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Research ArticleHEAD AND NECK IMAGING

[18F]-FDG Uptake as a Marker of Residual Anaplastic and Poorly Differentiated Thyroid Carcinoma following BRAF-Targeted Therapy

Samir A. Dagher, Kim O. Learned, Richard Dagher, Jennifer Rui Wang, Xiao Zhao, S. Mohsen Hosseini, Anastasios Maniakas, Maria E. Cabanillas, Naifa L. Busaidy, Ramona Dadu, Priyanka Iyer, Mark E. Zafereo and Alexander M. Khalaf
American Journal of Neuroradiology May 2025, DOI: https://doi.org/10.3174/ajnr.A8588
Samir A. Dagher
aFrom the Department of Neuroradiology/Head and Neck Imaging (S.A.M., K.O.L., R.D., A.M.K), The University of Texas MD Anderson Cancer Center, Houston, Texas
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Kim O. Learned
aFrom the Department of Neuroradiology/Head and Neck Imaging (S.A.M., K.O.L., R.D., A.M.K), The University of Texas MD Anderson Cancer Center, Houston, Texas
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Richard Dagher
aFrom the Department of Neuroradiology/Head and Neck Imaging (S.A.M., K.O.L., R.D., A.M.K), The University of Texas MD Anderson Cancer Center, Houston, Texas
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Jennifer Rui Wang
bDepartment of Head and Neck Surgery (J.R.W., X.Z., A.M., M.E.Z.), The University of Texas MD Anderson Cancer Center, Houston, Texas
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Xiao Zhao
bDepartment of Head and Neck Surgery (J.R.W., X.Z., A.M., M.E.Z.), The University of Texas MD Anderson Cancer Center, Houston, Texas
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S. Mohsen Hosseini
cDepartment of Pathology (S.M.H.), The University of Texas MD Anderson Cancer Center, Houston, Texas
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Anastasios Maniakas
bDepartment of Head and Neck Surgery (J.R.W., X.Z., A.M., M.E.Z.), The University of Texas MD Anderson Cancer Center, Houston, Texas
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Maria E. Cabanillas
dDepartment 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, Texas
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Naifa L. Busaidy
dDepartment 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, Texas
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Ramona Dadu
dDepartment 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, Texas
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Priyanka Iyer
dDepartment 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, Texas
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Mark E. Zafereo
bDepartment of Head and Neck Surgery (J.R.W., X.Z., A.M., M.E.Z.), The University of Texas MD Anderson Cancer Center, Houston, Texas
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Alexander M. Khalaf
aFrom the Department of Neuroradiology/Head and Neck Imaging (S.A.M., K.O.L., R.D., A.M.K), The University of Texas MD Anderson Cancer Center, Houston, Texas
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Abstract

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 noninvasively 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 patients with ATC treated with at least 30 days of neoadjuvant BRAF-directed therapy and who underwent FDG-PET/CT within 30 days before surgery. The highest pathologic grade observed for every head and neck lesion resected was recorded. Each lesion on preoperative PET/CT was retrospectively characterized. The primary end point 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 by using a receiver operating characteristic analysis, and the ability of this threshold to noninvasively and preoperatively risk-stratify patients by overall survival was then evaluated with a Kaplan-Meier plot.

RESULTS: Thirty patients (mean age 66.5 ± 9.0; 17 men) 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 with low-risk pathologies: median SULmax 5.01 (interquartile range [IQR] 2.81–10.95) versus 1.29 (IQR 1.06–3.1) (P < .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 cutoff had a worse prognosis compared with patients without high-risk lesions in the head and neck: median overall survival for the former group was 259 days and was not attained for the latter (P = .038, log-rank test).

CONCLUSIONS: Preoperative FDG-PET noninvasively 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 that correlates with residual high-risk pathology in BRAF-mutated ATC after 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

Footnotes

  • Disclosure forms provided by the authors are available with the full text and PDF of this article at www.ajnr.org.

  • Indicates article with online supplemental data.

  • © 2025 by American Journal of Neuroradiology
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Cite this article
Samir A. Dagher, Kim O. Learned, Richard Dagher, Jennifer Rui Wang, Xiao Zhao, S. Mohsen Hosseini, Anastasios Maniakas, Maria E. Cabanillas, Naifa L. Busaidy, Ramona Dadu, Priyanka Iyer, Mark E. Zafereo, Alexander M. Khalaf
[18F]-FDG Uptake as a Marker of Residual Anaplastic and Poorly Differentiated Thyroid Carcinoma following BRAF-Targeted Therapy
American Journal of Neuroradiology May 2025, DOI: 10.3174/ajnr.A8588

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FDG Uptake and Thyroid Cancer Post-BRAF Therapy
Samir A. Dagher, Kim O. Learned, Richard Dagher, Jennifer Rui Wang, Xiao Zhao, S. Mohsen Hosseini, Anastasios Maniakas, Maria E. Cabanillas, Naifa L. Busaidy, Ramona Dadu, Priyanka Iyer, Mark E. Zafereo, Alexander M. Khalaf
American Journal of Neuroradiology May 2025, DOI: 10.3174/ajnr.A8588
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