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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; 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 : ~ 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 ( ) Size≤ 1cm1 (reference)< > 1cm8.090 ( ) Coexisting pathologyAbsence1 (reference)0.005 Presence2.983 ( ) Subtype of PTC a Follicular variant1 (reference)0.003 Non-follicular variant4.032 ( ) PTC a Papillary thyroid cancer

13 2. Analysis for quantity of FDG uptake

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

15 Table 3. SUVmax by clinicopathologic parameters Variables NMedianQ 25 - Q 75 P value SexMale Female Age< 45 years ≥ 45 years Tumor size≤ 1cm > 1cm MulticenticityAbsence Presence Extrathyroidal extensionAbsence < Presence Lymph node metastasisAbsence Presence Coexisting pathology0.253 None Nodular hyperplasia (NH) – Hashimoti thyroiditis (HT) – NH + HT – Subtype of PTC (Papillary thyroid cancer)0.001 Classic – Follicular variant – Oncocytic variant – 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 < 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%) Size > 1cm 31 (23.8%) 64 (33.0%) < Age ≥ 45 years 74 (56.9%) 37 (57.8%) Female107 (82.3%) 47 (73.4%) Multicenticity 59 (45.7%) 33 (51.6%) SUVmax ≥ (42.3%) 45 (70.3%) <0.001 Subtype (follicular) 24 (18.5%) 4 (6.3%) Coexisting pathology 82 (63.1%) 40 (62.5%) 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) Presence ( – 4.199) Size≤ 1cm1 (reference) > 1cm2.552( – 5.460) SUVmax< (reference) ≥ (0.684 – 3.238) SubtypeFollicular variant 1 (reference) Non follicular variant (1.757 – ) → 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%) Size > 1cm25 (25.0%) 43 (45.7%) Age ≥ 45 years72 (72.0%) 39 (41.5%) <0.001 Female 81(81.0%) 73 (77.7%) Multicenticity45 (45.5%) 47 (50.0%) SUVmax ≥ (38.0%) 49 (52.1%) Subtype(follicular)20 (20.0%) 8 (8.5%) Coexisting pathology65 (65.0%)57 (60.6%) Cliniopathologic factors and lymph node metastasis by univariate analysis

20 Variable Hazard ratio (95% CI)P value ETEAbsence 1 (reference) Presence ( – 5.090) Size≤ 1cm1 (reference) > 1cm1.972( – 4.234) Age< 45 years0.245 (0.129 – 0.466)<0.001 ≥ 45 years 1 (reference) SUVmax < (reference) ≥ (0.455 – 1.971) SubtypeFollicular variant 1 (reference)0.103 Non-follicular variant (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 < 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%) Lymph node metz. 86 (51.8) 9 (28.6%) Size > 1cm 62 (37.3%) 6 (21.4%) Age ≥ 45 years 94 (56.6%) 17 (60.7) Female133 (80.7%) 21 (71.4%) Multicenticity 81 (49.1%) 12 (39.3%) SUVmax ≥ (70.9%) 9 (28.6%)<0.001 Coexisting pathology107 (64.5%)15 (53.6%) 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 ( ) Lymph node metastasisAbsence1 (reference) Presence1.964 (0.800 – 4.820) SUVmax of primary lesion< 2.01 (reference)<0.001 ≥ (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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