Department of Surgery, Walter Reed National Military Medical Center, and Uniformed Services University of Health Sciences, Bethesda, Maryland 20889, USA.
J Clin Endocrinol Metab. 2012 Aug;97(8):2754-63. doi: 10.1210/jc.2012-1533. Epub 2012 May 25.
Decisions regarding initial therapy and subsequent surveillance in patients with differentiated thyroid cancer (DTC) depend upon an accurate assessment of the risk of persistent or recurrent disease.
The objective of this study was to examine the predictive value of a single measurement of serum thyroglobulin (Tg) just before radioiodine remnant ablation (preablation Tg) on subsequent disease-free status.
Sources included MEDLINE and BIOSYS databases between January 1996 and June 2011 as well as data from the author's tertiary-care medical center.
Included studies reported preablation Tg values and the outcome of initial therapy at surveillance testing or during the course of long-term follow-up.
Two investigators independently extracted data and rated study quality using the Quality Assessment of Studies of Diagnostic Accuracy included in Systematic Reviews-2 (QUADAS-2) tool.
Fifteen studies involving 3947 patients with DTC were included. Seventy percent of patients had preablation Tg values lower than the threshold value being examined. The negative predictive value (NPV) of a preablation Tg below threshold was 94.2 (95% confidence interval = 92.8-95.3) for an absence of biochemical or structural evidence of disease at initial surveillance or subsequent follow-up. The summary receiver operator characteristic curve based on a bivariate mixed-effects binomial regression model showed a clustering of studies using a preablation Tg below 10 ng/ml near the summary point of optimal test sensitivity and specificity.
Preablation Tg testing is a readily available and inexpensive tool with a high NPV for future disease-free status. A low preablation Tg should be considered a favorable risk factor in patients with DTC. Further study is required to determine whether a low preablation Tg may be used to select patients for whom radioiodine remnant ablation can be avoided.
分化型甲状腺癌（DTC）患者初始治疗和后续监测的决策取决于对持续性或复发性疾病风险的准确评估。
本研究旨在探讨放射性碘残余消融（消融前 Tg）前单次血清甲状腺球蛋白（Tg）测量对随后无病状态的预测价值。
资料来源于 1996 年 1 月至 2011 年 6 月的 MEDLINE 和 BIOSYS 数据库以及作者的三级保健医疗中心的数据。
纳入的研究报告了消融前 Tg 值以及初始治疗的监测结果或长期随访期间的治疗结果。
两名研究者独立提取数据，并使用系统评价中诊断准确性研究质量评估工具（QUADAS-2）评估研究质量。
纳入了 15 项涉及 3947 例 DTC 患者的研究。70%的患者消融前 Tg 值低于所研究的阈值。消融前 Tg 值低于阈值时，在初始监测或随后随访时无生化或结构疾病证据的阴性预测值（NPV）为 94.2%（95%置信区间=92.8%~95.3%）。基于二变量混合效应二项回归模型的汇总受试者工作特征曲线显示，使用消融前 Tg 值低于 10ng/ml 的研究集中在汇总点附近，具有最佳的检测敏感性和特异性。
消融前 Tg 检测是一种现成的、廉价的工具，具有较高的未来无病状态的 NPV。低消融前 Tg 应被视为 DTC 患者的有利危险因素。需要进一步研究以确定低消融前 Tg 是否可用于选择可避免放射性碘残余消融的患者。
