraphy.
        Thyroid. 1999; 9: 583-589
        • Karwowski J.K.
        • Jeffrey R.B.
        • McDougall I.R.
        • Weigel R.J.
        Intraoperative ultrasonography improves identification of recurrent thyroid cancer.
        Surgery. 2002; 132: 924-928
        • Uematsu H.
        • Sadato N.
        • Ohtsubo T.
        • Tsuchida T.
        • Nakamura S.
        • Sugimoto K.
        • et al.
        Fluorine-18-fluorodeoxyglucose PET versus thallium-201 scintigraphy evaluation of thyroid tumors.
        J Nucl Med. 1998; 39: 453-459
        • Grunwald F.
        • Kalicke T.
        • Feine U.
        • Lietzenmayer R.
        • Scheidhauer K.
        • Dietlein M.
        • et al.
        Fluorine-18 fluorodeoxyglucose positron emission tomography in thyroid cancer: results of a multicentre study.
        Eur J Nucl Med. 1999; 26: 1547-1552
        • Hooft L.
        • Hoekstra O.S.
        • Deville W.
        • Lips P.
        • Teule G.J.
        • Boers M.
        • et al.
        Diagnostic accuracy of 18F-fluorodeoxyglucose positron emission tomography in the follow-up of papillary or follicular thyroid cancer.
        J Clin Endocrinol Metab. 2001; 86: 3779-3786
        • Hooft L.
        • van der Veldt A.A.
        • van Diest P.J.
        • Hoekstra O.S.
        • Berkhof J.
        • Teule G.J.
        • et al.
        [18F]fluorodeoxyglucose uptake in recurrent thyroid cancer is related to hexokinase i expression in the primary tumor.
        J Clin Endocrinol Metab. 2005; 90: 328-334
        • Chin B.B.
        • Patel P.
        • Cohade C.
        • Ewertz M.
        • Wahl R.
        • Ladenson P.
        Recombinant human thyrotropin stimulation of fluoro-D-glucose positron emission tomography uptake in well-differentiated thyroid carcinoma.
        J Clin Endocrinol Metab. 2004; 89: 91-95
        • Bergamaschi R.
        • Becouarn G.
        • Ronceray J.
        • Arnaud J.P.
        Morbidity of thyroid surgery.
        Am J Surg. 1998; 176: 71-75
        • Travagli J.P.
        • Cailleux A.F.
        • Ricard M.
        • Baudin E.
        • Caillou B.
        • Parmentier C.
        • et al.
        Combination of radioiodine (131I) and probe-guided surgery for persistent or recurrent thyroid carcinoma.
        J Clin Endocrinol Metab. 1998; 83: 2675-2680
        • Peltier P.
        • Curtet C.
        • Chatal J.F.
        • Le Doussal J.M.
        • Daniel G.
        • Aillet G.
        • et al.
        Radioimmunodetection of medullary thyroid cancer using a bispecific anti-CEA/anti-indium-DTPA antibody and an indium-111-labeled DTPA dimer.
        J Nucl Med. 1993; 34: 1267-1273
        • Mirallié E.
        • Visset J.
        • Sagan C.
        • Hamy A.
        • Le Bodic M.F.
        • Paineau J.
        Localization of cervical node metastasis of papillary thyroid carcinoma.
        World J Surg. 1999; 23: 970-973
        • Essner R.
        • Hsueh E.C.
        • Haigh P.I.
        • Glass E.C.
        • Huynh Y.
        • Daghighian F.
        Application of an [(18)F]fluorodeoxyglucose-sensitive probe for the intraoperative detection of malignancy.
        J Surg Res. 2001; 96: 120-126
      2. Zervos EE, Desai DC, DePalatis LR, Soble D, Martin EW. 18F-labeled fluorodeoxyglucose positron emission tomography-guided surgery for recurrent colorectal cancer: a feasibility study. J Surg Res 2001 1;97:9-13.