Purpose: To investigate the impact of [18F]FDG-PET/CT on the management of differentiated thyroid carcinoma (DTC) in routine clinical settings. Material and methods: In total, 98 patients (55 females, age 56 ± 18 years) with histologically confirmed thyroid cancer, including all types of DTC and poorly differentiated thyroid cancer (PDTC, n = 7), underwent [18F]FDG-PET/CT for staging or recurrence diagnostics performed using a state-of-the art clinical scanner (Biograph mCT, Siemens Healthineers) with a standardized examination protocol. The impact of PET/CT on clinical decision making was prospectively evaluated using standardized questionnaires completed by the referring physicians before and after PET/CT. Patient outcome was analyzed for OS drawn from patient records. Results: Referring physicians were unable to establish a treatment plan for 81% of patients with thyroid cancer in the absence of PET/CT. The use of PET/CT had a notable influence on patient management, leading to the development of a well-defined treatment plan for 92% of patients. Moreover, after PET/CT a change in pre-PET/CT-intended treatments occurred in 32% of cases, and further invasive diagnostic could be waived in 7% of cases. [18F]FDG-PET/CT revealed a tumor detection rate of 68% (local tumor: 19%, lymph node metastases: 40%, distant metastases: 42%). HTg levels, when stimulated via TSH, were considerably higher in patients with metastases detected on PET/CT, compared to those without metastatic findings (p= 0.02). OS was significantly worse in patients with PDTC (p= 0.002) compared to follicular thyroid cancer (FTC) and PTC or even in patients with distant metastases at first diagnosis (p= 0.03). Conclusions: This prospective registry study confirms that [18F]FDG-PET/CT used in a routine clinical setting has a very important impact on the management of patients with thyroid cancer by initiating treatments and reducing the uses of additional imaging and invasive tests.
目的：探讨在常规临床实践中，[18F]FDG-PET/CT对分化型甲状腺癌（DTC）诊疗策略的影响。材料与方法：共纳入98例经组织学确诊的甲状腺癌患者（女性55例，年龄56±18岁），包括所有类型的DTC及低分化甲状腺癌（PDTC，n=7）。所有患者均采用标准化检查方案，在先进临床扫描仪（Biograph mCT，西门子医疗）上接受[18F]FDG-PET/CT检查以进行分期或复发诊断。通过转诊医师在PET/CT检查前后填写的标准化问卷，前瞻性评估PET/CT对临床决策的影响。从患者病历中提取总生存期（OS）数据进行预后分析。结果：在未进行PET/CT检查的情况下，转诊医师无法为81%的甲状腺癌患者制定治疗方案。PET/CT的应用对患者管理产生显著影响，使92%的患者获得了明确治疗方案。此外，32%的病例在PET/CT检查后改变了原定治疗方案，7%的病例避免了进一步的侵入性检查。[18F]FDG-PET/CT的肿瘤检出率为68%（原发灶：19%，淋巴结转移：40%，远处转移：42%）。与PET/CT未发现转移灶的患者相比，PET/CT检出转移灶患者的TSH刺激后HTg水平显著更高（p=0.02）。PDTC患者的总生存期显著差于滤泡状甲状腺癌（FTC）和乳头状甲状腺癌（PTC）患者（p=0.002），甚至差于首次诊断即发现远处转移的患者（p=0.03）。结论：本前瞻性注册研究证实，在常规临床实践中应用[18F]FDG-PET/CT可通过启动针对性治疗、减少额外影像学及侵入性检查，对甲状腺癌患者的诊疗管理产生重要影响。
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