Journal List > Korean J Endocr Surg > v.10(4) > 1060010

M.D., M.D., M.D., M.D., and M.D.: Significance of 18F FDG PET-CT for Preoperative Diagnosis of Cervical Lymph Nodes Metastasis in Papillary Thyroid Carinoma

Abstract

Purpose:

To compare the diagnostic accuracy of US/CT with US/CT/18F-FDG PET-CT in the diagnosis of cervical lymph nodes metastasis in papillary thyroid carcinoma. Methods: From July 2008 to May 2010, 36 patients with papillary thyroid carcinoma, confirmed by aspiration cytology analysis, underwent neck US, neck CT and 18F-FDG PET-CT preoperatively. The sensitivity, specificity and diagnostic accuracy of the US/CT, US/CT/PET-CT was analyzed according to lymph node level (all: levels I∼VI, central: level VI, lateral: levels I∼V). Results: At all lymph nodes group (level I∼VI), US/CT/ PET-CT showed a sensitivity of 66.6%, a specificity of 61.9% and a diagnostic accuracy of 63.8%. The corresponding values for US/CT were 60.0%, 85.7%, 75.0% respectively. Considering the central cervical nodes group (level VI), US/CT/PET-CT showed a sensitivity of 57.1%, a specificity of 68.1%, and a diagnostic accuracy of 63.8%. The corresponding values of US/CT were 57.1%, 90.9%, 77.7% respectively. Considering the lateral cervical nodes group (level I∼V), US/CT/PET-CT showed a sensitivity of 100%, a specificity of 84.3%, and a diagnostic accuracy of 86.1%. The corresponding values of US/CT were 75.0%, 84.3%, 83.3% respectively. The diagnostic results of US/ CT, US/CT/PET-CT in initial evaluation of the cervical nodes metastasis did not differ significantly. Conclusion: Our preliminary results suggest that additional PET-CT evaluation in US/CT does not provide statistically significant benefit for initial diagnosis of cervical lymph nodes metastasis in papillary thyroid carcinoma. (Korean J Endocrine Surg 2010;10:235-239)

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Table 1.
Clinicopathologic characteristics of 36 patients
  Variables Results (n=36)
Age (year) Mean (range) 47.5 (27∼68)
Sex M 2 (5.6%)
  F 34 (94.4%)
Tumor size (cm) ≤0.5 cm 8 (22.2%)
  0.5 cm<tumor≤1 cm 19 (52.8%)
  >1 cm 9 (25.0%)
Tumor location Right 16 (44.4%)
  Left 12 (33.3%)
  Bilateral 8 (22.2%)
Operative method Lobectomy with CLND 1 (2.8%)
  Total thyroidectomy with 26 (72.2%)
  CLND  
  Total thyroidectomy with 9 (25.0%)
  CLND and LLND  
Node mtastasis Central LN only 11 (30.6%)
  Central LN and lateral LN 4 (11.1%)
  No metastasis 21 (58.3%)

M = male; F = female; CLND = central lympn node dissection; LLND = lateral lymph node dissection.

Table 2.
Pathologic and diagnostic result of US, CT and PET-CT in cervical lymph nodes metastasis
    US CT PET-CT
    (−) (+) (−) (+) (−) (+)
All LN (−) 19 2 20 1 15 6
(+) 10 5 8 7 8 7
Diagnostic values (%) Sensitivity (%) 33.3 46.6 46.6
Specificity (%) 90.4 85.2 71.4
PPV (%) 71.4 87.5 53.8
NPV (%) 65.5 71.4 65.2
Accuracy (%) 66.6 75 61.1
Central LN (−) 20 2 22 0 17 5
(+) 9 5 8 6 8 6
Diagnostic values (%) Sensitivity (%) 35.7 42.8 42.8
Specificity (%) 90.9 100 77.2
PPV (%) 71.4 100 54.5
NPV (%) 68.9 73.3 68
Accuracy (%) 69.4 77.7 63.8
Lateral LN (−) 29 3 29 3 31 1
(+) 3 1 1 3 1 3
Diagnostic values (%) Sensitivity (%) 25 75 75
Specificity (%) 90.6 90.6 96.8
PPV (%) 25 50 75
NPV (%) 90.6 96.6 96.8
Accuracy (%) 83.3 88.8 94.4

US = ulatrasound; CT = computed tomograpy; PET-CT =

18 F-fluorodeoxyglucose PET-CT; LN = lymph node; PPV = positive predictive value; NPV = negative predictive value.

Table 3.
Comparison of diagnostic results between combined US/CT and US/CT/PET-CTin cervical lymph nodes metastasis
    US/CT US/CT/PET-CT
    (−) (+) (−) (+)
All LN (−) 18 3 13 8
(+) 6 9 5 10
Diagnostic values(%)   Specificity: 85.7 Sensitivity: 60 Specificity: 61.9 Sensitivity: 66.6
  NPV: 75 PPV: 75 NPV: 72.2 PPV: 55.5
  Accuracy: 75   Accuracy: 63.8  
Central LN (−) 20 2 15 7
(+) 6 8 6 8
Diagnostic values (%)   Specificity: 90.9 Sensitivity: 57.1 Specificity: 68.1 Sensitivity: 57.1
  NPV: 76.9 PPV: 80 NPV: 71.4 PPV: 53.3
  Accuracy: 77.7   Accuracy: 63.8  
Lateral LN (−) 27 5 27 5
(+) 1 3 0 4
Diagnostic values (%)   Specificity: 84.3 Sensitivity: 75 Specificity: 84.3 Sensitivity: 100
  NPV: 96.4 PPV: 37.5 NPV: 100 PPV: 44.4
  Accuracy: 83.3   Accuracy: 86.1  

US = ulatrasound; CT = computed tomograpy; PET-CT =

18 F-fluorodeoxyglucose PET-CT; LN = lymph node; NPV = negative predictive value; PPV = positive predictive value.

Table 4.
Statistical comparison the assessment results of cervica nodes metastasis between US/CT and US/CT/PET-CT
Diagnostic accuracy US/CT vs US/CT/PET-CT
All LN Sensitivity 1.00
  Specificity 0.06
Central LN Sensitivity
  Specificity 0.06
Lateral LN Sensitivity 1.00
  specificity

P values were tested by Binomial test with a significance level of 0.05. ∗This comparison could not be statistically analyzed because of small sample size. US = ulatrasound; CT = computed

1 8F-fluorodeoxyglucose PET-CT; LN = tomograpy; PET-CT = lymph node.

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