Utility of I-124 PET/CT in identifying radioiodine avid lesions in differentiated thyroid cancer

a systematic review and meta-analysis

Prasanna Santhanam, David Taieb, Lilja Solnes, Wael Marashdeh, Paul W Ladenson

Research output: Contribution to journalReview article

Abstract

Introduction: Diagnostic I-123 scans have been shown to underestimate the disease burden in differentiated thyroid cancer (DTC) when compared to I-131 post-treatment scans, especially in children and patients who have had prior radioiodine (RAI) therapy and/or distant metastasis. I-124 PET/CT has been shown to be highly effective in imaging DTC-related metastatic disease. Methods: We performed a systematic review and meta-analysis of studies investigating the sensitivity and specificity of I-124 PET/CT in identifying lesions amenable to RAI therapy as confirmed by I-131 post-treatment scanning. Results: There were 141 patients and 415 lesions of DTC identified altogether. There was significant heterogeneity in the individual studies. The pooled sensitivity of the I-124 PET/CT in detecting lesions of differentiated thyroid cancer amenable to I-131 therapy was 94·2% (91·3–96·4% CI, P < 0·01), and the pooled specificity was 49·0% (34·8–63·4% CI, P < 0·01). The pooled positive likelihood ratio (LR) was 1·43 (1·05–1·94 CI), and the pooled negative LR was 0·28 (0·15–0·53 CI). Overall, the diagnostic odds ratio was 7·90 (3·39–18·48 CI). There were a small but increased number of lesions identified by I-124 PET/CT that was not detected on post-treatment scan. Conclusion: I-124 PET/CT is a sensitive tool to diagnose RAI avid DTC lesions, but also detects some new lesions that are not visualized on the post-treatment I-131 scan. Further, carefully designed dosimetric studies may be required to fully establish the role of I-124 PET CT for identifying potential lesions for I-131 therapy. I-124 PET/CT in patients with DTC may have other applications in specific clinical situations.

Original languageEnglish (US)
Pages (from-to)645-651
Number of pages7
JournalClinical Endocrinology
Volume86
Issue number5
DOIs
StatePublished - May 1 2017

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Thyroid Neoplasms
Meta-Analysis
piroxantrone
Therapeutics
Odds Ratio
Neoplasm Metastasis
Sensitivity and Specificity

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

Cite this

@article{636eed1909fe441a9f830bf631aadc85,
title = "Utility of I-124 PET/CT in identifying radioiodine avid lesions in differentiated thyroid cancer: a systematic review and meta-analysis",
abstract = "Introduction: Diagnostic I-123 scans have been shown to underestimate the disease burden in differentiated thyroid cancer (DTC) when compared to I-131 post-treatment scans, especially in children and patients who have had prior radioiodine (RAI) therapy and/or distant metastasis. I-124 PET/CT has been shown to be highly effective in imaging DTC-related metastatic disease. Methods: We performed a systematic review and meta-analysis of studies investigating the sensitivity and specificity of I-124 PET/CT in identifying lesions amenable to RAI therapy as confirmed by I-131 post-treatment scanning. Results: There were 141 patients and 415 lesions of DTC identified altogether. There was significant heterogeneity in the individual studies. The pooled sensitivity of the I-124 PET/CT in detecting lesions of differentiated thyroid cancer amenable to I-131 therapy was 94·2{\%} (91·3–96·4{\%} CI, P < 0·01), and the pooled specificity was 49·0{\%} (34·8–63·4{\%} CI, P < 0·01). The pooled positive likelihood ratio (LR) was 1·43 (1·05–1·94 CI), and the pooled negative LR was 0·28 (0·15–0·53 CI). Overall, the diagnostic odds ratio was 7·90 (3·39–18·48 CI). There were a small but increased number of lesions identified by I-124 PET/CT that was not detected on post-treatment scan. Conclusion: I-124 PET/CT is a sensitive tool to diagnose RAI avid DTC lesions, but also detects some new lesions that are not visualized on the post-treatment I-131 scan. Further, carefully designed dosimetric studies may be required to fully establish the role of I-124 PET CT for identifying potential lesions for I-131 therapy. I-124 PET/CT in patients with DTC may have other applications in specific clinical situations.",
author = "Prasanna Santhanam and David Taieb and Lilja Solnes and Wael Marashdeh and Ladenson, {Paul W}",
year = "2017",
month = "5",
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doi = "10.1111/cen.13306",
language = "English (US)",
volume = "86",
pages = "645--651",
journal = "Clinical Endocrinology",
issn = "0300-0664",
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TY - JOUR

T1 - Utility of I-124 PET/CT in identifying radioiodine avid lesions in differentiated thyroid cancer

T2 - a systematic review and meta-analysis

AU - Santhanam, Prasanna

AU - Taieb, David

AU - Solnes, Lilja

AU - Marashdeh, Wael

AU - Ladenson, Paul W

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Introduction: Diagnostic I-123 scans have been shown to underestimate the disease burden in differentiated thyroid cancer (DTC) when compared to I-131 post-treatment scans, especially in children and patients who have had prior radioiodine (RAI) therapy and/or distant metastasis. I-124 PET/CT has been shown to be highly effective in imaging DTC-related metastatic disease. Methods: We performed a systematic review and meta-analysis of studies investigating the sensitivity and specificity of I-124 PET/CT in identifying lesions amenable to RAI therapy as confirmed by I-131 post-treatment scanning. Results: There were 141 patients and 415 lesions of DTC identified altogether. There was significant heterogeneity in the individual studies. The pooled sensitivity of the I-124 PET/CT in detecting lesions of differentiated thyroid cancer amenable to I-131 therapy was 94·2% (91·3–96·4% CI, P < 0·01), and the pooled specificity was 49·0% (34·8–63·4% CI, P < 0·01). The pooled positive likelihood ratio (LR) was 1·43 (1·05–1·94 CI), and the pooled negative LR was 0·28 (0·15–0·53 CI). Overall, the diagnostic odds ratio was 7·90 (3·39–18·48 CI). There were a small but increased number of lesions identified by I-124 PET/CT that was not detected on post-treatment scan. Conclusion: I-124 PET/CT is a sensitive tool to diagnose RAI avid DTC lesions, but also detects some new lesions that are not visualized on the post-treatment I-131 scan. Further, carefully designed dosimetric studies may be required to fully establish the role of I-124 PET CT for identifying potential lesions for I-131 therapy. I-124 PET/CT in patients with DTC may have other applications in specific clinical situations.

AB - Introduction: Diagnostic I-123 scans have been shown to underestimate the disease burden in differentiated thyroid cancer (DTC) when compared to I-131 post-treatment scans, especially in children and patients who have had prior radioiodine (RAI) therapy and/or distant metastasis. I-124 PET/CT has been shown to be highly effective in imaging DTC-related metastatic disease. Methods: We performed a systematic review and meta-analysis of studies investigating the sensitivity and specificity of I-124 PET/CT in identifying lesions amenable to RAI therapy as confirmed by I-131 post-treatment scanning. Results: There were 141 patients and 415 lesions of DTC identified altogether. There was significant heterogeneity in the individual studies. The pooled sensitivity of the I-124 PET/CT in detecting lesions of differentiated thyroid cancer amenable to I-131 therapy was 94·2% (91·3–96·4% CI, P < 0·01), and the pooled specificity was 49·0% (34·8–63·4% CI, P < 0·01). The pooled positive likelihood ratio (LR) was 1·43 (1·05–1·94 CI), and the pooled negative LR was 0·28 (0·15–0·53 CI). Overall, the diagnostic odds ratio was 7·90 (3·39–18·48 CI). There were a small but increased number of lesions identified by I-124 PET/CT that was not detected on post-treatment scan. Conclusion: I-124 PET/CT is a sensitive tool to diagnose RAI avid DTC lesions, but also detects some new lesions that are not visualized on the post-treatment I-131 scan. Further, carefully designed dosimetric studies may be required to fully establish the role of I-124 PET CT for identifying potential lesions for I-131 therapy. I-124 PET/CT in patients with DTC may have other applications in specific clinical situations.

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U2 - 10.1111/cen.13306

DO - 10.1111/cen.13306

M3 - Review article

VL - 86

SP - 645

EP - 651

JO - Clinical Endocrinology

JF - Clinical Endocrinology

SN - 0300-0664

IS - 5

ER -