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Year : 2015  |  Volume : 14  |  Issue : 2  |  Page : 101-108

Utility of 99m Tc-Hynic-TOC in 131I Whole-Body Scan Negative Thyroid Cancer Patients with Elevated Serum Thyroglobulin Levels

1 Department of Nuclear Medicine, KMCH, Coimbatore, Tamil Nadu, India
2 Isotope Application and Radiopharmaceuticals Division, BARC, Mumbai, Maharashtra, India

Correspondence Address:
Ajit S Shinto
Department of Nuclear Medicine, KMCH, Coimbatore, Tamil Nadu 641 014
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DOI: 10.4103/1450-1147.154229

PMID: 26097420

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Several studies have reported on the expression of somatostatin receptors (SSTRs) in patients with differentiated thyroid cancer (DTC). The aim of this study was to evaluate the imaging abilities of a recently developed Technetium-99m labeled somatostatin analog, 99m Tc-Hynic-TOC, in terms of precise localization of the disease. The study population consisted of 28 patients (16 men, 12 women; age range: 39-72 years) with histologically confirmed DTC, who presented with recurrent or persistent disease as indicated by elevated serum thyroglobulin (Tg) levels after initial treatment (serum Tg > 10 ng/ml off T4 suppression for 4-6 weeks). All patients were negative on the Iodine-131 posttherapy whole-body scans. Fluorine-18 fluorodeoxyglucose positron emission tomography ( 18 F-FDG PET) was performed in all patients. SSTR scintigraphy was true positive in 23 cases (82.1%), true negative in two cases (7.1%) and false negative in three cases (10.7%) which resulted in a sensitivity of 88.46%, specificity of 100% and an accuracy of 89.2%. Sensitivity of 99m Tc-Hynic-TOC scan was higher (93.7%) for patients with advanced stages, that is stages III and IV. 18 F-FDG showed a sensitivity of 93.7%, a specificity of 50% and an accuracy of 89.3%. 18 F-FDG PET was found to be more sensitive, with lower specificity due to false positive results in 2 patients. Analysis on a lesion basis demonstrated substantial agreement between the two imaging techniques with a Cohen's kappa of 0.66. Scintigraphy with 99m Tc-Hynic-TOC might be a promising tool for treatment planning; it is easy to perform and showed sufficient accuracy for localization diagnostics in thyroid cancer patients with recurrent or metastatic disease.

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