18F-FDG PET/CT Combined with Serum Tg and BRAFV600E Mutation for Evaluating Recurrence/Metastasis in RAIR-DTC: Subgroup Analysis and Clinical Decision-Making Value.
Ji Liqiu, Zhang Wenwen, Hao Shanhu, Wang Zhiguo, Zhang Guoxu
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引用次数: 0
Abstract
Objective: This study evaluated the clinical diagnostic efficacy of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for recurrence and/or metastasis in patients with radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC) and analyzed its correlation with serum thyroglobulin (Tg), BRAFV600E mutation status, and postoperative clinical risk stratification.
Method: A retrospective analysis was conducted on the 18F-FDG PET/CT images and clinical data of 47 patients with RAIR-DTC. The diagnostic sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated, and the receiver operating characteristic curve was used to determine the optimal cutoff value of Tg. The correlation between maximum standardized uptake value (SUVmax) and clinical pathological characteristics was analyzed.
Results: For 18F-FDG PET/CT in detecting RAIR-DTC recurrence/metastasis, the diagnostic sensitivity was 94.87%, specificity 64.71%, PPV 92.50%, and NPV 73.33%. Regarding Tg, the optimal cutoff value for predicting RAIR-DTC recurrence/metastasis was 29.6 ng/mL, with an area under the curve of 0.7677. Further subgroup analysis showed that the serum Tg level in the PET/CT-positive group (212.56 ± 102.90 ng/mL) was significantly higher than that in the PET/CT-negative group (86.53 ± 69.67 ng/mL; t = 2.119, p = 0.039). In terms of clinical stage, the PET/CT positivity rate was significantly higher in patients with advanced RAIR-DTC (clinical stage III/IV) than in those with early-stage disease (81.82% versus 57.14%; p = 0.033). Correlation analysis revealed a positive correlation between 18F-FDG PET/CT- derived SUVmax and clinical stage (Pearson correlation coefficient, r = 0.361, p = 0.042). Furthermore, the SUVmax in the BRAFV600E-mutant group was significantly higher than that in the BRAFV600E wild-type group (7.84 ± 3.50 versus 3.85 ± 1.26; t = -4.219, p = 0.039). In addition, the detection rate of 18F-FDG PET/CT for RAIR-DTC recurrence/metastasis was significantly superior to that of Iodine-131 (131I) single-photon emission computed tomography/computed tomography (SPECT/CT) (88.89% versus 52.78%; Z = 2.652, p = 0.041).
Conclusions: 18F-FDG PET/CT exhibits high diagnostic efficacy for RAIR-DTC recurrence/metastasis, with its positivity and SUVmax significantly correlated with serum Tg, clinical stage, and BRAFV600E mutation. Clinically, this supports three key strategies: (1) Prioritize 18F-FDG PET/CT follow-up for patients with Tg > 29.6 ng/mL, BRAFV600E positivity or postoperative high risk; (2) consider treatment escalation for PET/CT-positive patients with SUVmax > 7.0; and (3) combine 18F-FDG PET/CT with 131I SPECT/CT to guide personalized management of RAIR-DTC.
期刊介绍：
Cancer Biotherapy and Radiopharmaceuticals is the established peer-reviewed journal, with over 25 years of cutting-edge content on innovative therapeutic investigations to ultimately improve cancer management. It is the only journal with the specific focus of cancer biotherapy and is inclusive of monoclonal antibodies, cytokine therapy, cancer gene therapy, cell-based therapies, and other forms of immunotherapies.
The Journal includes extensive reporting on advancements in radioimmunotherapy, and the use of radiopharmaceuticals and radiolabeled peptides for the development of new cancer treatments.
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