Kraus Teresa, Shengelia-de Lange Natalia, Einspieler Holger, Hacker Marcus, Haug Alexander, Kretschmer-Chott Elisabeth, Karanikas Georgios
Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
Division of Nuclear Medicine, Tbilisi State Medical University, Tbilisi, Georgia.
Endocr Connect. 2024 Apr 12;13(5). doi: 10.1530/EC-24-0007. Print 2024 May 1.
The most important part of the follow-up of differentiated thyroid carcinoma (DTC) is the measurement of serum thyroglobulin (Tg). An increase of Tg levels indicates likely tumor recurrence. According to the guidelines of the European Society of Medical Oncology (ESMO), the follow-up should consist of serum Tg assays and a neck ultrasound, while the American Thyroid Association (ATA) recommends serum Tg assays, neck ultrasounds, and a diagnostic radioiodine whole-body scan (WBS) if non-stimulated Tg is greater than 10 ng/mL or if Tg is rising. This study questions the necessity of a diagnostic WBS in patients with low stimulated Tg levels during the initial follow-up.
This study is a retrospective data analysis.
The data of 185 patients, who were in regular treatment and aftercare between 2015 and 2018 at the Department of Nuclear Medicine in Vienna, as well as the data of 185 patients who were treated in Tbilisi between 2015 and 2019, were analyzed.
There was a highly significant relationship between low stimulated Tg levels (<0.5 ng/mL) and the outcome of the diagnostic WBS at the first follow-up (χ 2 = 14.7, P < 0.001). In total, 31 out of 370 patients (8.4%) had positive findings in the diagnostic WBS. Seventy-five of 370 patients (19.74%) had stimulated Tg levels >0.5 ng/mL.
Our data suggest that the first follow-up, 4-12 months after the initial therapy of DTC, including the measurement of basal and stimulated Tg levels and Tg antibody levels, does not mandate a diagnostic WBS on all patients.
In this study, we examined the still commonly used routine diagnostic radioiodine whole-body scan in the first follow-up of patients with differentiated thyroid carcinoma. We questioned the necessity of the scan in patients with low stimulated thyroglobulin levels. Therefore, we combined retrospective data from the University Hospital in Vienna and in Tbilisi to analyze 370 patients. We were able to demostrate a highly significant relationship between low stimulated thyroglobulin levels (<0.5 ng/mL) and the outcome of the diagnostic scan at the first follow-up (χ = 14.7, P < 0.001).
分化型甲状腺癌（DTC）随访中最重要的部分是血清甲状腺球蛋白（Tg）的测定。Tg水平升高提示可能肿瘤复发。根据欧洲医学肿瘤学会（ESMO）指南，随访应包括血清Tg检测和颈部超声检查，而美国甲状腺协会（ATA）建议进行血清Tg检测、颈部超声检查，并且如果非刺激状态下Tg大于10 ng/mL或Tg呈上升趋势，则进行诊断性放射性碘全身扫描（WBS）。本研究对初次随访期间刺激后Tg水平较低的患者进行诊断性WBS的必要性提出质疑。
本研究为回顾性数据分析。
分析了2015年至2018年在维也纳核医学科接受正规治疗及后续护理的185例患者的数据，以及2015年至2019年在第比利斯接受治疗的185例患者的数据。
初次随访时刺激后Tg水平较低（<0.5 ng/mL）与诊断性WBS结果之间存在高度显著相关性（χ2 = 14.7，P < 0.001）。370例患者中共有31例（8.4%）诊断性WBS检查结果为阳性。370例患者中有75例（19.74%）刺激后Tg水平>0.5 ng/mL。
我们的数据表明，DTC初始治疗后4至12个月的初次随访，包括基础及刺激后Tg水平和Tg抗体水平的测定，并不要求对所有患者进行诊断性WBS。
在本研究中，我们检查了分化型甲状腺癌患者初次随访时仍常用的常规诊断性放射性碘全身扫描。我们对刺激后甲状腺球蛋白水平较低的患者进行扫描的必要性提出质疑。因此，我们合并了维也纳大学医院和第比利斯大学医院的回顾性数据，以分析370例患者。我们能够证明初次随访时刺激后甲状腺球蛋白水平较低（<0.5 ng/mL）与诊断性扫描结果之间存在高度显著相关性（χ = 14.7，P < 0.001）。
