术后儿童及青年分化型甲状腺癌患者诊断及治疗后碘-131全身扫描的最佳时间

Optimal Time of Diagnostic and Posttherapeutic Iodine-131 Whole-body Scan in Post-Operative Pediatric and Young Adult Differentiated Thyroid Cancer Patients.

作者信息

Kumar Praveen, Bal Chandrasekhar, Damle Nishikant Avinash

机构信息

Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.

出版信息

Indian J Nucl Med. 2024 Nov-Dec;39(6):428-435. doi: 10.4103/ijnm.ijnm_133_24. Epub 2025 Mar 20.

DOI:10.4103/ijnm.ijnm_133_24

PMID:40291353

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12020971/

Abstract

PURPOSE OF THE STUDY

The 2015 American Thyroid Association pediatric differentiated thyroid cancer (DTC) guidelines recommend posttherapy whole body scan (PTS) 4-7 days after (Iodine-131) I-131 activity administration. There is no recommendation of timing of performing a diagnostic whole-body scan (Dx-WBS). However, this 4-7 day time frame for PTS lacks a solid basis and is essentially arbitrary. This is especially crucial as it has the potential to significantly impact patient management. Our primary goal in this study was to establish the optimal timing for both Dx-WBS and PTS in pediatric and young adult patients with DTC.

METHODS

The DTC patients aged ≤21 years underwent serial whole-body scan (WBS) at 24 h, 48 h, and/or 72 h or more after the administration of diagnostic and therapeutic activities of I-131. The utility of Dx-WBS and PTS was assessed based on the identification of new lesions that could potentially influence the prescribed therapeutic activity of I-131. The optimal timing for acquiring Dx-WBS and PTS was determined based on when the first lesion appeared in the I-131 WBS.

RESULTS

Ninety-five patients (27 males and 68 females) with an average age of 17.9 ± 3 years received a 74 MBq I-131 for Dx-WBS. Ten patients (10.5%) showed no uptake in Dx-WBS, thus, no I-131 therapy was given. The remaining 85 patients received a therapeutic activity of 1.11-5.55 GBq I-131 based on the extent of their disease. The serial Dx-WBS or PTS showed no additional lesions in patients with thyroid remnants. However, additional nodes were detected in 2/32 patients in the ≥48 h Dx-WBS, and 1/32 patients in the known nodal disease patients, which were not clinically relevant. Importantly, 72 h PTS picked up pulmonary metastases in 17.6% (3 out of 17) of patients, which were missed in serial Dx-WBS. However, >72 h PTS did not have additional value.

CONCLUSION

I-131 Dx-WBS is best to be performed at 48 h, and PTS at 72 h in pediatric and young adult patients with DTC.

摘要

研究目的

2015年美国甲状腺协会儿科分化型甲状腺癌（DTC）指南推荐在给予（碘-131）I-131活性物质后4 - 7天进行治疗后全身扫描（PTS）。对于进行诊断性全身扫描（Dx-WBS）的时间未给出推荐。然而，PTS的这4 - 7天时间框架缺乏坚实依据，基本上是随意确定的。这一点尤为关键，因为它有可能对患者的治疗管理产生重大影响。本研究的主要目标是确定儿科和年轻成年DTC患者进行Dx-WBS和PTS的最佳时间。

方法

年龄≤21岁的DTC患者在给予I-131诊断和治疗活性物质后24小时、48小时和/或72小时及更长时间接受系列全身扫描（WBS）。基于对可能影响规定的I-131治疗活性的新病灶的识别来评估Dx-WBS和PTS的效用。根据I-131 WBS中首次出现病灶的时间来确定获取Dx-WBS和PTS的最佳时间。

结果

95例患者（27例男性和68例女性），平均年龄17.9±3岁，接受74 MBq的I-131进行Dx-WBS。10例患者（10.5%）在Dx-WBS中未显示摄取，因此未给予I-131治疗。其余85例患者根据疾病程度接受了1.11 - 5.55 GBq I-131的治疗活性物质。系列Dx-WBS或PTS在甲状腺残留患者中未显示额外病灶。然而，在≥48小时的Dx-WBS中，2/32例患者检测到额外淋巴结，在已知有淋巴结疾病的患者中有1/32例患者检测到额外淋巴结，这些淋巴结在临床上并无相关性。重要的是，72小时的PTS在17.6%（17例中的3例）的患者中发现了肺转移灶，而系列Dx-WBS中未检测到这些转移灶。然而，>72小时的PTS没有额外价值。