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Evaluation of 131I scintigraphy and stimulated thyroglobulin levels in the follow up of patients with DTC: a retrospective analysis of 1420 patients

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Aim

To study the clinical yield of diagnostic whole body 131I scintigraphy (DxWBS) in the follow-up of differentiated thyroid carcinoma (DTC) patients in relation to stimulated thyroglobulin (sTg) in the initial post-ablation setting, as well as in the setting of repeated monitoring in course of further DTC follow-up.

Methods

Data of 1420 thyroidectomized and radioiodine remnant-ablated DTC patients following a well-defined therapy and standardized follow-up protocol were evaluated. DxWBS and sTg were evaluated separately and in combination for various follow-up time points. The factual administration of the recorded indication for further oncologic therapy (excluding radioiodine therapies given for minimal normal remnants) within the following 4 months after follow-up served as the standard of reference. Furthermore, DxWBS was compared to post therapy WBS and SPECT(/CT) if available. Subgroup analysis was carried out for DTC patients < 45 years old at diagnosis without distant metastasis. The diagnostic impact of cervical ultrasound was not assessed.

Results

sTg can identify the patients at risk better than DxWBS. Furthermore, the most sensitive time point to assess response appears to be a time point beyond 3 months after RRA. When information received from both imaging and laboratory measurements are concordant, i.e. both construe absence of remaining disease, only a small fraction of patients (<2%) required treatment in the future. The strongest effect was observed 12 months after RRA. Only 0.9% of the negative DxWBS patients with concordant sTg below the functional sensitivity at this time point required treatment thereafter.

Conclusion

A complete omission of DxWBS in the post-RRA surveillance of DTC is justified once DxWBS is negative and sTg is below the functional sensitivity (with no evidence of thyroglobulin antibodies), as patients showing this combination of test results (especially 12 months after RRA) show an at worst marginal risk of recurrence. In all other cases DxWBS may still be justified.

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Authors and Affiliations

  1. Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany

    Jose Manuel Gonzalez Carvalho, Otmar Schober, Christian Wenning, Burkhard Riemann & Alexis Vrachimis

  2. Institute of Biostatistics and Clinical Research, Westfälische Wilhelms-Universität Münster, Münster, Germany

    Dennis Görlich

  3. Department of Nuclear Medicine, University Hospital Giessen and Marburg, Marburg, Germany

    Frederik Anton Verburg

Authors
  1. Jose Manuel Gonzalez Carvalho
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  2. Dennis Görlich
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  3. Otmar Schober
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  4. Christian Wenning
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  5. Burkhard Riemann
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  6. Frederik Anton Verburg
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  7. Alexis Vrachimis
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Corresponding author

Correspondence to Alexis Vrachimis.

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Ethical considerations

No financial support was provided for this work. Frederik A. Verburg is a consultant to Bayer and Genzyme and has received speaker honoraria from Genzyme and Diasorin. The other authors have nothing to declare. All procedures were in accordance with the ethical standards of the institutional national and committee on human experimentation and the Helsinki Declaration of 1975, as revised in 2008. No ethics committee review is required for this study under the applicable law according to the Joint Research Ethics Committee of the Faculty of Medicine, University of Münster and the locoregional Chamber of Physicians of Westfalen-Lippe.

Electronic supplementary material

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Supplementary Table 1

Evolvement of the DxWBS over time (V2-V4) with regards to DxWBS or treatment for the time points V1-V3 in stage I (AJCC 2009) patients < 45 years old. The percent value indicates the DxWBS previously negative patients treated in a subsequent control. (DxWBS): diagnostic whole body 131I scintigraphy; (RRA): radioiodine remnant ablation; (V1): follow-up 3 months after RRA; (V2): follow-up 12 months after RRA; (V3): follow-up 2/5 years after V2; (V4): follow-up 2/5 years after V3; (-): negative DxWBS; (+): positive DxWBS. (XLSX 11 kb)

Supplementary Table 2

Evolvement of the sTg in stage I (AJCC 2009) patients < 45 years old in different cut-off values over time in regards to DxWBS result within the same visit and need for treatment in the same and subsequent time points. The percent value indicates the patients treated despite having sTg below the cut-off value. (DxWBS): diagnostic whole body 131I scintigraphy; (RRA): radioiodine remnant ablation; (sTg): stimulated tumormarker Thyroglobulin; (V1): follow-up 3 months after RRA; (V2): follow-up 12 months after RRA; (V3): follow-up 2/5 years after V2; (V4): follow-up 2/5 years after V3; (-): negative DxWBS; (+): positive DxWBS. (XLSX 13 kb)

Supplementary Table 3

Comparison of patients undergoing exogenous (i.e. rhTSH) and endogenous (i.e. L-Thyroxine withdrawal) TSH stimulation in the 4 different time points. (FTC): follicular thyroid cancer; (PTC): papillary thyroid cancer; (SD): standard deviation; (Q1): first quartile; (Q3): third quartile; (RRA): radioiodine remnant ablation; (sTg): stimulated tumormarker Thyroglobulin; (V1): follow-up 3 months after RRA; (V2): follow-up 12 months after RRA; (V3): follow-up 2/5 years after V2; (V4): follow-up 2/5 years after V3; (n.s.): not significant. (XLSX 13 kb)

Supplementary Table 4

Complete remission evaluation as assessed with DxWBS in combination with sTg in different cut-off values over time (V2-V4) in stage I (AJCC 2009) patients < 45 years old. (DxWBS): diagnostic whole body 131I scintigraphy; (RRA): radioiodine remnant ablation; (sTg): stimulated tumormarker Thyroglobulin; (V1): follow-up 3 months after RRA; (V2): follow-up 12 months after RRA; (V3): follow-up 2/5 years after V2; (V4): follow-up 2/5 years after V3; (-): negative DxWBS; (+): positive DxWBS. (XLSX 12 kb)

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Gonzalez Carvalho, J.M., Görlich, D., Schober, O. et al. Evaluation of 131I scintigraphy and stimulated thyroglobulin levels in the follow up of patients with DTC: a retrospective analysis of 1420 patients. Eur J Nucl Med Mol Imaging 44, 744–756 (2017). https://doi.org/10.1007/s00259-016-3581-4

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  • DOI: https://doi.org/10.1007/s00259-016-3581-4

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