Abstract
Background: Recently, there has been a trend to reduce the use of radioiodine remnant ablation (RRA) in patients with low-risk (LR) and intermediate-risk (IR) differentiated thyroid cancer (DTC). Objectives: The aim of this paper was to evaluate the diagnostic role of whole-body scan (ptWBS) performed after RRA in LR and IR DTC patients. Methods: We analyzed 545 DTC patients treated with total thyroidectomy and RRA in hypothyroidism followed by a ptWBS. Neck ultrasound (US) and serum thyroglobulin measurement were performed. According to the American Thyroid Association guidelines, patients were classified as LR (n = 345) and IR (n = 200). Results: In addition to the thyroid remnant, the ptWBS showed the presence of further areas of 131I uptake in 16/545 (2.9%) cases. ptWBS showed laterocervical lymph node metastases in 11/16 patients (10/11 were also detected by US), mediastinal uptake in 1/16, lung metastases in 3/16, and bone metastases in 1/16. Only 6/545 (1.1%) metastases were detected by ptWBS alone. After 7.8 years, 8/16 patients were free of disease, and 8 had persistent disease: 4 “biochemical” and 4 “structural.” Remission was achieved in 3 cases after one single 131I course, in 1 case after surgery, and in the last 4 cases after several 131I courses. Conclusions: The ptWBS diagnostic role was clinically relevant for the therapeutic strategies of our patients only in 1.1% of the cases. The cost-effectiveness of performing RRA and ptWBS in all LR and IR patients to find 1–2% of the cases with distant metastases remains controversial.
References
1.
Mazzaferri
EL
, Jhiang
SM
. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer
. Am J Med
. 1994
Nov
;97
(5
):418
–28
.
[PubMed]
0002-93432.
Pacini
F
, Molinaro
E
, Lippi
F
, Castagna
MG
, Agate
L
, Ceccarelli
C
, et al. Prediction of disease status by recombinant human TSH-stimulated serum Tg in the postsurgical follow-up of differentiated thyroid carcinoma
. J Clin Endocrinol Metab
. 2001
Dec
;86
(12
):5686
–90
.
[PubMed]
0021-972X3.
Pacini
F
, Schlumberger
M
, Dralle
H
, Elisei
R
, Smit
JW
, Wiersinga
W
; European Thyroid Cancer Taskforce
. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium
. Eur J Endocrinol
. 2006
Jun
;154
(6
):787
–803
.
[PubMed]
0804-46434.
Sawka
AM
, Brierley
JD
, Tsang
RW
, Thabane
L
, Rotstein
L
, Gafni
A
, et al. An updated systematic review and commentary examining the effectiveness of radioactive iodine remnant ablation in well-differentiated thyroid cancer
. [x.]
. Endocrinol Metab Clin North Am
. 2008
Jun
;37
(2
):457
–80
.
[PubMed]
0889-85295.
Cherk
MH
, Kalff
V
, Yap
KS
, Bailey
M
, Topliss
D
, Kelly
MJ
. Incidence of radiation thyroiditis and thyroid remnant ablation success rates following 1110 MBq (30 mCi) and 3700 MBq (100 mCi) post-surgical 131I ablation therapy for differentiated thyroid carcinoma
. Clin Endocrinol (Oxf)
. 2008
Dec
;69
(6
):957
–62
.
[PubMed]
0300-06646.
Canale
D
, Ceccarelli
C
, Caglieresi
C
, Moscatelli
A
, Gavioli
S
, Santini
P
, et al. Effects of radioiodine treatment for differentiated thyroid cancer on testis function
. Clin Endocrinol (Oxf)
. 2015
Feb
;82
(2
):295
–9
.
[PubMed]
0300-06647.
Clement
SC
, Peeters
RP
, Ronckers
CM
, Links
TP
, van den Heuvel-Eibrink
MM
, Nieveen van Dijkum
EJ
, et al. Intermediate and long-term adverse effects of radioiodine therapy for differentiated thyroid carcinoma—a systematic review
. Cancer Treat Rev
. 2015
Dec
;41
(10
):925
–34
.
[PubMed]
0305-73728.
Piemonte
M
: [TNM -- classification of malignant tumors (VI edition -- 2002). Innovations in the classification of head and neck neoplasms]. Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale 2003
;23:132-135.9.
Kim
HJ
, Kim
NK
, Choi
JH
, Kim
SW
, Jin
SM
, Suh
S
, et al. Radioactive iodine ablation does not prevent recurrences in patients with papillary thyroid microcarcinoma
. Clin Endocrinol (Oxf)
. 2013
Apr
;78
(4
):614
–20
.
[PubMed]
0300-066410.
Lamartina
L
, Durante
C
, Filetti
S
, Cooper
DS
. Low-risk differentiated thyroid cancer and radioiodine remnant ablation: a systematic review of the literature
. J Clin Endocrinol Metab
. 2015
May
;100
(5
):1748
–61
.
[PubMed]
0021-972X11.
Tuttle
RM
, Tala
H
, Shah
J
, Leboeuf
R
, Ghossein
R
, Gonen
M
, et al. Estimating risk of recurrence in differentiated thyroid cancer after total thyroidectomy and radioactive iodine remnant ablation: using response to therapy variables to modify the initial risk estimates predicted by the new American Thyroid Association staging system
. Thyroid
. 2010
Dec
;20
(12
):1341
–9
.
[PubMed]
1050-725612.
Vaisman
F
, Momesso
D
, Bulzico
DA
, Pessoa
CH
, Dias
F
, Corbo
R
, et al. Spontaneous remission in thyroid cancer patients after biochemical incomplete response to initial therapy
. Clin Endocrinol (Oxf)
. 2012
Jul
;77
(1
):132
–8
.
[PubMed]
0300-066413.
Durante
C
, Montesano
T
, Torlontano
M
, Attard
M
, Monzani
F
, Tumino
S
, et al.; PTC Study Group
. Papillary thyroid cancer: time course of recurrences during postsurgery surveillance
. J Clin Endocrinol Metab
. 2013
Feb
;98
(2
):636
–42
.
[PubMed]
0021-972X14.
Padovani
RP
, Robenshtok
E
, Brokhin
M
, Tuttle
RM
. Even without additional therapy, serum thyroglobulin concentrations often decline for years after total thyroidectomy and radioactive remnant ablation in patients with differentiated thyroid cancer
. Thyroid
. 2012
Aug
;22
(8
):778
–83
.
[PubMed]
1050-725615.
Jonklaas
J
, Sarlis
NJ
, Litofsky
D
, Ain
KB
, Bigos
ST
, Brierley
JD
, et al. Outcomes of patients with differentiated thyroid carcinoma following initial therapy
. Thyroid
. 2006
Dec
;16
(12
):1229
–42
.
[PubMed]
1050-725616.
Podnos
YD
, Smith
DD
, Wagman
LD
, Ellenhorn
JD
. Survival in patients with papillary thyroid cancer is not affected by the use of radioactive isotope
. J Surg Oncol
. 2007
Jul
;96
(1
):3
–7
.
[PubMed]
0022-479017.
Haugen
BR
, Alexander
EK
, Bible
KC
, Doherty
GM
, Mandel
SJ
, Nikiforov
YE
, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer
. Thyroid
. 2016
Jan
;26
(1
):1
–133
.
[PubMed]
1050-725618.
Matrone
A
, Gambale
C
, Piaggi
P
, Viola
D
, Giani
C
, Agate
L
, et al. Postoperative Thyroglobulin and Neck Ultrasound in the Risk Restratification and Decision to Perform 131I Ablation
. J Clin Endocrinol Metab
. 2017
Mar
;102
(3
):893
–902
.
[PubMed]
1945-719719.
American Thyroid Association Guidelines Taskforce on Thyroid N
. Differentiated Thyroid C, Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM: revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer
. Thyroid
. 2009
;19
:1167
–214
.1050-725620.
Tsuda
K
, Namba
H
, Nomura
T
, Yokoyama
N
, Yamashita
S
, Izumi
M
, et al. Automated measurement of urinary iodine with use of ultraviolet irradiation
. Clin Chem
. 1995
Apr
;41
(4
):581
–5
.
[PubMed]
0009-914721.
Van Nostrand
D
. Selected Controversies of Radioiodine Imaging and Therapy in Differentiated Thyroid Cancer
. Endocrinol Metab Clin North Am
. 2017
Sep
;46
(3
):783
–93
.
[PubMed]
0889-852922.
Pacini
F
, Molinaro
E
, Castagna
MG
, Agate
L
, Elisei
R
, Ceccarelli
C
, et al. Recombinant human thyrotropin-stimulated serum thyroglobulin combined with neck ultrasonography has the highest sensitivity in monitoring differentiated thyroid carcinoma
. J Clin Endocrinol Metab
. 2003
Aug
;88
(8
):3668
–73
.
[PubMed]
0021-972X23.
Durante
C
, Haddy
N
, Baudin
E
, Leboulleux
S
, Hartl
D
, Travagli
JP
, et al. Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: benefits and limits of radioiodine therapy
. J Clin Endocrinol Metab
. 2006
Aug
;91
(8
):2892
–9
.
[PubMed]
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2018
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