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Preoperative PET-CT in papillary thyroid cancer Chung-Ang University, Korea Department of Surgery Byung Seup Kim, Ju Won Seok, Han suk Ryu, Kyung Ho Kang,

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Presentation on theme: "Preoperative PET-CT in papillary thyroid cancer Chung-Ang University, Korea Department of Surgery Byung Seup Kim, Ju Won Seok, Han suk Ryu, Kyung Ho Kang,"— Presentation transcript:

1 Preoperative PET-CT in papillary thyroid cancer Chung-Ang University, Korea Department of Surgery Byung Seup Kim, Ju Won Seok, Han suk Ryu, Kyung Ho Kang, Sung Jun Park, Bo Youn Cho

2 Introduction PET – CT 2-[fluorine-18]fluoro-2-deoxy- glucose FDG

3 Introduction Meaning of FDG -uptake Rate of uptake of FDG is proportional to metabolic activity An introduction to PET-CT imaging. Radigraphics 2004; 523-543 Uptake of FDG Metabolic activity

4 Flip – flop phenomenon PTC

5 Introduction About Primary lesion We evaluated the FDG uptake of papillary thyroid cancer in preoperative PET CT.

6 Method FNAB : Papillary thyroid cancer Preoperative PET- CT Operation Period : 2011.3.1 ~ 2012. 2. 29 PTC was preoperatively confirmed by FANB CND was routinely performed. Preoperative PET CT was performed when patient argeed it Enrolled patients : 194

7 Divided into PET negative(-) and positive(+) group Negative ; Absence of FDG uptatke Postive ; Presence of FDG uptake V S. Method Backgroud : surrounding thyroid tissue

8 Method 1. Analyze the cliniopathologic factors related to PET (+) 2..Analyze quantity of SUVmax value according to clinicopathologic factors SUVmax : maximal standardized uptake value SUVmax of PET negative patient = SUV of surrounding thyroid tissue

9 Results PET sensitivity ① Primary tumor : 71.7% (138/194 patients) ② Central lymph node metz. : 4.3% (3/70 patients) ③ Lateral lymph node metz. : 62.5% (15/24 patients) False positive : 1.1%

10 Results Table 1-1. PET-CT and clinicopathologic parameters Variables PET (-)PET (+)P value (n=56, 28.9%)(n=138, 71.7%) SexMale19 (33.9 %)21 (15.2%)0.004 Female37 (66.1%)117 (84.8%) Age< 45 years22 (39.3%)61 (44.2%)0.530 ≥ 45 years34 (60.7%)77 (55.8%) Size≤ 1cm49 (87.5%)77 (55.8%)<0.001 > 1cm7 (12.5%)61 (44.2%) MulticenticityAbsence31 (55.4%)71 (51.4%)0.621 Presence25 (44.6%)67 (48.6%) Extrathyroidal extensionAbsence43 (76.8%)87 (63.0%)0.065 Presence13 (23.2%)51 (37.0%) Lymph node metastasisAbsence33 (58.9%)67 (48.6%)0.190 Presence23 (41.1%)71 (51.4%)

11 Table 1-2. PET-CT and clinicopathologic parameters Variables PET (-)PET (+)P value (n=56, 28.9%)(n=138, 71.7%) Coexisting pathology0.001 None31 (55.4%)41 (29.7%) Nodular hyperplasia (NH)18 (32.1%)40 (29.0%) Hashimoto thyroiditis (HT)5 (8.9%)36 (26.1%) NH a + HT b 2 (3.6%)21 (15.2%) Subtype of PTC0.001 Classic38 (67.9%)110 (79.7%) Follicular variant17 (30.4%)12 (8.7%) Oncocytic variant1 (1.8%)14 (10.1%) Solid0 (0%)1 (0.7%) Tall cell variant0 (0%)1 (0.7%) Coexisting pathology0.001 Abscence31 (43.1%)41 (56.9%) Presence25 (20.5%)97 (79.5%) Subtype of PTC<0.001 Non-follicular variant39 (23.6%)126 (76.4%) Follicular variant17 (58.6%)12 (41.4%)

12 Results Table 2. PET positivity and cliniocopathologic parameters by logistic regression Variable Hazard ratio (95% CI b )P value SexMale1 (reference)0.021 Female2.843 ( 1.171 - 6.905) Size≤ 1cm1 (reference)< 0.001 > 1cm8.090 (3.000 - 21.813) Coexisting pathologyAbsence1 (reference)0.005 Presence2.983 (1.393 - 6.386) Subtype of PTC a Follicular variant1 (reference)0.003 Non-follicular variant4.032 (1.619 - 10.038) PTC a Papillary thyroid cancer

13 2. Analysis for quantity of FDG uptake

14 SUVmax Kolmogorov-Smirnove goodness P < 0.001 Non normally distributed data

15 Table 3. SUVmax by clinicopathologic parameters Variables NMedianQ 25 - Q 75 P value SexMale401.8501.000 - 4.1750.042 Female1542.7001.575 - 4.400 Age< 45 years832.7001.000 - 4.2000.658 ≥ 45 years1112.5001.000 - 4.400 Tumor size≤ 1cm1262.1001.000 - 3.0000.001 > 1cm684.9002.900 -10.200 MulticenticityAbsence1022.6001.000 - 4.5250.888 Presence922.6001.000 - 4.300 Extrathyroidal extensionAbsence1302.3001.000 - 3.300< 0.001 Presence644.001.900 - 9.400 Lymph node metastasisAbsence1002.4001.000 - 3.4000.017 Presence943.0001.125 - 5.000 Coexisting pathology0.253 None722.1501.875 - 4.225 Nodular hyperplasia (NH)582.3001.000 – 4.150 Hashimoti thyroiditis (HT)352.8002.400 – 4.100 NH + HT223.4502.475 – 4.475 Subtype of PTC (Papillary thyroid cancer)0.001 Classic1482.7501.000 – 4.875 Follicular variant291.0001.000 – 2.450 Oncocytic variant152.9002.300 – 3.200 Solid12.100Not available d Tall cell variant18.300Not available d d The number of case was only one so that quartile was not available

16 P value < 0.001 SUVmax 2.6 sensitivity 70.3% specificity 60.0% Analysis for quantity of FDG uptake Relationship between extrathyroidal extension and SUVmax ROC curve 1-specificity

17 Results ETE (-) (n=130, 67.0%) ETE (+) (n=64, 33.0%) P value Lymph node metz. (+) 52 (40.0%) 42 (65.6%) 0.001 Size > 1cm 31 (23.8%) 64 (33.0%) < 0.001 Age ≥ 45 years 74 (56.9%) 37 (57.8%) 0.906 Female107 (82.3%) 47 (73.4%) 0.151 Multicenticity 59 (45.7%) 33 (51.6%) 0.446 SUVmax ≥ 2.6 55 (42.3%) 45 (70.3%) <0.001 Subtype (follicular) 24 (18.5%) 4 (6.3%) 0.029 Coexisting pathology 82 (63.1%) 40 (62.5%) 0.938 Cliniopathologic factors and Extrathyroidal exntesion by univariate analysis

18 Extrathyroidal extension and clinicopathologic factors by mulivariate analysis Variable Hazard ratio (95% CI)P-value Lymph node metz.Absence 1 (reference) 0.046 Presence 2.063 ( 1.014 – 4.199) Size≤ 1cm1 (reference) 0.016 > 1cm2.552( 1.193 – 5.460) SUVmax< 2.6 1 (reference) 0.316 ≥ 2.6 1.488 (0.684 – 3.238) SubtypeFollicular variant 1 (reference) 0.114 Non follicular variant 4.469 (1.757 – 11.371) → SUVmax was not related to extrathyroidal extension

19 Results LN metz. (-) (n=100, 51.5%) LN metz. (+) (n=94, 48.5%) P-value Extrathyroidal ext. (+)22 (22.0%) 42 (44.7%) 0.001 Size > 1cm25 (25.0%) 43 (45.7%) 0.002 Age ≥ 45 years72 (72.0%) 39 (41.5%) <0.001 Female 81(81.0%) 73 (77.7%) 0.565 Multicenticity45 (45.5%) 47 (50.0%) 0.527 SUVmax ≥ 2.9 38 (38.0%) 49 (52.1%) 0.048 Subtype(follicular)20 (20.0%) 8 (8.5%) 0.023 Coexisting pathology65 (65.0%)57 (60.6%) 0.530 Cliniopathologic factors and lymph node metastasis by univariate analysis

20 Variable Hazard ratio (95% CI)P value ETEAbsence 1 (reference) 0.011 Presence 2.503 ( 1.231 – 5.090) Size≤ 1cm1 (reference) 0.081 > 1cm1.972( 0.919 – 4.234) Age< 45 years0.245 (0.129 – 0.466)<0.001 ≥ 45 years 1 (reference) SUVmax < 2.9 1 (reference) 0.884 ≥ 2.9 0.947 (0.455 – 1.971) SubtypeFollicular variant 1 (reference)0.103 Non-follicular variant 2.255 (0.848 – 5.993) Lymph node metastasis and clinicopathologic factors by mulivariate analysis → SUVmax was not related to lymph node metastasis

21 Subtype P value < 0.001 FDG 2.0 sensitivity 70.9% specificity 69.0 % Relationship between Non-follicular subtype and SUVmax ROC curve 1-specificity

22 Results Non follicular (n=165, 85.1%) follicular (n=29, 14.9%) P-value Extrathyroidal extension 60 (36.1%) 4 (14.3%) 0.018 Lymph node metz. 86 (51.8) 9 (28.6%) 0.042 Size > 1cm 62 (37.3%) 6 (21.4%) 0.079 Age ≥ 45 years 94 (56.6%) 17 (60.7) 0.686 Female133 (80.7%) 21 (71.4%) 0.261 Multicenticity 81 (49.1%) 12 (39.3%) 0.337 SUVmax ≥ 2.0117 (70.9%) 9 (28.6%)<0.001 Coexisting pathology107 (64.5%)15 (53.6%) 0.270 Cliniopathologic factors and subtype of PTC by univariate analysis

23 Non-follicular variant and clinicopathologic factors by mulivariate analysis Variable Hazard ratio (95% CI)P value Extrathyroidal extensionAbsence1 (reference)0.092 Presence2.690 (0.851 - 8.502) Lymph node metastasisAbsence1 (reference) 0.141 Presence1.964 (0.800 – 4.820) SUVmax of primary lesion< 2.01 (reference)<0.001 ≥ 2.05.044 (2.111 –12.056)

24 Conclusion The usefulness of preoperative PET-CT for PTC was not yet certain. PET positive results and SUVmax had no relation to significant clinical factors such as extrathyroidal extension and lymph node metastasis. PET negative results or low SUVmax indicate the possibility of follicular variant subtype in papillar thyroid cancer.

25 Thank you for your attention


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