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Szujo S, Sira L, Bajnok L, Bodis B, Gyory F, Nemes O, Rucz K, Kenyeres P, Valkusz Z, Sepp K, Schmidt E, Szabo Z, Szekeres S, Zambo K, Barna S, Nagy EV, Mezosi E. The impact of post-radioiodine therapy SPECT/CT on early risk stratification in differentiated thyroid cancer; a bi-institutional study. Oncotarget 2017; 8:79825-79834. [PMID: 29108364 PMCID: PMC5668097 DOI: 10.18632/oncotarget.19781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 07/18/2017] [Indexed: 11/25/2022] Open
Abstract
Objective SPECT/CT has numerous advantages over planar and traditional SPECT images. The aim of this study was to evaluate the role of post-radioiodine therapy SPECT/CT of patients with differentiated thyroid cancer (DTC) in early risk classification and in prediction of late prognosis. Patients and methods 323 consecutive patients were investigated after their first radioiodine treatment (1100–3700 MBq). Both whole body scan and SPECT/CT images of the head, neck, chest and abdomen regions were taken 4–6 days after radioiodine therapy. Patients were re-evaluated 9–12 months later as well as at the end of follow up (median 37 months). Results Post-radioiodine therapy SPECT/CT showed metastases in 22% of patients. Lymph node, lung and bone metastases were detected in 61, 13 and 5 patients, respectively, resulting in early reclassification of 115 cases (36%). No evidence of disease was found in 251 cases at 9–12 months after radioiodine treatment and 269 patients at the end of follow-up. To predict residual disease at the end of follow-up, the sensitivities, specificities and diagnostic accuracies of the current risk classification systems and SPECT/CT were: ATA: 77%, 47% and 53%; ETA: 70%, 62% and 64%; SPECT/CT: 61%, 88% and 83%, respectively. There was no difference between cohorts of the two institutions when data were analyzed separately. Conclusions Based on our bi-institutional experience, the accuracy of post-radioiodine SPECT/CT outweighs that of the currently used ATA and ETA risk classification systems in the prediction of long-term outcome of DTC.
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Affiliation(s)
- Szabina Szujo
- Ist Department of Medicine, University of Pecs, H-7624 Pecs, Hungary
| | - Livia Sira
- Department of Medicine, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Hungary
| | - Laszlo Bajnok
- Ist Department of Medicine, University of Pecs, H-7624 Pecs, Hungary
| | - Beata Bodis
- Ist Department of Medicine, University of Pecs, H-7624 Pecs, Hungary
| | - Ferenc Gyory
- Department of Surgery, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary
| | - Orsolya Nemes
- Ist Department of Medicine, University of Pecs, H-7624 Pecs, Hungary
| | - Karoly Rucz
- Ist Department of Medicine, University of Pecs, H-7624 Pecs, Hungary
| | - Peter Kenyeres
- Ist Department of Medicine, University of Pecs, H-7624 Pecs, Hungary
| | - Zsuzsanna Valkusz
- Ist Department of Medicine, University of Szeged, H-6720 Szeged, Hungary
| | - Krisztian Sepp
- Ist Department of Medicine, University of Szeged, H-6720 Szeged, Hungary
| | - Erzsebet Schmidt
- Department of Nuclear Medicine, University of Pecs, H-7624 Pecs, Hungary
| | - Zsuszanna Szabo
- Department of Nuclear Medicine, University of Pecs, H-7624 Pecs, Hungary
| | - Sarolta Szekeres
- Department of Nuclear Medicine, University of Pecs, H-7624 Pecs, Hungary
| | - Katalin Zambo
- Department of Nuclear Medicine, University of Pecs, H-7624 Pecs, Hungary
| | - Sandor Barna
- Department of Nuclear Medicine, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Hungary
| | - Endre V Nagy
- Department of Medicine, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Hungary
| | - Emese Mezosi
- Ist Department of Medicine, University of Pecs, H-7624 Pecs, Hungary
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Interrupted 131I Procedures for Patients With Differentiated Thyroid Cancer: Comparing Thyroxine Withdrawal With Recombinant Thyrotropin Preparation Techniques. Clin Nucl Med 2017; 42:247-249. [PMID: 28166158 DOI: 10.1097/rlu.0000000000001553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In patients with differentiated thyroid carcinoma scheduled to receive doses of I for diagnostic or therapeutic purposes, we compared patients prepared with thyroid hormone withdrawal (THW) versus recombinant human thyroid stimulating hormone (rh-TSH) to evaluate the incidence of cancelled procedures because of inadequate thyroid stimulation. METHODS Thyroid cancer patients after thyroidectomy who were scheduled for diagnostic or therapeutic I procedures between January 2012 and June 2015 were retrospectively reviewed. Patients were divided based on preparation modality (THW vs rh-TSH), and the incidence of cancelled procedures was compared. RESULTS Charts from 761 patients were reviewed, 292 THW and 569 rh-TSH. A total of 10 patients (3.4%) in the THW group had cancelled procedures because of insufficient thyroid stimulation (TSH < 20 mU/L). If a TSH threshold of 30 mU/L were used, 57 patients (17.1%) would have been cancelled. Comparing the groups with chi-squared analysis for both TSH thresholds yielded significantly more cancellations in the THW group (P < 0.001). CONCLUSIONS Our study has shown that THW in preparation for I procedures leads to significantly more cancellations because of insufficient thyroid stimulation as compared with rh-TSH, which led to no cancellations. The added cost and inconvenience to this cancer population should therefore be considered when selecting a preparation modality. LEVEL OF EVIDENCE Retrospective cohort-Level III.
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Isoda T, BaBa S, Maruoka Y, Kitamura Y, Tahara K, Sasaki M, Honda H. Impact of patient age on the iodine/FDG "flip-flop" phenomenon in lung metastasis from thyroid cancer. Ann Nucl Med 2016; 30:518-24. [PMID: 27380042 DOI: 10.1007/s12149-016-1104-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 05/22/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Radioiodine therapy is an effective treatment for lung metastasis from thyroid cancer. However, cases of lung metastasis without iodine uptake are often encountered. In such cases, FDG accumulation in lung lesions is often observed. There is a reverse relationship between iodine and FDG accumulation in thyroid cancer lesions, the so-called "flip-flop" phenomenon. The aim of this study was to assess the relationship between patient age and the occurrence of the flip-flop phenomenon. METHODS Eighty-six patients who underwent radioiodine therapy for lung metastasis were studied retrospectively (age 17-73 years; median 60 years; males:females 22:64). We compared the clinical data and imaging findings (size and FDG uptake of lung nodules) between patients with (n = 44) and without (n = 42) iodine uptake in lung metastasis. RESULTS Significantly more young patients showed iodine accumulation in lung metastasis than old patients (p = 0.0025). Lung metastases with larger size or greater FDG uptake showed no iodine uptake more frequently with significant difference (p = 0.015 and <0.001, respectively). Among patients with FDG uptake in the lung metastasis, 57.1 % of young patients (<60 years) and 24.3 % of the old patients (≥60 years) showed iodine uptake (p = 0.0029). CONCLUSIONS Higher patient age and lung nodules with large size or FDG accumulation are negative factors for iodine accumulation in lung metastases from thyroid cancer. In addition, our results show that young patients have a greater likelihood of iodine uptake even when FDG accumulates in lung metastasis, in contrast to old patients.
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Affiliation(s)
- Takuro Isoda
- Department of Clinical Radiology, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashi-Ku Fukuoka, Fukuoka, 812-8582, Japan.
| | - Shingo BaBa
- Department of Clinical Radiology, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashi-Ku Fukuoka, Fukuoka, 812-8582, Japan
| | - Yasuhiro Maruoka
- Department of Clinical Radiology, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashi-Ku Fukuoka, Fukuoka, 812-8582, Japan
| | - Yoshiyuki Kitamura
- Department of Clinical Radiology, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashi-Ku Fukuoka, Fukuoka, 812-8582, Japan
| | - Keiichiro Tahara
- Department of Clinical Radiology, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashi-Ku Fukuoka, Fukuoka, 812-8582, Japan
| | - Masayuki Sasaki
- Department of Health Sciences, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashi-Ku Fukuoka, Fukuoka, 812-8582, Japan
| | - Hiroshi Honda
- Department of Clinical Radiology, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashi-Ku Fukuoka, Fukuoka, 812-8582, Japan
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