European journal of nuclear medicine and molecular imaging · 2026
Diagnostic performance of [18F]Tetrafluoroborate PET versus 131I scintigraphy in differentiated thyroid cancer: a prospective study.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Sonmezoglu Kerim, Sahin Onur Erdem, Saglam Kerem, Karayel Emre, Pehlivanoglu Huseyin, Uslu-Besli Lebriz, Sayman Haluk Burcak
Аннотация
PURPOSE: Differentiated thyroid cancer (DTC) is primarily evaluated using radioiodine (RAI) scanning; however, this approach is limited by the suboptimal imaging properties of 131I, the cost and limited availability of 123I, and restricted access to 124I. [18F]Tetrafluoroborate (TFB), a PET radiotracer targeting the sodium/iodide symporter, has emerged as a promising alternative. This prospective study assessed the diagnostic performance and biodistribution of TFB PET compared with 131I scintigraphy in patients with DTC.
METHODS: This prospective study enrolled 58 patients with histopathologically confirmed DTC after total or near-total thyroidectomy. Forty-eight patients underwent both TFB PET/CT and 131I SPECT scintigraphy, while 10 underwent only TFB PET for biodistribution analysis. Patients were stratified into preradioiodine (TFB before 131I; n = 28) and postradioiodine (TFB after 131I; n = 20) subgroups based on recent radioiodine administration (either diagnostic or therapeutic) to evaluate the potential stunning effect of 131I on TFB uptake. Patient- and lesion-based analyses were performed, and agreement was assessed using Cohen's kappa.
RESULTS: In patient-based analysis, concordance between modalities showed both TFB and 131I positivity in 20 patients, TFB-only positivity in 1 patient, 131I-only positivity in 5 patients, and negativity in both modalities in 22 patients, yielding substantial overall agreement (κ = 0.75). Agreement was almost perfect in the preradioiodine group (κ = 0.84) but declined to a moderate level in the postradioiodine group (κ = 0.49). In lesion-based analysis (n = 56), overall detection rates were comparable (TFB, 85.7% vs. 131I, 73.2%) but significantly higher for TFB in the preradioiodine group (95.7% vs. 68.1%, p < 0.05). Lesion detection decreased markedly in the postradioiodine group (33.3%), consistent with a stunning effect. Biodistribution analysis showed highest physiological uptake in the stomach, salivary glands, esophagus, nasopharynx and unexpected uterine uptake in Nabothian cysts in 45% of female patients.
CONCLUSION: TFB PET demonstrates diagnostic accuracy and lesion detection rates comparable to 131I scintigraphy in DTC. Its diagnostic performance is superior in patients without recent radioiodine administration prior to TFB imaging, whereas lesion detectability decreases after radioiodine administration, likely due to a stunning effect. Therefore, TFB PET represents a promising alternative for disease burden assessment in DTC and warrants further multicenter validation.
METHODS: This prospective study enrolled 58 patients with histopathologically confirmed DTC after total or near-total thyroidectomy. Forty-eight patients underwent both TFB PET/CT and 131I SPECT scintigraphy, while 10 underwent only TFB PET for biodistribution analysis. Patients were stratified into preradioiodine (TFB before 131I; n = 28) and postradioiodine (TFB after 131I; n = 20) subgroups based on recent radioiodine administration (either diagnostic or therapeutic) to evaluate the potential stunning effect of 131I on TFB uptake. Patient- and lesion-based analyses were performed, and agreement was assessed using Cohen's kappa.
RESULTS: In patient-based analysis, concordance between modalities showed both TFB and 131I positivity in 20 patients, TFB-only positivity in 1 patient, 131I-only positivity in 5 patients, and negativity in both modalities in 22 patients, yielding substantial overall agreement (κ = 0.75). Agreement was almost perfect in the preradioiodine group (κ = 0.84) but declined to a moderate level in the postradioiodine group (κ = 0.49). In lesion-based analysis (n = 56), overall detection rates were comparable (TFB, 85.7% vs. 131I, 73.2%) but significantly higher for TFB in the preradioiodine group (95.7% vs. 68.1%, p < 0.05). Lesion detection decreased markedly in the postradioiodine group (33.3%), consistent with a stunning effect. Biodistribution analysis showed highest physiological uptake in the stomach, salivary glands, esophagus, nasopharynx and unexpected uterine uptake in Nabothian cysts in 45% of female patients.
CONCLUSION: TFB PET demonstrates diagnostic accuracy and lesion detection rates comparable to 131I scintigraphy in DTC. Its diagnostic performance is superior in patients without recent radioiodine administration prior to TFB imaging, whereas lesion detectability decreases after radioiodine administration, likely due to a stunning effect. Therefore, TFB PET represents a promising alternative for disease burden assessment in DTC and warrants further multicenter validation.