Salvatori M, Raffaelli M, Castaldi P, Treglia G, Rufini V, Perotti G, Lombardi C P, Rubello D, Ardito G, Bellantone R
Institute of Nuclear Medicine, Università Cattolica del S. Cuore, Rome, Italy.
Eur J Surg Oncol. 2007 Jun;33(5):648-54. doi: 10.1016/j.ejso.2007.02.034. Epub 2007 Apr 12.
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).
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.
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.
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.
量化无甲状腺残留患者的比例，确定甲状腺残留组织缺失的预测因素，并评估分化型甲状腺癌（DTC）全甲状腺切除术后甲状腺残留组织的数量、位置、大小和功能。
对1178例行DTC全甲状腺切除术的患者进行评估；排除343例有淋巴结或远处转移的患者以及115例可检测到甲状腺球蛋白自身抗体（TgAb）的患者。对其余720例患者进行无初步诊断性（131）I全身扫描（DxWBS）的（131）I消融治疗（RAI）、24小时（131）I颈部定量摄取（RAIU试验）以及停用左旋甲状腺素（L-T4）后的甲状腺球蛋白（Tg）评估。在252例患者中，术前使用99m锝高锝酸盐甲状腺扫描（99mTc扫描）与RAI后的（131）I颈部扫描进行比较，以评估甲状腺残留组织的位置。仅对RAI后6至10个月有甲状腺残留组织的患者进行消融成功评估。
治疗后全身扫描（TxWBS）显示720例患者中有50例无甲状腺残留组织，甲状腺残留组织缺失的最佳预测因素为RAIU<1%以及停用L-T4后Tg检测不到。720例患者中有670例存在甲状腺残留组织。在252例进行（99m）Tc扫描的患者中，发现617个有功能的甲状腺组织部位：381个位于甲状腺床内，236个位于甲状腺床外。670例有甲状腺残留组织的患者中有610例实现了完全成功消融。
本研究证实，大多数患者（93.1%）在DTC全甲状腺切除术后有甲状腺残留组织。大多数甲状腺残留组织位于肿瘤部位的对侧，甚至在甲状腺床外也有发现。然而，6.9%的患者实现了真正的全甲状腺切除，表现为TxWBS阴性、RAIU<1%以及停用L-T4后Tg检测不到。
