COMPARISON OF THE WHOLE BODY SCAN AND THYROGLOBULIN IN DETERMINING THE RESIDUE AND METASTASIS IN DIFFERENTIAL THYROID CANCER

Year 2022, Volume: 23 Issue: 1, 64 - 68, 17.01.2022

İsmail Koçak , Hasan Önner , Buğra Kaya , Oktay Sarı

https://doi.org/10.18229/kocatepetip.858379

Abstract

OBJECTIVE: In our study, we compare the importance of thyroglobulin (Tg) and post-treatment whole body scanning (WBS) scintigraphy in detecting residual and/or metastasis in patients with differentiated thyroid cancer (DTC) receiving radioactive iodine (RAI) treatment.
MATERIAL AND METHODS: The files of the patients who underwent total or near-total thyroidectomy surgery, who were diagnosed with DTC and subsequently received RAI ablation, were retrospectively reviewed. L-Thyroxine treatment was discontinued to the patients before the RAI treatment and an iodine-poor diet was given to them for 14 days. Serum TSH level was ensured to be higher than 30 IU / ml before treatment. Serum TSH, Tg, and thyroglobulin antibody (Anti-Tg) values were measured before ablation therapy. RAI treatment was given to the patients in the range of 50-250 mCi (mean 135 mCi). WBS was performed on the 7th day of the treatment.
RESULTS: Of the 483 patients examined in total, 431 patients with TSH> 30 IU / ml before treatment were included in the study. It was seen as Tg (+) in 243 of 373 patients with WBS (+), and distant metastasis was detected in 28 of these patients. In 13 of 58 patients with WBS (-), it was evaluated as Tg (+). Although 107 (24%) of 431 patients had WBS (+), serum Tg level was found to be true negative (Tg <2 ng/ml and AntiTg <100 U/ml). Distant metastasis was detected in one of these patients, while other patients had residual and / or cervical lymphatic metastasis.
CONCLUSIONS: Our findings show that Tg measurement is insufficient to reveal residual tissue and / or cervical lymphatic metastasis in patients with DTC. This study suggests that WBS has a complementary role in detecting and localizing residual and / or lymphatic metastases, especially in the neck area.

Keywords

Differentiated thyroid cancer, Thyroglobulin, Whole body scanning

DİFERANSİYE TİROİD KANSERİNDE REZİDÜ VE METASTAZIN BELİRLENMESİNDE TÜM VÜCUT TARAMA İLE TİROGLOBULİNİN KARŞILAŞTIRILMASI

Abstract

AMAÇ: Çalışmamızda, radyoaktif iyot (RAİ) tedavisi alan diferansiye tiroid kanserli (DTK) hastalarda tiroglobulin (Tg) ile tedavi sonrası tüm vücut tarama (TVT) sintigrafisinin rezidü ve/veya metastaz saptamada önemleri karşılaştırılmıştır.
GEREÇ VE YÖNTEM: Total ya da totale yakın tiroidektomi cerrahisi geçiren, DTK tanısı alan ve RAİ ablasyon tedavisi verilen hastaların dosyaları retrospektif olarak incelendi. Hastalara RAİ tedavisi öncesi L-Tiroksin tedavisi kesilip, 14 gün iyottan fakir diyet verilerek tedavi öncesinde serum TSH seviyesinin 30 IU/ml’den yüksek olması sağlandı. Tedavi öncesi serum tiroid stimülan hormon (TSH), Tg, tiroglobulin antikoru (Anti-Tg) değerlerine bakıldı. Hastalara 50-250 mCi (ortalama 135 mCi) aralığında RAİ tedavisi verildi. Tedavinin 7. gününde TVT yapıldı.
BULGULAR: Toplam incelenen 483 hastadan tedavi öncesi TSH >30 IU/ml olan 431 hasta çalışmaya dahil edildi. TVT (+) olan 373 hastanın 243’ünde Tg (+) olarak bulundu. 373 hastanın 28’inde uzak metastaz tespit edildi. TVT (-) 58 hastanın 13'ünde Tg (+) olarak bulundu. PET/BT'de bu 13 hastanın 2'sinde uzak metastaz gözlendi. 431 hastanın 107’sinde (% 24) TVT (+) olmasına rağmen serum Tg seviyesi gerçek negatif olarak (Tg <2 ng/ml ve AntiTg <100 U/ml) tespit edilmiştir. Bu hastalardan birinde uzak metastaz saptanırken, diğer hastalarda rezidü ve/veya servikal lenfatik metastaz mevcuttu.
SONUÇ: Bulgularımız DTK’inde Tg ölçümünün rezidü doku ve/veya servikal lenfatik metastazını ortaya koymada yetersizliğini göstermektedir. TVT’nin özellikle boyun bölgesindeki rezidü ve/veya lenfatik metastazları tespit ve lokalize etmede tamamlayıcı rolü olduğunu düşünmekteyiz.

Keywords

Diferansiye tiroid kanseri, Tiroglobulin, Tüm vücut tarama

References

• 1. Klein M, Aubert V, Weryha G, Leclere J. Classification and epidemiology of thyroid tumors. La Revue du Praticien 1996;46(19):2288-95.
• 2. Hundahl SA, Fleming ID, Fremgen AM, Menck HR. A National Cancer Data Base report on 53,856 cases of thyroid carcinoma treated in the US, 1985‐1995. Canser. 1998;83(12):2638-48.
• 3. Hay ID. Papillary thyroid carcinoma. Endocrinology and metabolism clinics of North America.1990;19(3):545-76.
• 4. Demirer A. Differansiye tiroid kanserlerinde tiroglobulin anti tiroglobulin ile I-131 tüm vücut ve Tc-99m sestamibi sintigrafilerinin karşılaştırılması, sestamibinin değeri. Uzmanlık Tezi. Ankara: Ankara Üniversitesi Tıp Fakültesi, Nükleer Tıp Anabilim Dalı, 2002.
• 5. Emer MÖ, Ilgan S, Alagöz E, Arslan N, Karaçalıoğlu AÖ, Günalp B, Özgüven MA. The role of 18F-fluoro-2-deoxyglucose positron emission tomography imaging in thyroid cancers. Gülhane Tıp Dergisi. 2009;51(4):230-6.
• 6. Iwata M, Kasagi K, Misaki T, Matsumoto K, Iida Y, Ishimori T. Comparison of whole-body 18 F-FDG PET, 99m Tc-MIBI SPET, and post-therapeutic 131 I-Na scintigraphy in the detection of metastatic thyroid cancer. European Journal of Nuclear Medicine and Molecular Imaging. 2004;31(4):491-8.
• 7. Helal BO, Merlet P, Toubert M-E, Franc B, Schvartz C, Gauthier-Koelesnikov H. Clinical impact of 18F-FDG PET in thyroid carcinoma patients with elevated thyroglobulin levels and negative 131I scanning results after therapy. European Journal of Nuclear Medicine and Molecular Imaging. 2001;42(10):1464-9.
• 8. Cooper DS, Doherty GM, Haugen BR, Hauger BR, Kloos RT, Lee SL. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167–214.
• 9. Park E-K, Chung J-K, Lim IH, Park DJ, Lee DS, Lee MC. Recurrent/metastatic thyroid carcinomas false negative for serum thyroglobulin but positive by posttherapy I-131 whole body scans. European Journal of Nuclear Medicine and Molecular Imaging. 2009;36(2):172-7.
• 10. Shinohara S, Kikuchi M, Suehiro A, Kishimoto I, Harada H, Hino M. Characteristics and prognosis of patients with thyroglobulin-positive and radioactive iodine whole-body scan-negative differentiated thyroid carcinoma. Japanese Journal of Clinical Oncology. 2015;45(5):427-32.
• 11. Miyauchi A, Kudo T, Kihara M, Higashiyama T, Ito Y, Kobayashi K. Relationship of biochemically persistent disease and thyroglobulin-doubling time to age at surgery in patients with papillary thyroid carcinoma. Endocrine Journal. 2012;12(1):103-9.
• 12. Zakani A, Saghari M, Eftekhari M, Fard-Esfahani A, Fallahi B, Esmaili J. Evaluation of radioiodine therapy in differentiated thyroid cancer subjects with elevated serum thyroglobulin and negative whole body scan using 131I with emphasize on the thallium scintigraphy in these subgroups. European Review for Medical and Pharmacological Sciences. 2011;15(10):1215-21.
• 13. John MH. 131I therapy: inpatient or outpatient?. Journal of Nuclear Medicine. 2000;41(11):1876-8.
• 14. Iuliano R, Chiefari E, Filetti A. Iodide symporter gene expression in normal and transformed rat thyroid cells. European Journal of Endocrinology. 1999;14(10):447-51.
• 15. Smanik PA, Ryu K-Y, Theil KS, Mazzaferri EL. Expression, exon-intron organization, and chromosome mapping of the human sodium iodide symporter. Endocrinology. 1997;138(8):3555-8.
• 16. Liu Q-R, Ryu K-Y. Cloning of the human sodium iodide symporter. Biochemical and Biophysical Research Communications. 1996;22(6):339-45.
• 17. Mellemgard A, From G, Jorgensen T, Johansen C, Olsen JH, Perrild H. Cancer risk in individuals with benign thyroid disorders. Thyroid.1998;8(9):751-4.
• 18. Monaco F, Grimaldi S, Dominici R, Robbins J. Defective thyroglobulin synthesis in an experimental rat thyroid tumor: iodination and thyroid hormone synthesis in isolated tumor thyroglobulin. Journal of Biological Chemistry. 1975;97(2):347-51.
• 19. Valenta L, Lissitzky S, Aquaron R. Thyroglobulin-iodine in thyroid tumors. The Journal of Clinical Endocrinology & Metabolism. 1968;28(4):437-41.
• 20. Joensuu H, Ahonen A. Imaging of Metastases of Thyroid Carcinoma with Fluorine-18 Fluorodeoxyglucose. Journal of Nuclear Medicine. 1987;28(910):910-4