1
|
Ran B, Shang J, Chen Y, Zhou M, Li H, He W, Li Y, Cai Q, Guo B, Gong J, Xu H. The value of the first postoperative diagnostic I-131 scan in patients with papillary thyroid carcinoma. J Cancer Res Clin Oncol 2024; 150:80. [PMID: 38319395 PMCID: PMC10847066 DOI: 10.1007/s00432-023-05581-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/25/2023] [Indexed: 02/07/2024]
Abstract
OBJECTIVE To explore the feasibility of the postoperative diagnostic 131I whole-body planar scans (Dx-WBS) in papillary thyroid cancer (PTC) patients, and to clarify its value for accurate staging, risk stratification, and postoperative radioactive iodine (RAI) treatment management. DESIGN Retrospective study from 2015 to 2021. SETTING A total of 1294 PTC patients in the tertiary referral hospital. PARTICIPANTS Patients with differentiated thyroid cancer who underwent total/subtotal thyroidectomy were included. Patients with non-PTC pathological type, non-first RAI treatment, and incomplete data such as Dx-WBS and postablation WBS (Rx-WBS) were excluded. METHODS The diagnostic efficacy of Dx-WBS was calculated with Rx-WBS as the reference. All patients were initially staged by the 8th edition of TNM staging, and risk stratification was performed based on clinical and pathological information. After Dx-WBS, the risk stratification was re-evaluated, and management was reconfirmed. RESULTS The detection rates of Dx-WBS for residual thyroid, cervical lymph nodes, upper mediastinal lymph nodes, lung, and bone distant metastasis were 97.6%, 78.3%, 82.1%, 66.7%, and 61.2%, respectively. The risk stratification of 113 patients (8.7%) changed after Dx-WBS, of which 107 patients changed from low to intermediate risk, 2 from low to high risk, and 4 from medium to high risk. A total of 241 patients (18.6%) adjusted the RAI regimen after Dx-WBS. CONCLUSION This study confirms the diagnostic efficacy of the postoperative Dx-WBS in PTC patients and the value of Dx-WBS in accurately assessing risk stratification, as well as assisting in determining RAI treatment.
Collapse
Affiliation(s)
- Bingyu Ran
- Department of Nuclear Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Jingjie Shang
- Department of Nuclear Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Yong Chen
- Department of Nuclear Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Miaoli Zhou
- Department of Nuclear Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Huihu Li
- Department of Nuclear Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Wenjun He
- Department of Nuclear Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Yingxin Li
- Department of Nuclear Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Qijun Cai
- Department of Nuclear Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Bin Guo
- Department of Nuclear Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Jian Gong
- Department of Nuclear Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China.
| | - Hao Xu
- Department of Nuclear Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China.
| |
Collapse
|
2
|
Okudan B, Seven B, Gülaldı NCM, Çapraz M, Açıkgöz Y. The Value of 99mTc-MIBI SPECT/CT in the Postoperative Assessment of Patients with Differentiated Thyroid Carcinoma. Curr Med Imaging 2021; 18:404-408. [PMID: 34749623 DOI: 10.2174/1573405617666211108154028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/24/2021] [Accepted: 09/13/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The therapeutic approaches of differentiated thyroid carcinoma (DTC) are surgery, ablation therapy with the postoperative use of radioiodine-131 (131I), and thyroid-stimulating hormone (TSH) suppression therapy. After the surgical therapy, the patient should be assessed for remnants/metastases. OBJECTIVE The purpose of this research was to investigate the role of technetium-99m-methoxyisobutylisonitrile (99mTc-MIBI) single photon emission computed tomography/computed tomography (SPECT/CT) in the postoperative management of patients with DTC. METHODS The study comprised 22 DTC patients (13 women, 9 men; mean age 46.55 ± 13.27 y) who underwent a total thyroidectomy previously. All patients were investigated for thyroid remnants/metastases by 99mTc-MIBI SPECT/CT, posttherapy 131I whole-body scan (WBS) and ultrasound (US). Serum TSH, thyroglobulin and anti-Tg antibody levels were measured. Results of imaging modalities and laboratory measurements were compared with each other. RESULTS 99mTc-MIBI SPECT/CT, 131I WBS and US respectively demonstrated thyroid remnants in 15 (68.18%), 22 (100%) and 14 (63.63%) of the all patients and metastatic lymph nodes in 8 (100%), 6 (75%) and 6 (75%) of the 8 patients with lymph node metastases. 99mTc-MIBI SPECT/CT also demonstrated lung metastases in 2 patients (9.09% of all patients). The same result was obtained with 131I WBS. CONCLUSION The findings of this study show that 99mTc-MIBI SPECT/CT can be effective for detecting metastases in patients with DTC who underwent surgery prior to 131I therapy.
Collapse
Affiliation(s)
- Berna Okudan
- Department of Nuclear Medicine, Ankara City Hospital, University of Health Sciences, Ankara. Turkey
| | - Bedri Seven
- Department of Nuclear Medicine, Sabuncuoğlu Şerefeddin Training and Research Hospital, Amasya. Turkey
| | - Nedim C M Gülaldı
- Department of Nuclear Medicine, Ankara City Hospital, Ankara. Turkey
| | - Mustafa Çapraz
- Department of Internal Medicine, School of Medicine, University of Amasya, Amasya. Turkey
| | - Yusuf Açıkgöz
- Division of Medical Oncology, Department of Internal Medicine, Ankara City Hospital, Ankara. Turkey
| |
Collapse
|
3
|
Arjani S, Quinn PL, Chokshi RJ. Preablation Diagnostic Whole-Body Scan vs Empiric Radioactive Iodine Ablation in Differentiated Thyroid Cancer: Cost-effectiveness Analysis. Otolaryngol Head Neck Surg 2020; 164:1172-1178. [PMID: 33076776 DOI: 10.1177/0194599820966982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To perform a comparative analysis of postthyroidectomy radioactive iodine ablation dosing with or without the implementation of a diagnostic whole-body scan in patients with well-differentiated thyroid cancer. STUDY DESIGN Decision analysis model. SETTING Hospital or ambulatory center. METHODS A decision tree model was created to determine the cost-effectiveness of radioactive iodine ablation dosed with diagnostic whole-body scans versus empiric radioactive iodine ablation in patients with differentiated thyroid cancer undergoing postthyroidectomy ablation. The decision tree was populated with values from the published literature. Costs were represented by 2020 Medicare reimbursement rates (US dollars), and morbidity and survival data were used to calculate quality-adjusted life-years. The incremental cost-effectiveness ratio was the primary outcome. RESULTS Empiric radioactive iodine dosing was the dominant economic strategy, producing 0.94 more quality-adjusted life-years while costing $1250.07 less than management with a diagnostic whole-body scan. Sensitivity analyses upheld these results except in cases involving a large discrepancy in successful ablation rates between the diagnostic and empiric treatment arms. CONCLUSION For patients with differentiated thyroid cancer requiring postthyroidectomy ablation, it is more cost-effective to administer radioactive iodine empirically.
Collapse
Affiliation(s)
- Simran Arjani
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Patrick L Quinn
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Ravi J Chokshi
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| |
Collapse
|
4
|
Usefulness of iodine-123 whole-body scan in planning iodine-131 treatment of the differentiated thyroid carcinoma in children and adolescence. Nucl Med Commun 2018; 39:1121-1128. [DOI: 10.1097/mnm.0000000000000922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
5
|
Esposito G. Initial radioiodine administration: when to use it and how to select the dose. Endocrinol Metab Clin North Am 2014; 43:385-400. [PMID: 24891168 DOI: 10.1016/j.ecl.2014.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
All published guidelines on the use of radioactive iodine for the treatment of well-differentiated thyroid cancer agree that an individualized assessment of the risk of cancer-related mortality and of disease recurrence should direct the decision of whether radioiodine treatment is needed and how much to administer. At the author's institution, they mostly follow the American Thyroid Association's risk stratification system, with the addition of a category of very-low-risk patients that do not receive radioactive iodine.
Collapse
Affiliation(s)
- Giuseppe Esposito
- Department of Radiology, Medstar Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC 20007, USA.
| |
Collapse
|
6
|
Chen MK, Yasrebi M, Samii J, Staib LH, Doddamane I, Cheng DW. The utility of I-123 pretherapy scan in I-131 radioiodine therapy for thyroid cancer. Thyroid 2012; 22:304-9. [PMID: 22300251 DOI: 10.1089/thy.2011.0203] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There is a growing belief that a pretherapy scan yields little or no additional information that would impact on radioiodine ablation dosing. In addition, there is some concern regarding on the stunning effect of a pretherapy scan, especially when I-131 radioisotope is used for imaging. We hypothesized that a pretherapy scan provides invaluable information on the amount of thyroid remnant, sometimes indicating the need for two-step I-131 ablation. It may also detect unsuspected local lymph node involvement or distant metastases, indicating the requirement for a higher I-131 dose after thyroidectomy. The aim of this study was to evaluate how effective pretherapy scans are for guiding I-131 therapy planning and augmenting information provided in the pathology reports for thyroidectomy specimens. METHODS We reviewed 122 patients who underwent I-123 pretherapy scan and I-131 radioablation at Yale New Haven Hospital between January 2006 and August 2007. The percentage of neck uptake and whole-body images were acquired 24 hours following the administration of 51.8 MBq (1.4 mCi) of I-123 NaI. A 24-hour uptake of >3% was used as the cutoff to determine whether there was a greater than desired quantity of thyroid remnant, which would require a two-step treatment protocol. Furthermore, attention was paid to identifying cervical lymph nodes, which may not have presented themselves in the euthyroid state at the time of thyroidectomy. Additional clinical information provided by pretherapy scans was computed as percentages with 95% confidence intervals by using adjusted Wald intervals. RESULTS Overall, the pretherapy scans provided additional critical information in 25% of the cases (31/122; 95% CI: 18%-34%). For cases demonstrating >3% uptake with midline lymph nodes, the pretherapy scan provided additional information in 50% of the cases (8/16; 95% CI: 28%-72%). CONCLUSIONS Our study demonstrated that I-123 pretherapy scans provide valuable information with regard to unsuspected lymph nodes or distant metastases, indicating the requirement for a significantly higher I-131 dose, and unexpected large thyroid remnants, suggesting the need for two-step ablation. We should take advantage of stimulated pretherapy scans and adjust the treatment dosing accordingly.
Collapse
Affiliation(s)
- Ming-Kai Chen
- Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut 06520, USA
| | | | | | | | | | | |
Collapse
|
7
|
Thyroid Remnant Estimation by Tc-99m-Sestamibi Scanning Predicts the Effectiveness of rhTSH-Stimulated I-131 Ablation in Patients With Differentiated Thyroid Carcinoma. Clin Nucl Med 2011; 36:781-5. [DOI: 10.1097/rlu.0b013e31821a29eb] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
8
|
Video-assisted thyroidectomy for papillary thyroid carcinoma. JOURNAL OF ONCOLOGY 2010; 2010. [PMID: 20953412 PMCID: PMC2952809 DOI: 10.1155/2010/148542] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 03/17/2010] [Accepted: 05/04/2010] [Indexed: 12/21/2022]
Abstract
Background. The results of video-assisted thyroidectomy (VAT) were evaluated in a large series of patients with papillary thyroid carcinoma (PTC), especially in terms of completeness of the surgical resection and short-to-medium term recurrence. Methods. The medical records of all patients who underwent video-assisted thyroidectomy for PTC between June 1998 and May 2009 were reviewed. Results. Three hundred fifty-nine patients were included. One hundred twenty-six patients underwent concomitant central neck node removal. Final histology showed 285 pT1, 26 pT2, and 48 pT3 PTC. Lymph node metastases were found in 27 cases. Follow-up was completed in 315 patients. Mean postoperative serum thyroglobulin level off levothyroxine was 5.4 ng/mL. Post operative ultrasonography showed no residual thyroid tissue in all the patients. Mean post-operative 131I uptake was 1.7%. One patient developed lateral neck recurrence. No other recurrence was observed.
Collapse
|
9
|
Papillary thyroid microcarcinoma: extrathyroidal extension, lymph node metastases, and risk factors for recurrence in a high prevalence of goiter area. World J Surg 2010; 34:1214-21. [PMID: 20052467 DOI: 10.1007/s00268-009-0375-x] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Although papillary thyroid microcarcinoma (PTMC) is diagnosed with increasing frequency, the best therapeutic option and follow-up protocol have not been established yet, especially in the case of incidental diagnosis. We reviewed our series of patients with PTMC to determine risk factors for recurrence in an area where there is a high prevalence of goiter. METHODS The medical records of all patients who underwent thyroidectomy with a final pathology report of PTMC between October 2002 and June 2007 were reviewed. PTMC was defined as a papillary thyroid carcinoma 10 mm or less in diameter. Follow-up evaluation was obtained by outpatient consultation and/or telephone interview. RESULTS In a series of 2,220 patients who underwent thyroidectomy for a thyroid carcinoma, 933 had a PTMC. Diagnosis was incidental in 704 patients (75.5%). Upon multivariate analysis, tumor size, nonincidental diagnosis, and neck node metastases at diagnosis were independent risk factors for extracapsular spread (ECS), while ECS, multifocal disease, and number of removed lymph nodes were independent risk factors for lymph node metastases at diagnosis. Follow-up evaluation was completed in 287 patients, 9 (3.1%) of whom experienced recurrence. The number of removed and metastasized nodes at first operation and the length of the follow-up were independent risk factors for recurrent disease. CONCLUSIONS Incidental diagnosis of PTMC is frequent in a high prevalence of goiter area. PTMC shows a variable degree of aggressiveness. Management protocols should be based on patient- and tumor-related prognostic factors, as for larger tumors.
Collapse
|
10
|
Giovanella L, Suriano S, Ricci R, Ceriani L, Anton Verburg F. Postsurgical thyroid remnant estimation by 99mTc-pertechnetate scintigraphy predicts radioiodine ablation effectiveness in patients with differentiated thyroid carcinoma. Head Neck 2010; 33:552-6. [DOI: 10.1002/hed.21490] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 04/14/2010] [Accepted: 04/20/2010] [Indexed: 11/09/2022] Open
|
11
|
Wu CT, Yang LH, Kuo SJ. Comparison of video-assisted thyroidectomy and traditional thyroidectomy for the treatment of papillary thyroid carcinoma. Surg Endosc 2009; 24:1658-62. [DOI: 10.1007/s00464-009-0826-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Accepted: 11/12/2009] [Indexed: 11/29/2022]
|
12
|
[Annex IV: modalities of iodine radioisotope administration and iodine 131 scintigraphies in the management of differentiated thyroid cancers]. ANNALES D'ENDOCRINOLOGIE 2008; 68 Suppl 2:S86-9. [PMID: 18342285 DOI: 10.1016/s0003-4266(07)78640-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
13
|
Lombardi CP, Raffaelli M, de Crea C, Princi P, Castaldi P, Spaventa A, Salvatori M, Bellantone R. Report on 8 years of experience with video-assisted thyroidectomy for papillary thyroid carcinoma. Surgery 2007; 142:944-51; discussion 944-51. [DOI: 10.1016/j.surg.2007.09.022] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Revised: 09/06/2007] [Accepted: 09/11/2007] [Indexed: 11/26/2022]
|
14
|
|
15
|
Abstract
OBJECTIVE To summarize the definitions of and management recommendations for low-risk thyroid cancer made by the American and European Thyroid Associations and synthesize this information with the recent literature, including systematic evaluations of tumor staging systems guiding therapy. METHODS The American Thyroid Association and European Thyroid Association guidelines were compared and pertinent literature since 2005 was reviewed. RESULTS Of papillary thyroid microcarcinomas (PTMC), up to 50% breach the thyroid capsule, 64% have lymph node metastases, up to 43% are multifocal, and as many as 2.8% have distant metastases. Locoregional and distant recurrences are, respectively, as high as 5.9% and 1.5%. As many as 1 in 4 patients with a papillary thyroid carcinoma 1.5 cm or smaller develop persistent disease. Cancer-related mortality rates are usually less than 1%, but are as high as 2% in some reports. Tumor staging systems are too inaccurate to guide therapy. CONCLUSION It is unlikely that many patients will forgo treatment after understanding their risk, especially when total thyroidectomy and radioiodine (131I) therapy can reduce the PTMC recurrence or persistence disease rate to zero. Preoperatively diagnosed PTMC should be treated with total or near-total thyroidectomy, regardless of tumor size. For very low-risk patients with unifocal PTMC smaller than 1 cm that is removed by chance during surgery to treat benign thyroid disease, lobectomy alone without 131I therapy may be sufficient therapy if there are no concerning histologic features and no tumor extension beyond the thyroid, metastases, history of head and neck irradiation, or positive family history--any of which requires total or near-total thyroidectomy and remnant ablation with 30 mCi.
Collapse
Affiliation(s)
- Ernest L Mazzaferri
- The Department of Medicine, Division of Endocrinology, University of Florida, Gainesville, Florida 32608-4653, USA
| |
Collapse
|
16
|
Salvatori M, Raffaelli M, Castaldi P, Treglia G, Rufini V, Perotti G, Lombardi CP, Rubello D, Ardito G, Bellantone R. Evaluation of the surgical completeness after total thyroidectomy for differentiated thyroid carcinoma. Eur J Surg Oncol 2007; 33:648-54. [PMID: 17433606 DOI: 10.1016/j.ejso.2007.02.034] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2007] [Accepted: 02/27/2007] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To quantify the rate of patients without thyroid remnants, to identify predictive factors for the absence of residual thyroid tissue and to evaluate number, site, size and function of thyroid remnants after total thyroidectomy for differentiated thyroid carcinoma (DTC). METHODS Thousand one hundred and seventy-eight patients who underwent total thyroidectomy for DTC were evaluated; 343 patients with lymph node or distant metastases and 115 patients with detectable thyroglobulin autoantibodies (TgAb) were excluded. (131)I ablative treatment (RAI) without preliminary diagnostic (131)I whole body scans (DxWBS), and 24-h (131)I quantitative neck uptake (RAIU test) and thyroglobulin (Tg) off L-T4 evaluation were performed in the remaining 720 pts. In 252 patients a 99mTc-pertechnetate pre-operative thyroid scan (99mTc-scan) was used for comparison with (131)I neck scans after RAI to evaluate site of thyroid remnants. Only patients with thyroid remnants were evaluated for successful ablation 6-10 months after RAI. RESULTS Post-treatment whole body scan (TxWBS) demonstrated lack of thyroid remnants in 50/720 patients and the best predictive factors for the absence of residual thyroid tissue were RAIU <1% and undetectable Tg off L-T4. Thyroid remnants were present in 670/720 patients. In 252 patients with (99m)Tc-scan, 617 sites of functioning thyroid tissue were found: 381 within and 236 outside the thyroid bed. Complete successful ablation was achieved in 610/670 patients with thyroid remnants. CONCLUSIONS This study confirms that most patients (93.1%) have thyroid remnant after total thyroidectomy for DTC. Most thyroid remnants were contralateral to tumour site and were even observed outside thyroid bed. However, a real total thyroidectomy, demonstrated by negative TxWBS, RAIU <1% and undetectable Tg off L-T4, was achieved in 6.9% of patients.
Collapse
Affiliation(s)
- M Salvatori
- Institute of Nuclear Medicine, Università Cattolica del S. Cuore, Rome, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|