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Paper 28 (0845)
FEASIBILITY OF 18F-FDG-GUIDED SURGERY IN THE MANAGEMENT OF METASTASES FROM DIFFERENTIATED THYROID CARCINOMA WITH NEGATIVE 131I UPTAKE
Background: 18F-FDG positron emission tomography (PET-FDG) is able to detect metastases in patients with differentiated thyroid carcinoma (DTC) and impaired iodine-trapping ability. Radio-guided surgery has been used in reoperation for repeated neck lymph node dissections. The aim of this study was to evaluate the feasibility and usefulness of peroperative PET-FDG imaging to detect malignancy using gamma handheld probe.
Conclusions: These preliminary Results: showed the feasibility of 18F-FDG radio-guided surgery with a gamma handheld probe in the management of DTC lymph node recurrences. The gamma probe detected in vivo a decrease of count after lymph node resection and ex vivo tumor-to-normal tissue ratio around 1.6 confirming tumor resection.
The 26th Annual Meeting of the American
Association of Endocrine Surgeons
April 3rd- 5th,2005 - Paradisus Riviera Cancun.
F. Kraeber-Bodere, C. Curtet, B. Cariou, B. Bridji, F. Dravet, C. Rousseau, I. Resche, B. Charbonnel, J. F. Chatal, B. Carnaille, E. Mirallié.
Hotel Dieu Hospital &, René Gauducheau Cancer Center, Nantes, France, Claude Huriez, Hospital, Lille, France,
Methods: A gamma handheld probe (Modelo 2, Novelec) with a BgO scintillator, and a window setting at 511 keV, was used intraoperatively to detect recurrent DTC as determined by high serum thyroglobulin level and abnormal 18F-FDG uptake. The patients received a mean activity of 278 MBq of 18F-FDG 30 minutes before surgery. Counts/second from tumor and normal tissue (neck and shoulder) were determined before and after resection. Exposure of the surgeon was measured with thermoluminescents dosimeters.
Results: Nine patients, with 1 to 3 lymph node foci on PET-FDG were evaluated, 4 of them had injection of recombinant human TSH (Thyrogen ) during 2 days before surgery. In all patients, abnormal findings on preoperative PET-FDG were detected by gamma-probe, with a median tumor counts in vivo of 3255 and tumor-to-neck and tumor-to-shoulder ratios respectively equal to 1.3 and 1.7. Surgical tumor resection was incomplete in 2 patients because of vascular adherence. When the resection was complete, counts of tumor site decreased of 36 % and tumor-to-neck and tumor-to-shoulder ratios respectively of 20% and 21%. Ex vivo mean tumor counts was 353 with tumor-to-normal tissue ratio equal to 1.6. Except in one case of non-specific inflammation, all-probe positive tissues were histologically confirmed to be DTC. Hand exposure of the surgeon ranged from 90 to 270 microSv.