Significance of 18F FDG PET-CT for Preoperative Diagnosis of Cervical Lymph Nodes Metastasis in Papillary Thyroid Carinoma

Su-Ran Kim M.D.; Hyun-Jong Kang M.D.; Kyoung-Sik Park M.D.; Nam-Sun Paik M.D.; Young-Bum Yoo M.D.

doi:10.16956/kjes.2010.10.4.235

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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

Review Article

Korean J Endocrine Surg 2010;10(4):235-239.

Published online: 18 December 2010

DOI: https://doi.org/10.16956/kjes.2010.10.4.235

Significance of ¹⁸F FDG PET-CT for Preoperative Diagnosis of Cervical Lymph Nodes Metastasis in Papillary Thyroid Carinoma

Su-Ran Kim M.D., Hyun-Jong Kang M.D., Kyoung-Sik Park M.D., Nam-Sun Paik M.D., Young-Bum Yoo M.D.

Department of Surgery, Konkuk University Graduate School of Medicine, Seoul, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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)

Keywords: Papillary thyroid carcinoma, Cervical lymph nodes metastasis, ¹⁸F FDG PET-CT

REFERENCES

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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
All LN	(＋)	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
Central LN	(＋)	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
Lateral LN	(＋)	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
All LN	(＋)	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
Central LN	(＋)	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
Lateral LN	(＋)	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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