Recurrent thyroid cancer diagnosis: ROC study of the effect of a high-resolution head and neck 18F-FDG PET/CT scan.

Rationale and Objectives 18 F-fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT) has demonstrated significant value in the evaluation of patients with indication of recurrent thyroid cancer with negative conventional workup. The hypothesis of this study was that the addition of a dedicated, high-resolution head and neck scan (HNS) to the standard whole-body scan (WBS) improves the accuracy of the detection and diagnosis of recurrent thyroid cancer. Materials and Methods Forty-three consecutive patients suspected for recurrent thyroid cancer, as indicated by increased tumor markers, prospectively underwent a WBS and a HNS with 18 F-FDG PET/CT. The patients were followed up to establish ground truth. A receiver operator characteristic (ROC) study with two observers was conducted to evaluate the impact of the additional HNS on the detection and diagnosis of recurrent thyroid cancer. Indices of performance included the area under the ROC curve (AUC), the number of detected abnormal foci, and the size of the detected foci without and with the HNS images. Results ROC results showed that the addition of the HNS to the standard WBS increased the average AUC index of performance from 0.69 to 0.96, a statistically significant difference with a confidence interval (CI) of −0.33 to −0.19. Diagnosis was also improved with the average AUC increasing from 0.79 to 0.87 but differences were not statistically significant (CI, −0.19 to 0.04). Interreader agreement was “good” in the detection task and “excellent” in the diagnostic task. The addition of the HNS increased the number of detected foci in the positive patients by an average of 37%, whereas false-positive detections in the negative patients increased by an average of 10%. Reported average maximum lesion size also increased with the HNS addition by an average of 11%. Conclusions The addition of a high-resolution HNS to the standard whole-body PET/CT imaging improves readers' performance in the detection and diagnosis of recurrent thyroid cancer and could greatly benefit patient care.