Ozdemir Didem, Cuhaci Fatma N, Ozdemir Elif, Aydin Cevdet, Ersoy Reyhan, Turkolmez Seyda, Cakir Bekir
Departments of aEndocrinology and Metabolism bNuclear Medicine, School of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey.
Nucl Med Commun. 2016 Jun;37(6):640-5. doi: 10.1097/MNM.0000000000000492.
Surgery and radioactive iodine (RAI) ablation constitute the mainstay of the treatment of differentiated thyroid carcinoma (DTC). In this study, we aimed to evaluate the diagnostic value of postoperative early Tc-99m pertechnetate scanning to detect remnant thyroid tissue and predict ablation success.
DTC patients evaluated with postoperative Tc-99m pertechnetate scintigraphy and treated with RAI between January 2007 and December 2014 were recruited. The results of Tc-99m pertechnetate scanning were compared with therapeutic I-131 whole-body scanning (TxWBS) and diagnostic I-131 whole-body scanning (DxWBS) performed 6-9 months after RAI.
There were 154 (21.5%) male and 563 (78.5%) female patients, with a mean age of 49.11±12.35 years. Postoperative Tc-99m pertechnetate scanning was positive in 499 patients (69.6%) and negative in 218 (30.4%) patients. There were 673 (93.9%) patients with a positive TxWBS scan and 44 (6.1%) patients with negative TxWBS scan. Considering TxWBS as the standard test, sensitivity, specificity, positive predictive value, and negative predictive value of Tc-99m pertechnetate scanning were 72.2, 70.5, 97.4, and 14.2%, respectively. DxWBS was positive in 57 (9.0%) and negative in 564 (91%) patients. Ablation dose was higher and preablation thyroglobulin was lower in patients with negative DxWBS (P=0.001 and 0.04, respectively). Overall, 171 (92.9%) of 184 patients with negative Tc-99m pertechnetate had negative DxWBS.
Postoperative Tc-99m pertechnetate scintigraphy has a high positive predictive value to detect remnant tissue in patients with DTC. Although negative Tc-99m pertechnetate scanning does not indicate removal of all thyroid tissue, it is related to successful ablation in more than 90% of patients.
手术和放射性碘（RAI）消融是分化型甲状腺癌（DTC）治疗的主要手段。在本研究中，我们旨在评估术后早期高锝[Tc-99m]酸盐扫描对检测残留甲状腺组织及预测消融成功的诊断价值。
纳入2007年1月至2014年12月间接受术后高锝[Tc-99m]酸盐闪烁扫描并接受RAI治疗的DTC患者。将高锝[Tc-99m]酸盐扫描结果与RAI治疗后6 - 9个月进行的治疗性碘-131全身扫描（TxWBS）和诊断性碘-131全身扫描（DxWBS）结果进行比较。
共有154例（21.5%）男性和563例（78.5%）女性患者，平均年龄为49.11±12. .35岁。术后高锝[Tc-99m]酸盐扫描阳性患者499例（69.6%），阴性患者218例（30.4%）。TxWBS扫描阳性患者673例（93.9%），阴性患者44例（6.1%）。以TxWBS为标准检测，高锝[Tc-99m]酸盐扫描的敏感性、特异性、阳性预测值和阴性预测值分别为72.2%、70.5%、97.4%和14.2%。DxWBS阳性患者57例（9.0%），阴性患者564例（91%）。DxWBS阴性患者的消融剂量较高且消融前甲状腺球蛋白较低（P分别为0.001和0.04）。总体而言，184例高锝[Tc-99m]酸盐扫描阴性患者中有171例（92.9%）DxWBS阴性。
术后高锝[Tc-99m]酸盐闪烁扫描对检测DTC患者残留组织具有较高的阳性预测值。虽然高锝[Tc-99m]酸盐扫描阴性并不表明所有甲状腺组织均已清除，但在超过90%的患者中与消融成功相关。
