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

Yıl 2022, Cilt: 23 Sayı: 1, 64 - 68, 17.01.2022

İsmail Koçak , Hasan Önner , Buğra Kaya , Oktay Sarı

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

Öz

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.

Anahtar Kelimeler

Differentiated thyroid cancer, Thyroglobulin, Whole body scanning

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

Öz

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.

Anahtar Kelimeler

Diferansiye tiroid kanseri, Tiroglobulin, Tüm vücut tarama

Kaynakça

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