National Cancer Institute of the Ministry of Health of Ukraine, 33/43 Lomonosova St., Kyiv, 03022, Ukraine.
All-Ukrainian Center of Radiosurgery at the Feofania Hospital of the State Administrative Department, 21 Akademika Zabolotnoho St., Kyiv, 03143, Ukraine.
Probl Radiac Med Radiobiol. 2020 Dec;25:579-591. doi: 10.33145/2304-8336-2020-25-579-591.
Developing of algorithm for the post-surgical management of patients with iodine-negative metastasesof differentiated thyroid cancer (DTC).
The DTC patients with iodine-negative metastases (n = 115) were enrolled in the study.Of them the whole body scintigraphy (WBS) was performed with technetium-99m-hexakis-2-methoxyisobutylisonitrile(99mTc-MIBI) (n = 30), WBS with technetium-99m dimercaptosuccinic acid (99mTc-DMSA) (n = 30), 18FDG PET (n = 30), andcomputer tomography (CT-scan) (n = 25). Complex 99mTc-pertechnetate scans including the dynamic and static scintigraphy was performed supplementary to 99mTc-MIBI WBS in 10 patients to obtain the angiographic curves from DTCmetastatic foci. The non-radioiodine radiopharmaceutical technologies, namely the labeled 99mTc-MIBI, 99mTc-DMSA, 99mTc-pertechnetate, and 18FDG were applied to detect the iodine-negative DTC metastases. Radioisotopic examinationswere performed at the dual-head gamma camera (Mediso Medical Imaging Systems Ltd., Hungary) and single photonemission computed tomography (SPECT) scanner «E.CAM» (Siemens, Germany). PET/CT scans were performed on the«Biograph 64 TruePoint» imaging platform (Siemens, Germany) in accordance with the European Association of NuclearMedicine (EANM) recommendations for the Siemens imaging devices with 3D-mode data acquisition.
The conducted research suggested that it is feasible to use the non-radioiodine (99mTc-MIBI and 99mTc-DMSA)radiopharmaceutical technologies to detect the iodine-negative DTC metastases. 18FDG PET is a highly informativetechnology for the detection of iodine-negative DTC metastases in case of lung involvement in the process. Compareof the non-radioiodine radiopharmaceuticals, CT scan and 18FDG-PET/CT indicated the highest sensitivity of 18FDGPET/CT (p < 0.05). WBS with 99mTc-MIBI and 99mTc-DMSA featured the highest specificity (100 %, p < 0.05). X-ray CTis marked by the significantly lower either sensitivity, specificity, and accuracy rate (p > 0.05). Developing andapplication of algorithm for the post-surgical management of patients with iodine-negative forms of DTC will allowfor the betimes detection of relapses and metastases with administration of adequate surgical, radiation, and targeted treatment.
Obtained results offer the opportunity to optimize the post-surgical management of patients withiodine-negative DTC forms using the options of radionuclide diagnostics with non-radioiodine radiopharmaceuticals. The latter are readily available providing the cost-cutting of diagnostic support in these patients. Place ofmorphological methods of diagnosis is determined and stage of monitoring of patients with the iodine-negativemetastases is established. Possibility of the 18FDG-PET tests for the early diagnosis of iodine-negative metastases inDTC for the first time have been studied and substantiated in Ukraine. A comprehensive radiation algorithm for thelong-term monitoring of this category of patients will allow the timely detection of recurrences and metastases ofDTC and appropriate surgery, radiation and targeted therapy administration. Data obtained as a result of the studyallowed to improve the overall and recurrence-free survival rates in the able-bodied DTC patients and reduce thecosts of follow-up of patients with iodine-negative forms of DTC.
制定分化型甲状腺癌（DTC）碘阴性转移患者术后管理的算法。
本研究纳入了 115 例碘阴性转移的 DTC 患者。其中，30 例行锝-99m 六甲基异丁基异腈（99mTc-MIBI）全身闪烁扫描（WBS），30 例行锝-99m 二巯丁二酸（99mTc-DMSA）WBS，30 例行 18FDG PET，25 例行计算机断层扫描（CT 扫描）。为了从 DTC 转移灶获得血管造影曲线，在 10 例患者中，我们在 99mTc-MIBI WBS 之外还进行了补充的 99mTc-高锝酸盐动态和静态闪烁扫描。我们使用标记的 99mTc-MIBI、99mTc-DMSA、99mTc-高锝酸盐和 18FDG 等非放射性核素放射性药物技术来检测碘阴性 DTC 转移灶。我们在 Mediso Medical Imaging Systems Ltd. 的双头伽马相机（匈牙利）和西门子的单光子发射计算机断层扫描仪（SPECT）扫描仪“E.CAM”（德国）上进行放射性同位素检查。根据欧洲核医学协会（EANM）对具有 3D 模式数据采集功能的西门子成像设备的建议，我们在“Biograph 64 TruePoint”成像平台（西门子，德国）上进行了 PET/CT 扫描。
研究表明，使用非放射性碘（99mTc-MIBI 和 99mTc-DMSA）放射性药物技术来检测碘阴性 DTC 转移灶是可行的。在肺部受累的情况下，18FDG PET 是一种非常有价值的检测碘阴性 DTC 转移灶的技术。在比较非放射性放射性药物时，CT 扫描和 18FDG-PET/CT 显示 18FDG-PET/CT 的敏感性最高（p < 0.05）。99mTc-MIBI 和 99mTc-DMSA 的 WBS 具有最高的特异性（100%，p < 0.05）。X 射线 CT 的敏感性、特异性和准确性均显著较低（p > 0.05）。制定和应用碘阴性 DTC 术后管理的算法将允许及时发现复发和转移，并进行适当的手术、放射和靶向治疗。
获得的结果为使用非放射性核素放射性药物的放射性核素诊断方法的选择提供了优化碘阴性 DTC 患者术后管理的机会。这些方法在这些患者中很容易获得，从而降低了诊断支持的成本。形态学诊断方法的位置已确定，并且确定了碘阴性转移患者的监测阶段。18FDG-PET 测试在乌克兰首次用于碘阴性转移的 DTC 的早期诊断的可能性已得到研究和证实。长期监测这一类患者的综合放射算法将允许及时发现 DTC 的复发和转移，并进行适当的手术、放射和靶向治疗。该研究的结果使我们能够提高有能力的 DTC 患者的总生存率和无复发生存率，并降低随访碘阴性 DTC 患者的成本。
