Diagnostic value of [18F]Fluorocholine PET/CT in detection of primary medullary thyroid cancer

Abstract

Objective

Medullary thyroid cancer (MTC) is a challenging neuroendocrine malignancy where the role of nuclear medicine imaging is currently limited. This paper investigates the potential diagnostic value of [18F]Fluorocholine PET/CT in primary MTC.

Methods

We prospectively enrolled 25 patients (10 male, 15 female) with suspicion for primary MTC based on fine-needle aspiration biopsy (FNAB). All patients had a baseline three phase [18F]Fluorocholine PET/CT (2.5 MBq/kg): two regional head and neck and upper mediastinum studies at 5 min (first phase) and 120 min (third phase) and a whole-body PET/CT (from the skull vertex to mid-thighs) at 60 min (second phase). Any non-physiological radiotracer uptake was regarded as MTC positive. All patients referred to surgery had a preoperative neck-US. True lesion status was assessed using either histopathology, FNAB results or follow-up imaging and laboratory (calcitonin, CEA) results. Results with p < 0.05 were considered statistically significant.

Results

Nineteen of 25 patients (76%) were surgically treated and histopathology reports were obtained. Patient-based sensitivity and positive predictive value for detection of any MTC lesion using [18F]Fluorocholine PET/CT were both 100%. Neck-US was more specific (100% vs 70%; p = 0.002) and had a higher positive predictive value than [18F]Fluorocholine PET/CT (100% vs 55%; p = 0.018) for N1a and N1b staging. [18F]Fluorocholine PET/CT had a higher sensitivity (100% vs 50%; p = 0.025) and higher negative predictive value (100% vs 81%; p = 0.026) than neck-US for N1b staging. The optimal SUVmax cut-off to differentiate malignant from benign neck lesions at 60 and 120 min was 2.56. Patients with M1 stage on PET/CT had higher calcitonin (median of 5,372 vs 496.6 pg/ml; p = 0.005) and CEA concentrations (median of 95.8 vs 18.65 µg/l; p = 0.034) compared to patients with M0 disease.

Conclusion

[18F]Fluorocholine PET/CT appears to be a promising radiotracer for primary staging of MTC by increasing diagnostic accuracy for N staging and detecting possible distant metastatic sites at initial presentation of disease.

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Acknowledgements

We thank all doctors, radiopharmacists, technologist, nurses and other supporting staff working at our respective departments, as well as our families and friends, for their help in making our research projects possible.

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Authors

Contributions

The manuscript design, data analysis and main drafting was performed by the first author JJ under direct supervision of the corresponding author LL. MH, DB, KZ and SR contributed substantially to interpretation of the data. All authors provided detailed revisions during the manuscript preparation, approved the final version and are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Luka Lezaic.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the National Medical Ethics Committee of Slovenia in 2014 (No. 92/08/14) and is registered at ClinicalTrials.gov (NCT03643055).

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Jamsek, J., Hocevar, M., Bergant, D. et al. Diagnostic value of [18F]Fluorocholine PET/CT in detection of primary medullary thyroid cancer. Ann Nucl Med (2021). https://doi.org/10.1007/s12149-021-01579-7

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Keywords

  • Medullary thyroid cancer
  • PET/CT
  • Neck-US
  • [18F]Fluorocholine
  • Cancer staging