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Original Paper, Endocrine I-131 Avid Versus FDG avid Loco-Regional Recurrent Differentiated Thyroid Carcinoma;Clinic-Pathological, Diagnostic & Therapy Outcome Differences Talaat, O. Fathy H. Hussein M. Bahaa S. Nuclear Medicine department, National Cancer Institute. Radiology departments, Faculty of Medicine .Surgical Oncology departments, National Cancer Institute, Cairo University. Egypt. ABSTRACT: Purpose: Toassess the clinic-pathological, diagnostic & therapy outcome differences between I-131 avid and FDG avid loco-regional recurrence in differentiated thyroid carcinoma (DTC) patients.Materials and methods: 125 patients with pathologically proved loco-regional recurrent DTC afterinitial remission with complete radio-surgical thyroid ablation were included. Clinico-pathological data, serum thyroglobulin levels, diagnostic radiology, I-131 &FDG PET/CT scanning, therapeutic approaches and follow up data were collected.Results:125patients with loco-regional recurrence were divided into: (I) I-131 avid group:60 patients with 112 confirmed recurrent malignant lesions (8 thyroid bed, 104 nodal). (II) FDG avid group: 65 patients with 206 confirmed recurrent malignant lesions (14 thyroid bed, 192 nodal). Out of clinicpathological data, significantly higher pathological grading was demonstrated in FDG avid group (49 patients) compared to I-131 avid group (18 patients) P<0.05. In I-131 avid group. Thesensitivity, specificity and accuracy for locoregional recurrence using I-131WBS were 77% ,100%&81% and 87.5%,30% and 77% using ultrasound (US) respectively . In FDG avid group the sensitivity, specificity and accuracy for FDGPET/CT were95.1%, 76.1% and 91.5%, for neck US were78%, 37.5% and 72.2% and for CT were 83%, 47%and 79% respectively. The added value of post-operative RAI-131 therapy results in better outcome in I-131 avid group.Conclusions:FDG avid loco-regional recurrence seemed to be linked to higher pathological grading with less favorable prognosis compared to I-131 avid loco-regional recurrence. Specificity rather than sensitivity indices tend to be significantly higher with functional compared to anatomical based techniques in both groups.