ACTA ENDOCRINOLOGICA (BUC)

Aim. The aim of this study is to present the personal experience of the authors regarding the use of positron emission tomography-computer tomography fusion image (PET/CT), with 18Ffluoro-2-deoxy-D-glucose (FDG), in the follow-up of differentiated thyroid carcinoma (DTC).\r\nPatients and Methods. Twenty seven cases of DTC admitted and treated in the “Prof. Ion Chiricu??” Institute of Oncology Cluj-Napoca (IOCN), performed PET/CT investigation\r\nbetween 2007 and 2009, in DOTE Centre Debrecen (Hungary) and Pozitron Center Oradea (Romania). The patients underwent the surgical intervention and had histology of differentiated carcinoma; they received radioiodine therapy with I-131, had suppression therapy with thyroid hormones and had in the follow-up whole body scans (WBS) with I-131, neck ultrasound and serological determination of thyroglobulin (Tg) and anti-thyroglobulin antibodies (anti-Tg). All patients were referred to PET/CT after radical treatment, after a negative WBS I-131 and a dynamic increase of the serological level of Tg or anti-Tg, without any clinical signs of\r\nrecurrence and no neck ultrasound pathological findings.\r\nResults. All patients included in this study presented abnormal levels of Tg: between 2.76 ng/ml and 4173 ng/ml, with a median value of 43.15 ng/ml. In 23 cases (85.1%) the PET/CT results revealed the neoplasm recurrence, in 3 cases we obtained true negative results and in 1 case a false negative image; in 2 cases (7.4%) we found a second malignancy. All patients needed to change the treatment strategies.\r\nConclusion. The significant increase of the number of DTC and the more aggressive behaviour of the disease in some situations, determines the existence of a clear strategy of\r\ntreatment and monitoring, where the role of PET/CT is well defined.

The optimization of the diagnosis and therapy strategies, and also their standardization represent a continuous activity of the professional societies. The aim of the study is to review the data from the literature, regarding the thyroid cancer guidelines and to propose a national consensus, especially for differentiated thyroid cancers. There were analyzed the guidelines of diagnosis and treatment for thyroid nodules and thyroid cancer published by the European and American Thyroid Associations (ETA, ATA), by British Thyroid Association, American Association of Clinical Endocrinologist (AACE) and endocrine surgeons (AAES), by European Association of Nuclear Medicine (EANM) and American and European Societies of Clinical Oncology (ASCO and ESMO). We studied the national cancer registry, the institutional cancer registry and the database of nuclear medicine departments from Romania, regarding the limits and instruments as are registered at the National Nuclear Committee. The significant increase of the incidence of thyroid cancer and of the epidemiological data concerning the high percentage of clinically and ultrasoundly detected thyroid nodules, requires a debate around a consensus for the diagnosis and treatment of the differentiated thyroid carcinoma.