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<meta name="DC.Title" content="[18F]-Fluorodeoxyglucose Uptake as a Marker of Residual Anaplastic and Poorly Differentiated Thyroid Carcinoma Following BRAF-Targeted Therapy" />
<meta name="DC.Identifier" content="10.3174/ajnr.A8588" />
<meta name="DC.Date" content="2024-11-21" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Neoadjuvant BRAF-directed therapy and immunotherapy followed by surgery improves survival in patients with BRAFV600E-mutant anaplastic thyroid carcinoma (ATC), more so in those who have complete ATC pathologic response. This study assesses the ability of FDG-PET to non-invasively detect residual high-risk pathologies including ATC and poorly differentiated thyroid carcinoma (PDTC) in the preoperative setting.

MATERIALS AND METHODS: This retrospective, single-center study included consecutive BRAFV600E-mutant ATC patients treated with at least 30 days of neoadjuvant BRAF-directed therapy and who underwent FDG-PET/CT within 30 days prior to surgery. The highest pathologic grade observed for every head and neck lesion resected was recorded. Each lesion on pre-operative PET/CT was retrospectively characterized. The primary endpoint was to contrast the standardized uptake normalized by lean body mass (SULmax) for lesions with residual high-risk (ATC, PDTC) versus low-risk pathologies (papillary thyroid carcinoma, negative). An optimal SULmax threshold was then identified using a ROC analysis, and the ability of this threshold to non-invasively and preoperatively risk-stratify patients by overall survival was then evaluated with a Kaplan-Meier plot.

RESULTS: 30 patients (mean age 66.5±9.0; 17 males) were included in this study, with 94 surgically sampled lesions. Of these lesions, 57 (60.6%) were low-risk (39 negative, 18 papillary thyroid carcinoma) and 37 (39.4%) were high-risk (29 ATC, 8 PDTC). FDG uptake was higher for high-risk compared to low-risk pathologies: median SULmax 5.01 \[IQR 2.81 – 10.95] versus 1.29 [IQR 1.06 – 3.1\] (P&lt;.001, Mann-Whitney U test). The sensitivity, specificity, and accuracy for detecting high-risk pathologies at the optimal threshold of SULmax ≥ 2.75 were 0.784 [95% CI 0.628–0.886], 0.702 [95% CI 0.573–0.805], and 0.734 [95% CI 0.637–0.813], respectively. Patients with at least 1 high-risk lesion identified with the aforementioned cut-off had a worse prognosis compared to patients without high-risk lesions in the head and neck: median OS for the former group was 259 days and was not attained for the latter (P=.038, log-rank test).

CONCLUSIONS: Preoperative FDG-PET non-invasively identifies lesions with residual high-risk pathologies following neoadjuvant BRAF-directed targeted therapy and immunotherapy for BRAF-mutated ATC. FDG-PET avidity may serve as an early prognostic marker which correlates with residual high-risk pathology in BRAF-mutated ATC following neoadjuvant therapy.

ABBREVIATIONS: ATC = anaplastic thyroid carcinoma; IQR = interquartile range; OS = overall survival; PDTC = poorly differentiated thyroid carcinoma; PTC = papillary thyroid carcinoma; ROC = receiver operating characteristic; SUL= standardized uptake value normalized by lean body mass." />
<meta name="DC.Contributor" content="Samir A. Dagher" />
<meta name="DC.Contributor" content="Kim O. Learned" />
<meta name="DC.Contributor" content="Richard Dagher" />
<meta name="DC.Contributor" content="Jennifer Rui Wang" />
<meta name="DC.Contributor" content="Xiao Zhao" />
<meta name="DC.Contributor" content="S. Mohsen Hosseini" />
<meta name="DC.Contributor" content="Anastasios Maniakas" />
<meta name="DC.Contributor" content="Maria E. Cabanillas" />
<meta name="DC.Contributor" content="Naifa L. Busaidy" />
<meta name="DC.Contributor" content="Ramona Dadu" />
<meta name="DC.Contributor" content="Priyanka Iyer" />
<meta name="DC.Contributor" content="Mark E. Zafereo" />
<meta name="DC.Contributor" content="Alexander M. Khalaf" />
<meta name="article:published_time" content="2024-11-21" />
<meta name="article:section" content="ORIGINAL RESEARCH" />
<meta name="citation_title" content="[18F]-Fluorodeoxyglucose Uptake as a Marker of Residual Anaplastic and Poorly Differentiated Thyroid Carcinoma Following BRAF-Targeted Therapy" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;ABSTRACT&lt;/h3&gt;
&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Neoadjuvant BRAF-directed therapy and immunotherapy followed by surgery improves survival in patients with BRAF&lt;sup&gt;V600E&lt;/sup&gt;-mutant anaplastic thyroid carcinoma (ATC), more so in those who have complete ATC pathologic response. This study assesses the ability of FDG-PET to non-invasively detect residual high-risk pathologies including ATC and poorly differentiated thyroid carcinoma (PDTC) in the preoperative setting.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;This retrospective, single-center study included consecutive BRAF&lt;sup&gt;V600E&lt;/sup&gt;-mutant ATC patients treated with at least 30 days of neoadjuvant BRAF-directed therapy and who underwent FDG-PET/CT within 30 days prior to surgery. The highest pathologic grade observed for every head and neck lesion resected was recorded. Each lesion on pre-operative PET/CT was retrospectively characterized. The primary endpoint was to contrast the standardized uptake normalized by lean body mass (SULmax) for lesions with residual high-risk (ATC, PDTC) versus low-risk pathologies (papillary thyroid carcinoma, negative). An optimal SULmax threshold was then identified using a ROC analysis, and the ability of this threshold to non-invasively and preoperatively risk-stratify patients by overall survival was then evaluated with a Kaplan-Meier plot.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;30 patients (mean age 66.5±9.0; 17 males) were included in this study, with 94 surgically sampled lesions. Of these lesions, 57 (60.6%) were low-risk (39 negative, 18 papillary thyroid carcinoma) and 37 (39.4%) were high-risk (29 ATC, 8 PDTC). FDG uptake was higher for high-risk compared to low-risk pathologies: median SULmax 5.01 [IQR 2.81 – 10.95] versus 1.29 [IQR 1.06 – 3.1] (P&amp;lt;.001, Mann-Whitney U test). The sensitivity, specificity, and accuracy for detecting high-risk pathologies at the optimal threshold of SULmax ≥ 2.75 were 0.784 [95% CI 0.628–0.886], 0.702 [95% CI 0.573–0.805], and 0.734 [95% CI 0.637–0.813], respectively. Patients with at least 1 high-risk lesion identified with the aforementioned cut-off had a worse prognosis compared to patients without high-risk lesions in the head and neck: median OS for the former group was 259 days and was not attained for the latter (P=.038, log-rank test).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Preoperative FDG-PET non-invasively identifies lesions with residual high-risk pathologies following neoadjuvant BRAF-directed targeted therapy and immunotherapy for BRAF-mutated ATC. FDG-PET avidity may serve as an early prognostic marker which correlates with residual high-risk pathology in BRAF-mutated ATC following neoadjuvant therapy.&lt;/p&gt;&lt;p&gt;ABBREVIATIONS: ATC = anaplastic thyroid carcinoma; IQR = interquartile range; OS = overall survival; PDTC = poorly differentiated thyroid carcinoma; PTC = papillary thyroid carcinoma; ROC = receiver operating characteristic; SUL= standardized uptake value normalized by lean body mass.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
<meta name="citation_publisher" content="American Journal of Neuroradiology" />
<meta name="citation_publication_date" content="2024/11/21" />
<meta name="citation_mjid" content="ajnr;ajnr.A8588v1" />
<meta name="citation_id" content="ajnr.A8588v1" />
<meta name="citation_public_url" content="http://ajnr-stage2.stage.highwire.org/content/early/2024/11/21/ajnr.A8588" />
<meta name="citation_abstract_html_url" content="http://ajnr-stage2.stage.highwire.org/content/early/2024/11/21/ajnr.A8588.abstract" />
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<meta name="citation_issn" content="0195-6108" />
<meta name="citation_issn" content="1936-959X" />
<meta name="citation_doi" content="10.3174/ajnr.A8588" />
<meta name="citation_pmid" content="39572200" />
<meta name="citation_article_type" content="Research Article" />
<meta name="citation_section" content="ORIGINAL RESEARCH" />
<meta name="citation_author" content="Samir A. Dagher" />
<meta name="citation_author_institution" content="From the Department of Neuroradiology / Head and Neck Imaging (S.A.D., K.O.L., R.D., A.M.K.), Department of Head and Neck Surgery (J.R.W., X.Z., A.M., M.E.Z.), Department of Pathology (S.M.H.), and Department of Endocrine Neoplasia and Hormonal Disorders (M.E.C., N.L.B., R.D., P.I.), The University of Texas MD Anderson Cancer Center, Houston, TX, USA." />
<meta name="citation_author" content="Kim O. Learned" />
<meta name="citation_author_institution" content="From the Department of Neuroradiology / Head and Neck Imaging (S.A.D., K.O.L., R.D., A.M.K.), Department of Head and Neck Surgery (J.R.W., X.Z., A.M., M.E.Z.), Department of Pathology (S.M.H.), and Department of Endocrine Neoplasia and Hormonal Disorders (M.E.C., N.L.B., R.D., P.I.), The University of Texas MD Anderson Cancer Center, Houston, TX, USA." />
<meta name="citation_author" content="Richard Dagher" />
<meta name="citation_author_institution" content="From the Department of Neuroradiology / Head and Neck Imaging (S.A.D., K.O.L., R.D., A.M.K.), Department of Head and Neck Surgery (J.R.W., X.Z., A.M., M.E.Z.), Department of Pathology (S.M.H.), and Department of Endocrine Neoplasia and Hormonal Disorders (M.E.C., N.L.B., R.D., P.I.), The University of Texas MD Anderson Cancer Center, Houston, TX, USA." />
<meta name="citation_author" content="Jennifer Rui Wang" />
<meta name="citation_author_institution" content="From the Department of Neuroradiology / Head and Neck Imaging (S.A.D., K.O.L., R.D., A.M.K.), Department of Head and Neck Surgery (J.R.W., X.Z., A.M., M.E.Z.), Department of Pathology (S.M.H.), and Department of Endocrine Neoplasia and Hormonal Disorders (M.E.C., N.L.B., R.D., P.I.), The University of Texas MD Anderson Cancer Center, Houston, TX, USA." />
<meta name="citation_author" content="Xiao Zhao" />
<meta name="citation_author_institution" content="From the Department of Neuroradiology / Head and Neck Imaging (S.A.D., K.O.L., R.D., A.M.K.), Department of Head and Neck Surgery (J.R.W., X.Z., A.M., M.E.Z.), Department of Pathology (S.M.H.), and Department of Endocrine Neoplasia and Hormonal Disorders (M.E.C., N.L.B., R.D., P.I.), The University of Texas MD Anderson Cancer Center, Houston, TX, USA." />
<meta name="citation_author" content="S. Mohsen Hosseini" />
<meta name="citation_author_institution" content="From the Department of Neuroradiology / Head and Neck Imaging (S.A.D., K.O.L., R.D., A.M.K.), Department of Head and Neck Surgery (J.R.W., X.Z., A.M., M.E.Z.), Department of Pathology (S.M.H.), and Department of Endocrine Neoplasia and Hormonal Disorders (M.E.C., N.L.B., R.D., P.I.), The University of Texas MD Anderson Cancer Center, Houston, TX, USA." />
<meta name="citation_author" content="Anastasios Maniakas" />
<meta name="citation_author_institution" content="From the Department of Neuroradiology / Head and Neck Imaging (S.A.D., K.O.L., R.D., A.M.K.), Department of Head and Neck Surgery (J.R.W., X.Z., A.M., M.E.Z.), Department of Pathology (S.M.H.), and Department of Endocrine Neoplasia and Hormonal Disorders (M.E.C., N.L.B., R.D., P.I.), The University of Texas MD Anderson Cancer Center, Houston, TX, USA." />
<meta name="citation_author" content="Maria E. Cabanillas" />
<meta name="citation_author_institution" content="From the Department of Neuroradiology / Head and Neck Imaging (S.A.D., K.O.L., R.D., A.M.K.), Department of Head and Neck Surgery (J.R.W., X.Z., A.M., M.E.Z.), Department of Pathology (S.M.H.), and Department of Endocrine Neoplasia and Hormonal Disorders (M.E.C., N.L.B., R.D., P.I.), The University of Texas MD Anderson Cancer Center, Houston, TX, USA." />
<meta name="citation_author" content="Naifa L. Busaidy" />
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<meta name="citation_author" content="Ramona Dadu" />
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<meta name="citation_author" content="Priyanka Iyer" />
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<meta name="citation_author" content="Mark E. Zafereo" />
<meta name="citation_author_institution" content="From the Department of Neuroradiology / Head and Neck Imaging (S.A.D., K.O.L., R.D., A.M.K.), Department of Head and Neck Surgery (J.R.W., X.Z., A.M., M.E.Z.), Department of Pathology (S.M.H.), and Department of Endocrine Neoplasia and Hormonal Disorders (M.E.C., N.L.B., R.D., P.I.), The University of Texas MD Anderson Cancer Center, Houston, TX, USA." />
<meta name="citation_author" content="Alexander M. Khalaf" />
<meta name="citation_author_institution" content="From the Department of Neuroradiology / Head and Neck Imaging (S.A.D., K.O.L., R.D., A.M.K.), Department of Head and Neck Surgery (J.R.W., X.Z., A.M., M.E.Z.), Department of Pathology (S.M.H.), and Department of Endocrine Neoplasia and Hormonal Disorders (M.E.C., N.L.B., R.D., P.I.), The University of Texas MD Anderson Cancer Center, Houston, TX, USA." />
<meta name="twitter:title" content="[18F]-Fluorodeoxyglucose Uptake as a Marker of Residual Anaplastic and Poorly Differentiated Thyroid Carcinoma Following BRAF-Targeted Therapy" />
<meta name="twitter:card" content="summary" />
<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Neoadjuvant BRAF-directed therapy and immunotherapy followed by surgery improves survival in patients with BRAFV600E-mutant anaplastic thyroid carcinoma (ATC), more so in those who have complete ATC pathologic response. This study assesses the ability of FDG-PET to non-invasively detect residual high-risk pathologies including ATC and poorly differentiated thyroid carcinoma (PDTC) in the preoperative setting.

MATERIALS AND METHODS: This retrospective, single-center study included consecutive BRAFV600E-mutant ATC patients treated with at least 30 days of neoadjuvant BRAF-directed therapy and who underwent FDG-PET/CT within 30 days prior to surgery. The highest pathologic grade observed for every head and neck lesion resected was recorded. Each lesion on pre-operative PET/CT was retrospectively characterized. The primary endpoint was to contrast the standardized uptake normalized by lean body mass (SULmax) for lesions with residual high-risk (ATC, PDTC) versus low-risk pathologies (papillary thyroid carcinoma, negative). An optimal SULmax threshold was then identified using a ROC analysis, and the ability of this threshold to non-invasively and preoperatively risk-stratify patients by overall survival was then evaluated with a Kaplan-Meier plot.

RESULTS: 30 patients (mean age 66.5±9.0; 17 males) were included in this study, with 94 surgically sampled lesions. Of these lesions, 57 (60.6%) were low-risk (39 negative, 18 papillary thyroid carcinoma) and 37 (39.4%) were high-risk (29 ATC, 8 PDTC). FDG uptake was higher for high-risk compared to low-risk pathologies: median SULmax 5.01 \[IQR 2.81 – 10.95] versus 1.29 [IQR 1.06 – 3.1\] (P&lt;.001, Mann-Whitney U test). The sensitivity, specificity, and accuracy for detecting high-risk pathologies at the optimal threshold of SULmax ≥ 2.75 were 0.784 [95% CI 0.628–0.886], 0.702 [95% CI 0.573–0.805], and 0.734 [95% CI 0.637–0.813], respectively. Patients with at least 1 high-risk lesion identified with the aforementioned cut-off had a worse prognosis compared to patients without high-risk lesions in the head and neck: median OS for the former group was 259 days and was not attained for the latter (P=.038, log-rank test).

CONCLUSIONS: Preoperative FDG-PET non-invasively identifies lesions with residual high-risk pathologies following neoadjuvant BRAF-directed targeted therapy and immunotherapy for BRAF-mutated ATC. FDG-PET avidity may serve as an early prognostic marker which correlates with residual high-risk pathology in BRAF-mutated ATC following neoadjuvant therapy.

ABBREVIATIONS: ATC = anaplastic thyroid carcinoma; IQR = interquartile range; OS = overall survival; PDTC = poorly differentiated thyroid carcinoma; PTC = papillary thyroid carcinoma; ROC = receiver operating characteristic; SUL= standardized uptake value normalized by lean body mass." />
<meta name="og-title" property="og:title" content="[18F]-Fluorodeoxyglucose Uptake as a Marker of Residual Anaplastic and Poorly Differentiated Thyroid Carcinoma Following BRAF-Targeted Therapy" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2024/11/21/ajnr.A8588" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Neoadjuvant BRAF-directed therapy and immunotherapy followed by surgery improves survival in patients with BRAFV600E-mutant anaplastic thyroid carcinoma (ATC), more so in those who have complete ATC pathologic response. This study assesses the ability of FDG-PET to non-invasively detect residual high-risk pathologies including ATC and poorly differentiated thyroid carcinoma (PDTC) in the preoperative setting.

MATERIALS AND METHODS: This retrospective, single-center study included consecutive BRAFV600E-mutant ATC patients treated with at least 30 days of neoadjuvant BRAF-directed therapy and who underwent FDG-PET/CT within 30 days prior to surgery. The highest pathologic grade observed for every head and neck lesion resected was recorded. Each lesion on pre-operative PET/CT was retrospectively characterized. The primary endpoint was to contrast the standardized uptake normalized by lean body mass (SULmax) for lesions with residual high-risk (ATC, PDTC) versus low-risk pathologies (papillary thyroid carcinoma, negative). An optimal SULmax threshold was then identified using a ROC analysis, and the ability of this threshold to non-invasively and preoperatively risk-stratify patients by overall survival was then evaluated with a Kaplan-Meier plot.

RESULTS: 30 patients (mean age 66.5±9.0; 17 males) were included in this study, with 94 surgically sampled lesions. Of these lesions, 57 (60.6%) were low-risk (39 negative, 18 papillary thyroid carcinoma) and 37 (39.4%) were high-risk (29 ATC, 8 PDTC). FDG uptake was higher for high-risk compared to low-risk pathologies: median SULmax 5.01 \[IQR 2.81 – 10.95] versus 1.29 [IQR 1.06 – 3.1\] (P&lt;.001, Mann-Whitney U test). The sensitivity, specificity, and accuracy for detecting high-risk pathologies at the optimal threshold of SULmax ≥ 2.75 were 0.784 [95% CI 0.628–0.886], 0.702 [95% CI 0.573–0.805], and 0.734 [95% CI 0.637–0.813], respectively. Patients with at least 1 high-risk lesion identified with the aforementioned cut-off had a worse prognosis compared to patients without high-risk lesions in the head and neck: median OS for the former group was 259 days and was not attained for the latter (P=.038, log-rank test).

CONCLUSIONS: Preoperative FDG-PET non-invasively identifies lesions with residual high-risk pathologies following neoadjuvant BRAF-directed targeted therapy and immunotherapy for BRAF-mutated ATC. FDG-PET avidity may serve as an early prognostic marker which correlates with residual high-risk pathology in BRAF-mutated ATC following neoadjuvant therapy.

ABBREVIATIONS: ATC = anaplastic thyroid carcinoma; IQR = interquartile range; OS = overall survival; PDTC = poorly differentiated thyroid carcinoma; PTC = papillary thyroid carcinoma; ROC = receiver operating characteristic; SUL= standardized uptake value normalized by lean body mass." />
<meta name="og-type" property="og:type" content="article" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node111977--5" data-node-nid="111977" id="top-node-111977--61854506759" data-pisa="ajnr;ajnr.A8588v1" data-pisa-master="ajnr;ajnr.A8588" data-apath="/ajnr/early/2024/11/21/ajnr.A8588.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">ORIGINAL RESEARCH</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">[18F]-Fluorodeoxyglucose Uptake as a Marker of Residual Anaplastic and Poorly Differentiated Thyroid Carcinoma Following BRAF-Targeted Therapy</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Samir A. Dagher</span>, <span class="highwire-citation-author" data-delta="1">Kim O. Learned</span>, <span class="highwire-citation-author" data-delta="2">Richard Dagher</span>, <span class="highwire-citation-author" data-delta="3">Jennifer Rui Wang</span>, <span class="highwire-citation-author" data-delta="4">Xiao Zhao</span>, <span class="highwire-citation-author" data-delta="5">S. Mohsen Hosseini</span>, <span class="highwire-citation-author" data-delta="6">Anastasios Maniakas</span>, <span class="highwire-citation-author" data-delta="7">Maria E. Cabanillas</span>, <span class="highwire-citation-author" data-delta="8">Naifa L. Busaidy</span>, <span class="highwire-citation-author" data-delta="9">Ramona Dadu</span>, <span class="highwire-citation-author" data-delta="10">Priyanka Iyer</span>, <span class="highwire-citation-author" data-delta="11">Mark E. Zafereo</span> and <span class="highwire-citation-author" data-delta="12">Alexander M. Khalaf</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">November 2024,  </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">ajnr.A8588; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A8588 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-111977--61854506759" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Samir A. Dagher </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Neuroradiology / Head and Neck Imaging (S.A.D., K.O.L., R.D., A.M.K.), Department of Head and Neck Surgery (J.R.W., X.Z., A.M., M.E.Z.), Department of Pathology (S.M.H.), and Department of Endocrine Neoplasia and Hormonal Disorders (M.E.C., N.L.B., R.D., P.I.), The University of Texas MD Anderson Cancer Center, Houston, TX, USA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Samir%2BA.%2BDagher%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Dagher%20SA&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ASamir%2BA.%2BDagher%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">Kim O. Learned </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Neuroradiology / Head and Neck Imaging (S.A.D., K.O.L., R.D., A.M.K.), Department of Head and Neck Surgery (J.R.W., X.Z., A.M., M.E.Z.), Department of Pathology (S.M.H.), and Department of Endocrine Neoplasia and Hormonal Disorders (M.E.C., N.L.B., R.D., P.I.), The University of Texas MD Anderson Cancer Center, Houston, TX, USA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Kim%2BO.%2BLearned%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Learned%20KO&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AKim%2BO.%2BLearned%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">Richard Dagher </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Neuroradiology / Head and Neck Imaging (S.A.D., K.O.L., R.D., A.M.K.), Department of Head and Neck Surgery (J.R.W., X.Z., A.M., M.E.Z.), Department of Pathology (S.M.H.), and Department of Endocrine Neoplasia and Hormonal Disorders (M.E.C., N.L.B., R.D., P.I.), The University of Texas MD Anderson Cancer Center, Houston, TX, USA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Richard%2BDagher%2B" 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Disorders (M.E.C., N.L.B., R.D., P.I.), The University of Texas MD Anderson Cancer Center, Houston, TX, USA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Jennifer%2BRui%2BWang%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Wang%20JR&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AJennifer%2BRui%2BWang%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">Xiao Zhao </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Neuroradiology / Head and Neck Imaging (S.A.D., K.O.L., R.D., A.M.K.), Department of Head and Neck Surgery (J.R.W., X.Z., A.M., M.E.Z.), Department of Pathology (S.M.H.), and Department of Endocrine Neoplasia and Hormonal Disorders (M.E.C., N.L.B., R.D., P.I.), The University of Texas MD Anderson Cancer Center, Houston, TX, USA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Xiao%2BZhao%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Zhao%20X&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on 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Mohsen Hosseini </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Neuroradiology / Head and Neck Imaging (S.A.D., K.O.L., R.D., A.M.K.), Department of Head and Neck Surgery (J.R.W., X.Z., A.M., M.E.Z.), Department of Pathology (S.M.H.), and Department of Endocrine Neoplasia and Hormonal Disorders (M.E.C., N.L.B., R.D., P.I.), The University of Texas MD Anderson Cancer Center, Houston, TX, USA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.%2BMohsen%2BHosseini%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Hosseini%20SM&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AS.%2BMohsen%2BHosseini%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">Anastasios Maniakas </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Neuroradiology / Head and Neck Imaging (S.A.D., K.O.L., R.D., A.M.K.), Department of Head and Neck Surgery (J.R.W., X.Z., A.M., M.E.Z.), Department of Pathology (S.M.H.), and Department of Endocrine Neoplasia and Hormonal Disorders (M.E.C., N.L.B., R.D., P.I.), The University of Texas MD Anderson Cancer Center, Houston, TX, USA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Anastasios%2BManiakas%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Maniakas%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AAnastasios%2BManiakas%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">Maria E. Cabanillas </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Neuroradiology / Head and Neck Imaging (S.A.D., K.O.L., R.D., A.M.K.), Department of Head and Neck Surgery (J.R.W., X.Z., A.M., M.E.Z.), Department of Pathology (S.M.H.), and Department of Endocrine Neoplasia and Hormonal Disorders (M.E.C., N.L.B., R.D., P.I.), The University of Texas MD Anderson Cancer Center, Houston, TX, USA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Maria%2BE.%2BCabanillas%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Cabanillas%20ME&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AMaria%2BE.%2BCabanillas%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-8"><div class="author-tooltip-name">Naifa L. Busaidy </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Neuroradiology / Head and Neck Imaging (S.A.D., K.O.L., R.D., A.M.K.), Department of Head and Neck Surgery (J.R.W., X.Z., A.M., M.E.Z.), Department of Pathology (S.M.H.), and Department of Endocrine Neoplasia and Hormonal Disorders (M.E.C., N.L.B., R.D., P.I.), The University of Texas MD Anderson Cancer Center, Houston, TX, USA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Naifa%2BL.%2BBusaidy%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Busaidy%20NL&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ANaifa%2BL.%2BBusaidy%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-9"><div class="author-tooltip-name">Ramona Dadu </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Neuroradiology / Head and Neck Imaging (S.A.D., K.O.L., R.D., A.M.K.), Department of Head and Neck Surgery (J.R.W., X.Z., A.M., M.E.Z.), Department of Pathology (S.M.H.), and Department of Endocrine Neoplasia and Hormonal Disorders (M.E.C., N.L.B., R.D., P.I.), The University of Texas MD Anderson Cancer Center, Houston, TX, USA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Ramona%2BDadu%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Dadu%20R&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ARamona%2BDadu%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-10"><div class="author-tooltip-name">Priyanka Iyer </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Neuroradiology / Head and Neck Imaging (S.A.D., K.O.L., R.D., A.M.K.), Department of Head and Neck Surgery (J.R.W., X.Z., A.M., M.E.Z.), Department of Pathology (S.M.H.), and Department of Endocrine Neoplasia and Hormonal Disorders (M.E.C., N.L.B., R.D., P.I.), The University of Texas MD Anderson Cancer Center, Houston, TX, USA.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Priyanka%2BIyer%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Iyer%20P&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3APriyanka%2BIyer%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-11"><div class="author-tooltip-name">Mark E. 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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2 class="">ABSTRACT</h2><div id="sec-1" class="subsection"><p id="p-2"><strong>BACKGROUND AND PURPOSE:</strong> Neoadjuvant BRAF-directed therapy and immunotherapy followed by surgery improves survival in patients with BRAF<sup>V600E</sup>-mutant anaplastic thyroid carcinoma (ATC), more so in those who have complete ATC pathologic response. This study assesses the ability of FDG-PET to non-invasively detect residual high-risk pathologies including ATC and poorly differentiated thyroid carcinoma (PDTC) in the preoperative setting.</p></div><div id="sec-2" class="subsection"><p id="p-3"><strong>MATERIALS AND METHODS:</strong> This retrospective, single-center study included consecutive BRAF<sup>V600E</sup>-mutant ATC patients treated with at least 30 days of neoadjuvant BRAF-directed therapy and who underwent FDG-PET/CT within 30 days prior to surgery. The highest pathologic grade observed for every head and neck lesion resected was recorded. Each lesion on pre-operative PET/CT was retrospectively characterized. The primary endpoint was to contrast the standardized uptake normalized by lean body mass (SULmax) for lesions with residual high-risk (ATC, PDTC) versus low-risk pathologies (papillary thyroid carcinoma, negative). An optimal SULmax threshold was then identified using a ROC analysis, and the ability of this threshold to non-invasively and preoperatively risk-stratify patients by overall survival was then evaluated with a Kaplan-Meier plot.</p></div><div id="sec-3" class="subsection"><p id="p-4"><strong>RESULTS:</strong> 30 patients (mean age 66.5±9.0; 17 males) were included in this study, with 94 surgically sampled lesions. Of these lesions, 57 (60.6%) were low-risk (39 negative, 18 papillary thyroid carcinoma) and 37 (39.4%) were high-risk (29 ATC, 8 PDTC). FDG uptake was higher for high-risk compared to low-risk pathologies: median SULmax 5.01 [IQR 2.81 – 10.95] versus 1.29 [IQR 1.06 – 3.1] (P&lt;.001, Mann-Whitney U test). The sensitivity, specificity, and accuracy for detecting high-risk pathologies at the optimal threshold of SULmax ≥ 2.75 were 0.784 [95% CI 0.628–0.886], 0.702 [95% CI 0.573–0.805], and 0.734 [95% CI 0.637–0.813], respectively. Patients with at least 1 high-risk lesion identified with the aforementioned cut-off had a worse prognosis compared to patients without high-risk lesions in the head and neck: median OS for the former group was 259 days and was not attained for the latter (P=.038, log-rank test).</p></div><div id="sec-4" class="subsection"><p id="p-5"><strong>CONCLUSIONS:</strong> Preoperative FDG-PET non-invasively identifies lesions with residual high-risk pathologies following neoadjuvant BRAF-directed targeted therapy and immunotherapy for BRAF-mutated ATC. FDG-PET avidity may serve as an early prognostic marker which correlates with residual high-risk pathology in BRAF-mutated ATC following neoadjuvant therapy.</p><p id="p-6">ABBREVIATIONS: ATC = anaplastic thyroid carcinoma; IQR = interquartile range; OS = overall survival; PDTC = poorly differentiated thyroid carcinoma; PTC = papillary thyroid carcinoma; ROC = receiver operating characteristic; SUL= standardized uptake value normalized by lean body mass.</p></div></div><div class="section fn-group" id="fn-group-1"><h2>Footnotes</h2><ul><li class="fn-conflict" id="fn-1"><p id="p-1">The authors declare no conflicts of interest related to the content of this article.</p></li></ul></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2024 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div>  </div>

  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">Samir A.</span> <span class="nlm-surname">Dagher</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">Kim O.</span> <span class="nlm-surname">Learned</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">Richard</span> <span class="nlm-surname">Dagher</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">Jennifer Rui</span> <span class="nlm-surname">Wang</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">Xiao</span> <span class="nlm-surname">Zhao</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">S. Mohsen</span> <span class="nlm-surname">Hosseini</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">Anastasios</span> <span class="nlm-surname">Maniakas</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">Maria E.</span> <span class="nlm-surname">Cabanillas</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">Naifa L.</span> <span class="nlm-surname">Busaidy</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">Ramona</span> <span class="nlm-surname">Dadu</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">Priyanka</span> <span class="nlm-surname">Iyer</span></span>, <span class="highwire-citation-author" data-delta="11"><span class="nlm-given-names">Mark E.</span> <span class="nlm-surname">Zafereo</span></span>, <span class="highwire-citation-author" data-delta="12"><span class="nlm-given-names">Alexander M.</span> <span class="nlm-surname">Khalaf</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Nov 2024, </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">ajnr.A8588; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A8588 </span></div>
  
  
  
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      <div class="highwire-cite-title">[18F]-Fluorodeoxyglucose Uptake as a Marker of Residual Anaplastic and Poorly Differentiated Thyroid Carcinoma Following BRAF-Targeted Therapy</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">Samir A.</span> <span class="nlm-surname">Dagher</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">Kim O.</span> <span class="nlm-surname">Learned</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">Richard</span> <span class="nlm-surname">Dagher</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">Jennifer Rui</span> <span class="nlm-surname">Wang</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">Xiao</span> <span class="nlm-surname">Zhao</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">S. Mohsen</span> <span class="nlm-surname">Hosseini</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">Anastasios</span> <span class="nlm-surname">Maniakas</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">Maria E.</span> <span class="nlm-surname">Cabanillas</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">Naifa L.</span> <span class="nlm-surname">Busaidy</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">Ramona</span> <span class="nlm-surname">Dadu</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">Priyanka</span> <span class="nlm-surname">Iyer</span></span>, <span class="highwire-citation-author" data-delta="11"><span class="nlm-given-names">Mark E.</span> <span class="nlm-surname">Zafereo</span></span>, <span class="highwire-citation-author" data-delta="12"><span class="nlm-given-names">Alexander M.</span> <span class="nlm-surname">Khalaf</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Nov 2024, </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">ajnr.A8588; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A8588 </span></div>
  
  
  
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