Stegenga Merel T, Visser W Edward, Peeters Robin P, van Kemenade Folkert J, Medici Marco, van Ginhoven Tessa M, Verburg Frederik A, van Velsen Evert F S
Academic Center for Thyroid Disease, Department of Internal Medicine, Erasmus Medical Center, 3015 CE, Rotterdam, the Netherlands.
Academic Center for Thyroid Disease, Department of Pathology, Erasmus Medical Center, 3015 CE, Rotterdam, the Netherlands.
J Endocr Soc. 2025 Apr 3;9(5):bvaf051. doi: 10.1210/jendso/bvaf051. eCollection 2025 May.
Guidelines vary in their recommendations for postoperative radioactive iodine (RAI) in differentiated thyroid cancer (DTC). Omitting RAI reduces overtreatment but poses the possibility of missing distant metastases.
This study compares 4 guidelines on RAI indications and potentially missed metastases.
DTC patients were included retrospectively, including 48 patients with distant metastases after first RAI cycle, and 469 without distant metastases. The percentage of distant metastases missed was calculated if RAI had been omitted following the 2015 American Thyroid Association (ATA), 2019 European Society for Medical Oncology (ESMO), 2022 European Thyroid Association (ETA), and 2022 American Society of Nuclear Medicine and Molecular Imaging/European Association of Nuclear Medicine (SNMMI/EANM) guidelines.
In patients without RAI indication, 1.3% to 1.6% of distant metastases may initially be missed with the ATA, ESMO, and ETA guidelines. All these cases had postoperative thyroglobulin (Tg) between 1 and 10 ng/mL or positive Tg antibodies (Tg-abs). In patients for whom RAI should be considered following the ATA, ESMO, and ETA guidelines, 2.6% to 4.0% of distant metastases may initially be missed, with all but 1 case having Tg greater than 10 ng/mL or positive Tg-abs. With the SNMMI/EANM guideline, no distant metastases would be missed, but it resulted in markedly higher RAI use in low-risk patients (82% vs 0%).
Omitting postoperative RAI in low- and intermediate-risk patients, as recommended by the 2015 ATA, 2019 ESMO, and 2022 ETA guidelines, may lead to a small number of initially undetected distant metastases. However, these metastases could potentially be detected later due to the presence of biochemical disease. In contrast, the broader RAI indications endorsed by SNMMI/EANM reduce the likelihood of missed metastases, but substantially increases RAI use, exposing patients to unnecessary treatment and side effects.
分化型甲状腺癌（DTC）术后放射性碘（RAI）的推荐指南各不相同。省略RAI可减少过度治疗，但存在遗漏远处转移的可能性。
本研究比较了4项关于RAI适应症和潜在遗漏转移的指南。
回顾性纳入DTC患者，包括48例首次RAI周期后发生远处转移的患者和469例无远处转移的患者。如果按照2015年美国甲状腺协会（ATA）、2019年欧洲医学肿瘤学会（ESMO）、2022年欧洲甲状腺协会（ETA）以及2022年美国核医学与分子影像学会/欧洲核医学协会（SNMMI/EANM）指南省略RAI，则计算遗漏远处转移的百分比。
在无RAI适应症的患者中，根据ATA、ESMO和ETA指南，最初可能会遗漏1.3%至1.6%的远处转移。所有这些病例术后甲状腺球蛋白（Tg）在1至10 ng/mL之间或Tg抗体（Tg-abs）呈阳性。在根据ATA、ESMO和ETA指南应考虑进行RAI的患者中，最初可能会遗漏2.6%至4.0%的远处转移，除1例患者外，所有患者的Tg均大于10 ng/mL或Tg-abs呈阳性。按照SNMMI/EANM指南，不会遗漏远处转移，但这导致低风险患者的RAI使用显著增加（82%对0%）。
按照2015年ATA、2019年ESMO和2022年ETA指南的建议，在低风险和中风险患者中省略术后RAI可能会导致少数远处转移最初未被发现。然而，由于存在生化疾病，这些转移可能随后被检测到。相比之下，SNMMI/EANM认可的更广泛的RAI适应症降低了遗漏转移的可能性，但大幅增加了RAI的使用，使患者面临不必要的治疗和副作用。
