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Objectives: the primary aim of this study is to determine the impact of Positron emission tomography PET-CT) in the management of differentiated thyroid cancer. These results will be compared the results from (PET-CT) with other imaging techniques. The second goal is to determine if there is a correlation between the SUV max and the value of thyroglobulin. Methods: forty-two patients with a histologically proven differentiated thyroid carcinoma. All patients included in this retrospective study had a PET-CT in St-Luc University Clinic between May 2007 and January 2014.We included 42 patients with an mean age of 53,5 years of whom64,3% were women. 33 patients (78,6 %) had a papillary carcinoma, 9 (21,4 %) a follicular variant of a papillary carcinoma, 7 patients (16,7%) had follicular carcinoma and 2 (4,8%) were suffering from a Hürtle cell carcinoma. In this study, 12 patients or28, 6% have a T4 as initial stage, while T2 and T3count for 11 patients each. Only 7 patients (16,7 %) had T1. When we analyze the PET-CT, 67,5% are positive 32,5% negative. Papillary carcinomas have a median SUV max of 5,6. ln contrast, the SUV max of follicular carcinomas is on average 10, 4. Some PET-CT was followed by histological examination 60% of PET-CT matched with the presence of a recurrent or metastatic lesion. In 37,8 % of cases, the scintigraphy with radioiodine is negative while the PET-CT is abnormal. An increased (unstimulated) thyroglobulin was found in 54,5 % of the patients with a positive PET-CT.Conversely, the unstimulated Tg remained normal in 20,7% of the patients with an abnormal PET-CT. In this a work, a correlation between the thyroglobulin level and he SUV max found.This correlation was more pronounced for the unstimulated thyroglobulin than with the Thyrogen-stimulated thyroglobulin. Among the positive PET-CT, a therapeutic decision was taken, of which in 16 cases a surgical treatment. Conversely, in 92% of the patients with a normal PET-CT, no therapeutic change was proposed. Conclusion : PET-CT has a important role for the detection of an aggressive recurring and/or metastatic thyroid carcinoma. It is indicated when the scintigraphy with radioiodine is negative and the thryoflobulin detectable. The high SUV max is a sign of dedifferentiated of DTC. PET-CT is important not only for the therapeutic decision but also a prognostic value. This study suggests that the PET-CT allow to adapt the treatment of DTC. Le premier but de ce travail est de déterminer l'impact de la tomographie par émission à combiner au scanner (PET-CT) dans la prise en charge du cancer différencié de la thyroïde.Mais aussi de comparer les résultats obtenus au PET-scan avec les autres techniques d'imagerie. Le second objectif sera de déterminer s'il y a une corrélation entre la SUV max et le taux de thyroglobuline.Matériel et méthodes: Quarante-deux patients présentant un carcinome différencié de la thyroïde prouvé histologiquement. Tous ces patients inclus dans cette étude rétrospective ont eu un PET-CT aux Cliniques Universitaires Saint-Luc entre mai 2007 etjanvier 2014.Résultats : Nous avons inclus 42 patients d'un âge moyen de 53,5 ans et dont 64,3% sont des femmes. 33 patient s (78,6%) présentent un carcinome papillaire, dont 9 (soit 21,4%) sont à variant folliculaire, 7 patients (16,7%) ont des carcinomes folliculaires et 2 (4,8%) étaient atteints d'un carcinome oncocytaire. Dans cette étude, les 12 patients soit 28,6% ont comme stade initial un T4, alors que le T2 et T3 comptabilisent chacun 11 patients. Seuls 7 patients soit 16,7% présentent un Tl. Lorsqu’on analyse les images PET-CT, 67,5% sont positifs et 32,5% sont négatifs. Les carcinomes papillaires ont une SUV max moyenne de 5,6. En comparaison, la SUV max moyenne des folliculaires est de 10,4. Certains PET-scan étaient suivis d'un examen histologique. 60% des PET scan concordaient avec la présence d'une lésion néoplasique à distance. Dans 37,8% des cas, la scintigraphie à l'iode radioactif est négative alors que le PET-CT est pathologique. Une Tg augmentée est détectée avec un PET-CT positif chez 54,5%. Lorsque le PET-CT est positif, on note toutefois que la thyroglobuline non stimulée peut être non détectable chez 20,7%. Dans cette étude, il existe une corrélation entre le taux de thyroglobuline et la SUV max. Mais cela est plus marqué pour la thyroglobuline non stimulée que pour celle stimulée par Thyrogen. Parmi les PET­ CT positifs, 37 cas soit 68,% ont bénéfic ié d'un traitement et dont 16 étaient pour un traitement chirurgical. A contrario, 92% PET-scan normaux n'entraînent aucun changement dans la thérapeutique du CDT.Conclusion :Le PET-CT a un rôle important dans la détection d'un CDT agressif récidivant et/ou métastatique. Il est donc indiqué quand la scintigraphie à l'iode radioactif est négative et la thyroglobuline détectable . La SUV max élevé est un signe de dédifférenciation du CDT. Le PET­ scan a donc une importance tant sur le plan thérapeutique que sur le pronostic du CDT. L'étude suggère que le PET-CT permet d'adapter la prise en charge des CDT.

Thyroid Neoplasms --- Positron-Emission Tomography --- Tomography, X-Ray Computed

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This volume provides a comprehensive overview of quality metrics and methods used to improve quality for all major modalities of CRC screening. It introduces the readers to the evidence of effectiveness behind various CRC screening modalities: stool-based tests (Fecal Occult Blood, Fecal Immunochemical and Fecal DNA tests), flexible sigmoidoscopy, colonoscopy and CT colonography.  In-depth chapters review the latest guidelines for CRC screening, compare differences among the five major national guidelines, and highlight the need for valid quality and cost indicators. While the main focus of this volume is on colonoscopy, since most quality indicators and analyses have focused on this modality of screening and surveillance, one chapter is devoted to quality indicators of other screening modalities. Differences between process and outcome measures are also highlighted and a small but valid set of recommended national measures are listed.  Written by experts in the field, Colorectal Cancer Screening: Quality and Benchmarks is an important and useful resource written for gastroenterologists, primary care physicians, general and colorectal surgeons, family physicians, and investigators with research focus in screening and quality metrics.

Medicine & Public Health. --- Gastroenterology. --- Primary Care Medicine. --- Surgery. --- General Practice / Family Medicine. --- Medicine. --- Family medicine. --- Emergency medicine. --- Médecine --- Médecine familiale --- Gastroentérologie --- Médecine d'urgence --- Chirurgie --- Colonography, Computed Tomographic -- methods. --- Colorectal Neoplasms -- diagnosis. --- Colorectal Neoplasms. --- Mass Screening. --- Medicine --- Family medicine --- Gastroenterology --- Emergency medicine --- Surgery --- Tomography, X-Ray Computed --- Intestinal Neoplasms --- Analytical, Diagnostic and Therapeutic Techniques and Equipment --- Endoscopy, Gastrointestinal --- Investigative Techniques --- Endoscopy, Digestive System --- Image Interpretation, Computer-Assisted --- Gastrointestinal Neoplasms --- Diagnostic Techniques, Digestive System --- Digestive System Neoplasms --- Diagnostic Imaging --- Diagnostic Techniques and Procedures --- Neoplasms by Site --- Neoplasms --- Diseases --- Methods --- Colorectal Neoplasms --- Diagnosis --- Colonoscopy --- Colonography, Computed Tomographic --- Health & Biological Sciences --- Colon (Anatomy) --- Rectum --- Cancer --- Diagnosis. --- General practice (Medicine). --- Primary care (Medicine). --- Family practice (Medicine) --- General practice (Medicine) --- Physicians (General practice) --- Surgery, Primitive --- Medicine, Emergency --- Critical care medicine --- Disaster medicine --- Medical emergencies --- Internal medicine --- Digestive organs --- Gastroenterology . --- Primary medical care --- Medical care