Bianchi R, Iervasi G, Matteucci F, Turchi S, Cazzuola F, Bellina C R, Boni G, Molea N, Ferdeghini M, Toni M G
CNR Institute of Clinical Physiology, University of Pisa, Italy.
J Nucl Med. 1993 Nov;34(11):2032-7.
Patients with differentiated thyroid cancer (DTC) are conventionally followed with serial 131I whole-body scintigraphy (WBS) and serum thyroglobulin (hTg) assay. Given the 15%-20% incidence of discordant results, we developed a sensitive and specific procedure for monitoring such patients, based on the assumption that 131I uptake, even if too low to be detected by 131I WBS, could be assayed in serum as thyroid products (hTg, T3 and T4) endogenously labeled with 131I. Our study included 125 patients routinely monitored for tumor recurrence or for the persistence of functioning thyroid tissue after complete primary treatment for DTC (surgery and 131I ablation of remnants). A plasma sample, taken 72 hr after administering 131I for WBS was fractionated on a Sephadex-G25 superfine column by first eluting all of the radioactive species except the thyroid hormones and then the radioiodothyronines. The sensitivity and specificity of chromatography in detecting functioning thyroid tissue after primary treatment for DTC were 98.4% and 100% (accuracy 99.2%), respectively, versus 90.6% and 95.1% for 131I WBS (accuracy 92.8%) and 60.9% and 100% for hTg (accuracy 80%). Combining chromatography with serum hTg gave the highest gains in diagnostic performance (100% for all parameters). This chromatographic method can be used in addition to conventional procedures in the follow-up of patients with DTC and represents a highly sensitive test for assessing the results of 131I ablation of postsurgical remnants.
分化型甲状腺癌（DTC）患者传统上采用连续的¹³¹I全身闪烁扫描（WBS）和血清甲状腺球蛋白（hTg）检测进行随访。鉴于结果不一致的发生率为15%-20%，我们基于这样的假设开发了一种敏感且特异的程序来监测此类患者，即¹³¹I摄取，即使低至¹³¹I WBS无法检测到，也可以在血清中作为内源性标记有¹³¹I的甲状腺产物（hTg、T3和T4）进行检测。我们的研究纳入了125例在DTC初次完全治疗（手术和¹³¹I清除残余组织）后常规监测肿瘤复发或功能性甲状腺组织残留情况的患者。在进行¹³¹I WBS后72小时采集的血浆样本，先在Sephadex-G25超细柱上进行分离，洗脱除甲状腺激素外的所有放射性物质，然后洗脱放射性碘甲状腺原氨酸。对于DTC初次治疗后检测功能性甲状腺组织，色谱法的敏感性和特异性分别为98.4%和100%（准确率99.2%），而¹³¹I WBS的敏感性和特异性分别为90.6%和95.1%（准确率92.8%），hTg的敏感性和特异性分别为60.9%和100%（准确率80%）。将色谱法与血清hTg相结合在诊断性能方面提升最大（所有参数均为100%）。这种色谱方法可用于DTC患者随访的常规程序之外，是评估¹³¹I清除术后残余组织结果的一种高度敏感的检测方法。
