Gonzalez Carvalho Jose Manuel, Görlich Dennis, Schober Otmar, Wenning Christian, Riemann Burkhard, Verburg Frederik Anton, Vrachimis Alexis
Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany.
Institute of Biostatistics and Clinical Research, Westfälische Wilhelms-Universität Münster, Münster, Germany.
Eur J Nucl Med Mol Imaging. 2017 May;44(5):744-756. doi: 10.1007/s00259-016-3581-4. Epub 2016 Dec 1.
To study the clinical yield of diagnostic whole body I scintigraphy (DxWBS) in the follow-up of differentiated thyroid carcinoma (DTC) patients in relation to stimulated thyroglobulin (sTg) in the initial post-ablation setting, as well as in the setting of repeated monitoring in course of further DTC follow-up.
Data of 1420 thyroidectomized and radioiodine remnant-ablated DTC patients following a well-defined therapy and standardized follow-up protocol were evaluated. DxWBS and sTg were evaluated separately and in combination for various follow-up time points. The factual administration of the recorded indication for further oncologic therapy (excluding radioiodine therapies given for minimal normal remnants) within the following 4 months after follow-up served as the standard of reference. Furthermore, DxWBS was compared to post therapy WBS and SPECT(/CT) if available. Subgroup analysis was carried out for DTC patients < 45 years old at diagnosis without distant metastasis. The diagnostic impact of cervical ultrasound was not assessed.
sTg can identify the patients at risk better than DxWBS. Furthermore, the most sensitive time point to assess response appears to be a time point beyond 3 months after RRA. When information received from both imaging and laboratory measurements are concordant, i.e. both construe absence of remaining disease, only a small fraction of patients (<2%) required treatment in the future. The strongest effect was observed 12 months after RRA. Only 0.9% of the negative DxWBS patients with concordant sTg below the functional sensitivity at this time point required treatment thereafter.
A complete omission of DxWBS in the post-RRA surveillance of DTC is justified once DxWBS is negative and sTg is below the functional sensitivity (with no evidence of thyroglobulin antibodies), as patients showing this combination of test results (especially 12 months after RRA) show an at worst marginal risk of recurrence. In all other cases DxWBS may still be justified.
研究诊断性全身碘闪烁扫描（DxWBS）在分化型甲状腺癌（DTC）患者随访中的临床价值，该价值与初始消融后刺激甲状腺球蛋白（sTg）相关，以及在DTC后续随访的重复监测过程中的价值。
评估了1420例接受甲状腺切除和放射性碘残余消融的DTC患者的数据，这些患者遵循明确的治疗和标准化的随访方案。在不同的随访时间点分别评估DxWBS和sTg，并将两者结合评估。随访后接下来4个月内实际进行的进一步肿瘤治疗记录指征（不包括因微小正常残余组织而进行的放射性碘治疗）作为参考标准。此外，将DxWBS与治疗后WBS和SPECT(/CT)（如有）进行比较。对诊断时年龄<45岁且无远处转移的DTC患者进行亚组分析。未评估颈部超声的诊断影响。
sTg比DxWBS能更好地识别有风险的患者。此外，评估反应最敏感的时间点似乎是放射性碘残余消融（RRA）后3个月以上的时间点。当影像学和实验室测量得到的信息一致，即两者都推断没有残留疾病时，只有一小部分患者（<2%）未来需要治疗。在RRA后12个月观察到最强的效果。此时，DxWBS阴性且sTg低于功能敏感性且两者一致的患者中，只有0.9%的患者此后需要治疗。
一旦DxWBS为阴性且sTg低于功能敏感性（无甲状腺球蛋白抗体证据），在DTC的RRA后监测中完全省略DxWBS是合理的，因为显示这种检查结果组合的患者（尤其是RRA后12个月）复发风险极低。在所有其他情况下，DxWBS可能仍然是合理的。
