European journal of nuclear medicine and molecular imaging · 2026
Prospective study on the [18F]FDOPA PET/CT role in the management of medullary thyroid cancer patients with high residual calcitonin level after surgery.
СтатьяМногоцентровое исследованиеКлиническое исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Terroir Marie, Lusque Amelie, Hindié Elif, Taieb David, Eberle-Pouzeratte Marie-Claude, Verbeke Sandrine, Decote Anne, Grunenwald Solange, Zerdoud Slimane
Аннотация
PURPOSE: After surgery, beyond 150 pg/ml of calcitonin (ctn) in medullary thyroid cancer (MTC) patients, international recommendations suggest adding 6-[¹⁸F]fluoro-L-3,4-dihydroxyphenylalanine positron emission tomography ([18F]FDOPA PET/CT) to conventional imaging (CI). The aim of this study was to measure the impact of the [18F]FDOPA in the management of MTC patients.
METHODS: This prospective, multicenter, study evaluated the benefit of [18F]FDOPA compared to CI. The primary endpoint was the relative true-positive rate of metastatic cervical lymph nodes in a per lymph node analysis. Secondary endpoints are discordance rate between [18F]FDOPA and CI, changes in patient management according to a board of experts and concordance between [18F]FDOPA reading in the investigating center and a centralized review.
RESULTS: The study included 24 patients. The median ctn rate was 824 pg/mL (range 176-16418). Sixty lymph nodes were detected by [18F]FDOPA or CI, fifty-three were defined involved and 7 non-involved. [18F]FDOPA detected 1.5 (95% CI 1.25-1.84) times more metastatic lymph nodes compared to CI. For metastases, the discordance rate was 46.4% (95% CI 27.5-66.1). According to the tumor board, 14 patients (58.3%, 95%CI: 36.6-77.9) had a change in management after [18F]FDOPA results (monitoring or surgery or modified surgery or fine needle aspiration or local/ systemic treatment). The discordance rate for [18F]FDOPA reading was 20.8% (95%CI: 7.1-42.2, 5/24 patients).
CONCLUSION: In this multicenter prospective study, [18F]FDOPA is more effective than CI for detecting metastatic lymph nodes and would change management in 58% of cases. The [18F]FDOPA reading remains challenging and requires a learning curve in case of MTC.
METHODS: This prospective, multicenter, study evaluated the benefit of [18F]FDOPA compared to CI. The primary endpoint was the relative true-positive rate of metastatic cervical lymph nodes in a per lymph node analysis. Secondary endpoints are discordance rate between [18F]FDOPA and CI, changes in patient management according to a board of experts and concordance between [18F]FDOPA reading in the investigating center and a centralized review.
RESULTS: The study included 24 patients. The median ctn rate was 824 pg/mL (range 176-16418). Sixty lymph nodes were detected by [18F]FDOPA or CI, fifty-three were defined involved and 7 non-involved. [18F]FDOPA detected 1.5 (95% CI 1.25-1.84) times more metastatic lymph nodes compared to CI. For metastases, the discordance rate was 46.4% (95% CI 27.5-66.1). According to the tumor board, 14 patients (58.3%, 95%CI: 36.6-77.9) had a change in management after [18F]FDOPA results (monitoring or surgery or modified surgery or fine needle aspiration or local/ systemic treatment). The discordance rate for [18F]FDOPA reading was 20.8% (95%CI: 7.1-42.2, 5/24 patients).
CONCLUSION: In this multicenter prospective study, [18F]FDOPA is more effective than CI for detecting metastatic lymph nodes and would change management in 58% of cases. The [18F]FDOPA reading remains challenging and requires a learning curve in case of MTC.