F-18-Dopa Positron Emission Tomography/Computed Tomography Is More Sensitive Than Whole-Body Magnetic Resonance Imaging for the Localization of Persistent / Recurrent Disease of Medullary Thyroid Cancer Patients

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  • Calcitonin (Ctn) is a highly sensitive and specific tumor marker of medullary thyroid carcinoma (MTC):
    • Postoperatively:
      • High levels of Ctn due to residual disease are frequently observed:
        • Particularly in patients with a:
          • High number of metastatic lymph nodes at initial diagnosis.
  • Elevated Ctn levels correlate with tumor burden:
    • When Ctn levels are:
      • Less than 150 pg/mL and neck ultrasonography (US) is normal:
        • Other imagings are not recommended:
          • Because in most cases, they fail to localize residual disease:
            • The clinical challenge is, however:
              • To localize the disease when a surgical resection can be curative.
  • Based on the ATA and NCCN guidelines:
    • The best imaging methods to explore MTC with postoperative elevated Ctn levels consisted in:
      • Neck US in combination with chest computed tomography (CT) scan, liver magnetic resonance imaging (MRI), and bone scintigraphy or spine MRI.
    • The performances of fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT:
      • Is disappointing:
        • Except for patients with:
          • Short Ctn doubling time.
  • F-18-Dopa (fluoro dihydroxyphenylalanine) PET/CT:
    • Is abnormal in 66% to 75% of MTC patients with elevated Ctn levels:
      • In these studies:
        • All patients have persistent disease:
          • Since they have a postoperatively elevated Ctn level.
      • The detection rate per patient or the patient-based sensitivity is highly dependent on:
        • The tumor burden and the Ctn levels of the patients studied, and the per-lesion sensitivity or the lesion detection rate is highly dependent on the other imaging modalities performed. 
  • In a study of 36 consecutive patients:
    • Results:
      • 21 females
      • Mean age: 57 years
      • Sporadic MTC in 26 cases
      • Median serum Ctn level: 760 pg/mL; range: 21–10,121)
      • The reference assessment:
        • Localized disease in 24 (64%) patients:
          • With 74 lesions detected in the:
            • Thyroid bed, in neck lymph nodes, mediastinal lymph nodes, lungs, liver, bones, and other site.
      • At the patient level:
        • The detection rates were:
          • 64% (CI 0.48–0.80) for F-18-Dopa PET/CT with early acquisitions
          • 40% (CI 0.24–0.56) for F-18-FDG PET/CT
          • 40% (CI 0.24–0.56) for WB MRI
          • 48% (CI 0.31–0.66) for WB CT scan
    • Conclusions:
      • In MTC patients with increased Ctn and no known distant metastases:
        • F-18-Dopa PET/CT is more sensitive:
          • To detect structural disease than any other imaging modality, including WB MRI.

 

  • Marie Terroir, Caroline Caramella, Isabelle Borget, Sophie Bidault, Clarisse Dromain, Khadija El Farsaoui, Désirée Deandreis, Serena Grimaldi, Jean Lumbroso, Amandine Berdelou, Julien Hadoux, Segolene Hescot, Dana Hartl, Eric Baudin, Martin Schlumberger, and Sophie Leboulleux.Thyroid.Oct 2019.1457-1464.http://doi.org/10.1089/thy.2018.0351
    • Published in Volume: 29 Issue 10: October 15, 2019
    • Online Ahead of Editing: September 18, 2019

 

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  • What is Head and Neck Surgery?:
    • It is a surgical sub-specialty that deals mainly with benign and malignant tumors of the head and neck region, including:
      • The scalp, facial region, eyes, ears, nose, nasal fossae, paranasal sinuses, oral cavity, pharynx (nasopharynx, oropharynx, hypopharynx), larynx (supraglotic larynx, glottis larynx, subglotic larynx), thyroid gland, parathyroid gland, salivary glands (parotid glands, submandibular glands, sublingual glands, minor salivary glands), soft tissues of the neck, skin of the head and neck region.
        • The head and neck surgeon’s work area:
          • Does not cover tumors or diseases of the brain and other areas of the central nervous system or those of the cervical spine:
            • This is the neurosurgeon field.
    • Among the diagnostic procedures performed by the head and neck surgeon,  are the following:
      • Nasopharyngolaryngoscopy:
        • Performed to examine, evaluate and, possibly perform a biopsy, of oral cavity, pharyngeal and laryngeal lesions.
    • The surgeries most commonly performed by the head and neck surgeon are:
      • Total or near total thyroidectomies
      • Hemithryoidectomies (lobectomies)
      • Comprehensive neck dissections
      • Selective neck dissections
      • Maxillectomies:
        • Total maxillectomy
        • Subtotal maxillectomy
        • Infrastructure maxillectomy
        • Suprastructure maxillectomy
        • Medial maxillectomy
      • Mandibulectomy:
        • Segmental
        • Marginal
      • Tracheostomy
      • Salivary gland surgeries:
        • Parotid gland operations:
          • Limited superficial parotidectomy with identification and preservation of the facial nerve
          • Superficial parotidectomy with identification and preservation of the facial nerve
          • Near total parotidectomy with identification and preservation of the facial nerve
          • Total parotidectomy
        • Submandibular gland resection
        • Sublingual gland resection
      • Resection of tumors of the oral cavity:
        • Glossectomy
        • Resection of the floor of the mouth tumors
      • Resection of tumors of the pharynx
      • Resection of tumors of the larynx
      • Split-thickness skin grafts
      • Full-thickness skin grafts
      • Sentinel lymph node mapping and sentinel lymph node biopsy
      • Resection of malignant skin tumors (BCC, SCC, melanoma) of the head and neck region
  • The formation of the head and neck surgeon includes mastering the following subjects:
    • Surgical Anatomy
    • History and Basic Principles of Head and Neck Surgery
    • Epidemiology, Etiology, and Pathology of Head and Neck Diseases
    • Diagnostic Radiology of the Head and Neck Region
    • Tumors of the Scalp, Skin and Melanoma
    • Eyelids and Orbit
    • Nasal Cavity and Paranasal Sinuses
    • Skull Base and Temporal Bone
    • Lips and Oral Cavity
    • Pharynx and Esophagus
    • Larynx and Trachea
    • Cervical Lymph Nodes
    • Thyroid and Parathyroid Glands
    • Salivary Glands
    • Neurogenic Tumors and Paragangliomas
    • Soft Tissue Tumors
    • Bone Tumors and Odontogenic Lesions
    • Reconstructive Surgery
    • Oncologic Dentistry and Maxillofacial Prosthetics
    • Principles of Radiation Oncology
    • Principles of Chemotherapy
    • Molecular Oncology, Genomics and Immunology
    • Nutrition
    • Biostatistic

 

  • Rodrigo Arrangoiz MS, MD, FACS a head and neck surgeon / endocrine surgeon / surgical oncologist and is a member of Sociedad Quirúrgica S.C at the America British Cowdray Medical Center in Mexico City:

 

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  • Rodrigo Arrangoiz MS, MD, FACS:
    • Is a member of the American Head and Neck Society

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    • He is a member of the American Thyroid Association:

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Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

#Arrangoiz

#Teacher

#Surgeon

#Cirujano

#ThyroidExpert

#ThyroidSurgeon

#CirujanodeTiroides

#ExpertoenTiroides

#ExpertoenParatiroides

#Paratiroides

#Hiperparatiroidismo

#CancerdeTiroides

#ThyroidCancer

#PapillaryThyroidCancer

#SurgicalOncologist

#CirujanoOncologo

#CancerSurgeon

#CirujanodeCancer

#HeadandNeckSurgeon

#CirugiaEndocrina

#CirujanodeTumoresdeCabezayCuello

#OralCavityCancer

#Melanoma

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