FDG PET/CT imaging in recurrent papillary thyroid cancer: does BRAF mutation status matter?

Area of Science:

• Oncology
• Nuclear Medicine
• Molecular Diagnostics

Background:

• Papillary thyroid carcinoma (PTC) with BRAFV600E mutation presents aggressive features, higher recurrence rates, and increased mortality.
• Radioiodine (RAI) therapy is a standard treatment for PTC, but recurrence remains a challenge.

Purpose of the Study:

• To investigate the association between BRAFV600E mutation status and clinicopathological characteristics in recurrent PTC patients post-RAI therapy.
• To explore the relationship between BRAFV600E mutation status and [18F]FDG uptake patterns on PET/CT in recurrent PTC.

Main Methods:

• A cohort of 38 recurrent PTC patients post-RAI therapy with documented BRAFV600E status and elevated thyroglobulin (Tg) levels were analyzed.
• Clinicopathological data including tumor size and metastases were collected. Lesion metrics (SUVmax, SUVpeak, SUVmean, MTV, TLG) from [18F]FDG-PET/CT were assessed and correlated with BRAF status.

Main Results:

• Significant associations were found between BRAFV600E mutation status and higher SUVmax, SUVpeak, and SUVmean values (P<0.01).
• Tumor size independently correlated with SUVmax, but no significant difference in tumor size was observed between BRAF-mutated and wild-type groups.
• No significant association was found between TLG, MTV, or Tg levels and SUV metrics.

Conclusions:

• BRAFV600E mutation and larger tumor size are linked to increased FDG uptake in recurrent PTC, suggesting altered metabolic behavior.
• Current [18F]FDG-PET/CT metrics and BRAFV600E status alone do not support changes in clinical management or risk stratification.
• Further research is needed to explore [18F]FDG-PET/CT metrics as potential biomarkers for personalized treatment in BRAFV600E-positive PTC.