Department of Nuclear Medicine and Endocrine Oncology, Institut Gustave Roussy, Univ. Paris-Sud, Villejuif, France.
Endocr Relat Cancer. 2011 Mar 3;18(2):R29-40. doi: 10.1677/ERC-10-0292. Print 2011 Apr.
(131)I is given in differentiated thyroid cancer (DTC) without taking into account thyroglobulin (Tg) levels at the time of ablation, whereas 6-18 months later it is a major criterion for cure. This single-center retrospective study assessed the frequency and risk factors for persistent disease on postablation whole body scan (WBS) and postoperative neck ultrasonography (n-US) and for recurrent disease during the subsequent follow-up, in patients with DTC and undetectable TSH-stimulated Tg level (TSH-Tg) in the absence of Tg antibodies (TgAb) at the time of ablation. Among 1031 patients ablated, 242 (23%) consecutive patients were included. Persistent disease occurred in eight cases (3%) (seven abnormal WBS and one abnormal n-US), all with initial neck lymph node metastases (N1). N1 was a major risk factor for persistent disease. Among 203 patients with normal WBS and a follow-up over 6 months, TSH-Tg 6-18 months after ablation was undetectable in the absence of TgAb in 173 patients, undetectable with TgAb in 1 patient and equal to 1.2 ng/ml in 1 patient. n-US was normal in 152 patients and falsely positive in 3 patients. After a mean follow-up of 4 years, recurrence occurred in two cases (1%), both with aggressive histological variants. The only risk factor for recurrence was an aggressive histological variant (P = 0.03). In conclusion, undetectable postoperative TSH-Tg in the absence of TgAb at the time of ablation is frequent. In these patients, repeating TSH-Tg 6-18 months after ablation is not useful. (131)I ablation could be avoided in the absence of N1 and aggressive histological variant.
(131)I 治疗仅考虑了消融时的甲状腺球蛋白（Tg）水平，而 6-18 个月后才是治愈的主要标准。这项单中心回顾性研究评估了在消融时 TSH 刺激 Tg 水平（TSH-Tg）无法检测且不存在 Tg 抗体（TgAb）的情况下，DTC 患者行消融术后的全身扫描（WBS）和颈部超声（n-US）检查是否存在持续性疾病，以及在随后的随访中是否存在复发性疾病。在 1031 例接受消融的患者中，连续纳入 242 例患者。8 例（3%）患者发生持续性疾病（7 例 WBS 异常和 1 例 n-US 异常），均存在初始颈部淋巴结转移（N1）。N1 是持续性疾病的主要危险因素。在 203 例 WBS 正常且随访时间超过 6 个月的患者中，173 例患者在无 TgAb 的情况下，消融后 6-18 个月 TSH-Tg 无法检测，1 例患者 TSH-Tg 检测值为 1.2ng/ml，1 例患者 TgAb 阳性。152 例患者 n-US 正常，3 例患者 n-US 假阳性。平均随访 4 年后，2 例（1%）患者复发，均为侵袭性组织学变异。唯一的复发危险因素是侵袭性组织学变异（P = 0.03）。总之，在消融时 TSH-Tg 无法检测且不存在 TgAb 的情况下，术后 TSH-Tg 无法检测的情况很常见。在这些患者中，消融后 6-18 个月重复检测 TSH-Tg 并无益处。如果不存在 N1 和侵袭性组织学变异，可以避免进行(131)I 消融。
