Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
Endocrinol Metab (Seoul). 2019 Mar;34(1):63-69. doi: 10.3803/EnM.2019.34.1.63. Epub 2019 Feb 15.
Postoperative routine radioiodine (RAI) treatment is currently debated for patients with low-risk differentiated thyroid carcinoma (DTC) patients. If performed, a low ¹³¹I activity (i.e., 1 to 2 GBq) is recommended with the aim to ablate thyroid remnant and facilitate subsequent follow-up by thyroglobulin measurement. The purpose of this study was to evaluate the relationship between postsurgical technetium-99m (Tc)-pertechnetate scintigraphy and the rate of successful remnant ablation after low activity radioiodine ablation in patients with DTC.
Enrolled were 193 patients with low risk DTC who underwent total thyroidectomy and RAI ablation with a fixed 1.1 GBq activity of ¹³¹I. Tc-pertechnetate scans were done and thyrotropin stimulated thyroglobulin (sTg) levels measured just before ablation. Ablation effectiveness was assessed 6 to 12 months later by sTg measurement, neck ultrasound and diagnostic whole body scan.
A negative Tc-perthecnetate scans was the best predictor of successful ablation (<0.001) followed by preablative sTg levels <0.8 ng/mL (=0.008) and Tc-pertechnetate uptake rate values <0.9% (=0.065). Neither sex nor age of the patient at the time of ablation or tumor histology and size showed a significant association with the rate of successful ablation.
The Tc-pertechnetate scintigraphy is a simple and feasible tool to predict effectiveness of low activity ¹³¹I thyroid to ablate thyroid remnants in patients with DTC.
目前对于低危分化型甲状腺癌（DTC）患者，术后是否进行常规放射性碘（RAI）治疗仍存在争议。如果进行，则推荐使用低剂量¹³¹I（即 1 至 2GBq），其目的是清除甲状腺残余组织，并通过甲状腺球蛋白（Tg）测量来促进后续随访。本研究旨在评估 DTC 患者接受低剂量¹³¹I 放射性碘消融治疗后，甲状腺残留组织清除效果与术后锝-99m（Tc）-过锝酸盐扫描之间的关系。
共纳入 193 例低危 DTC 患者，均接受全甲状腺切除术和 ¹³¹I 消融治疗，¹³¹I 活度固定为 1.1GBq。在消融治疗前，进行 Tc-过锝酸盐扫描并测量促甲状腺激素刺激 Tg（sTg）水平。消融治疗 6-12 个月后，通过 sTg 测量、颈部超声和诊断性全身扫描评估消融效果。
阴性 Tc-过锝酸盐扫描是预测消融成功的最佳指标（<0.001），其次是消融前 sTg 水平<0.8ng/ml（=0.008）和 Tc-过锝酸盐摄取率<0.9%（=0.065）。消融时患者的性别、年龄、肿瘤组织学和大小均与消融成功率无显著相关性。
Tc-过锝酸盐扫描是一种简单可行的工具，可预测低剂量¹³¹I 甲状腺治疗 DTC 患者甲状腺残余组织的消融效果。
