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D Deandreis Department of Nuclear Medicine and Endocrine Oncology, Department of Pathology and Clinical Biology, Unit 605, National Institute of Health and Medical Research, Institut Gustave Roussy and University Paris Sud, 39 Rue Camille Desmoulins, 94805 Villejuif, France

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A Al Ghuzlan Department of Nuclear Medicine and Endocrine Oncology, Department of Pathology and Clinical Biology, Unit 605, National Institute of Health and Medical Research, Institut Gustave Roussy and University Paris Sud, 39 Rue Camille Desmoulins, 94805 Villejuif, France

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S Leboulleux Department of Nuclear Medicine and Endocrine Oncology, Department of Pathology and Clinical Biology, Unit 605, National Institute of Health and Medical Research, Institut Gustave Roussy and University Paris Sud, 39 Rue Camille Desmoulins, 94805 Villejuif, France

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L Lacroix Department of Nuclear Medicine and Endocrine Oncology, Department of Pathology and Clinical Biology, Unit 605, National Institute of Health and Medical Research, Institut Gustave Roussy and University Paris Sud, 39 Rue Camille Desmoulins, 94805 Villejuif, France

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J P Garsi Department of Nuclear Medicine and Endocrine Oncology, Department of Pathology and Clinical Biology, Unit 605, National Institute of Health and Medical Research, Institut Gustave Roussy and University Paris Sud, 39 Rue Camille Desmoulins, 94805 Villejuif, France

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M Talbot Department of Nuclear Medicine and Endocrine Oncology, Department of Pathology and Clinical Biology, Unit 605, National Institute of Health and Medical Research, Institut Gustave Roussy and University Paris Sud, 39 Rue Camille Desmoulins, 94805 Villejuif, France

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J Lumbroso Department of Nuclear Medicine and Endocrine Oncology, Department of Pathology and Clinical Biology, Unit 605, National Institute of Health and Medical Research, Institut Gustave Roussy and University Paris Sud, 39 Rue Camille Desmoulins, 94805 Villejuif, France

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E Baudin Department of Nuclear Medicine and Endocrine Oncology, Department of Pathology and Clinical Biology, Unit 605, National Institute of Health and Medical Research, Institut Gustave Roussy and University Paris Sud, 39 Rue Camille Desmoulins, 94805 Villejuif, France

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B Caillou Department of Nuclear Medicine and Endocrine Oncology, Department of Pathology and Clinical Biology, Unit 605, National Institute of Health and Medical Research, Institut Gustave Roussy and University Paris Sud, 39 Rue Camille Desmoulins, 94805 Villejuif, France

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J M Bidart Department of Nuclear Medicine and Endocrine Oncology, Department of Pathology and Clinical Biology, Unit 605, National Institute of Health and Medical Research, Institut Gustave Roussy and University Paris Sud, 39 Rue Camille Desmoulins, 94805 Villejuif, France

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M Schlumberger Department of Nuclear Medicine and Endocrine Oncology, Department of Pathology and Clinical Biology, Unit 605, National Institute of Health and Medical Research, Institut Gustave Roussy and University Paris Sud, 39 Rue Camille Desmoulins, 94805 Villejuif, France

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The aim of this study is to search for relationships between histology, radioiodine (131I) uptake, fluorodeoxyglucose (FDG) uptake, and disease outcome in patients with metastatic thyroid cancer. Eighty patients with metastatic thyroid cancer (34 males, 46 females, mean age at the time of the diagnosis of metastases: 55 years) were retrospectively studied. All patients were treated with radioactive iodine and evaluated by FDG-positron emission tomography (PET). Primary tumor tissue sample was available in all cases. Forty-five patients (56%) had a papillary, 12 (15%) a follicular, and 23 (29%) a poorly differentiated thyroid cancer. Cellular atypias, necrosis, mitoses, thyroid capsule infiltration, and vascular invasion were frequently detected (70, 44, 52, 60, and 71% respectively). Metastases disclosed FDG uptake in 58 patients (72%) and 131I uptake in 37 patients (45%). FDG uptake was the only significant prognostic factor for survival (P=0.02). The maximum standardized uptake value and the number of FDG avid lesions were also related to prognosis (P=0.03 and 0.009). Age at the time of the diagnosis of metastases (P=0.001) and the presence of necrosis (P=0.002) were independent predictive factors of FDG uptake. Radioiodine uptake was prognostic for stable disease (P=0.001) and necrosis for progressive disease at 1 year (P=0.001). Histological subtype was not correlated with in vivo tumor metabolism and prognosis. In conclusion, FDG uptake in metastatic thyroid cancer is highly prognostic for survival. Histological subtype alone does not correlate with 131I/FDG uptake pattern and patient outcome. Well-differentiated thyroid cancer presenting histological features such as necrosis and FDG uptake on PET scan should be considered aggressive differentiated cancers.

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