Franceschi M, Kusić Z, Franceschi D, Lukinac L, Roncević S
Department of Nuclear Medicine and Oncology, University Hospital, Sestre Milosrdnice, Zagreb, Croatia.
J Nucl Med. 1996 Mar;37(3):446-51.
The long-term prognosis of patients with differentiated thyroid carcinoma depends on the early diagnosis and treatment of metastases and local recurrences. We evaluated serum thyroglobulin measurements, neck ultrasonography with ultrasound-guided biopsy and 131I whole-body scintigraphy in the follow-up of 359 patients after surgical thyroidectomy and radioiodine ablation of the thyroid remnant.
Serum thyroglobulin levels were determined and considered abnormal when the values were > 5 ng/ml. Ultrasonography over the entire neck region and fine-needle aspiration biopsy of the mass or enlarged lymph nodes were carried out using 5- and 7.5-MHz transducers and 23-gauge needles. Whole-body scintigraphy was performed after administration of 185 MBq (5 mCi)131I.
Increased levels of thyroglobulin (ranging from 12 to > 600 ng/ml) were measured in 40 of 55 (73%) patients with metastases or local recurrences. Ultrasonography revealed occult neck masses that were not detected by other methods. Neck ultrasonography and ultrasound-guided biopsy were positive for malignancy in 23 patients. Thyroglobulin levels were undetectable in 12 (52%) of these patients and 131I whole-body scintigraphy was negative in 19 (83%) of them.
The combined use of three diagnostic modalities (measurement of serum thyroglobulin, neck ultrasonography with ultrasound-guided biopsy for detecting recurrences of carcinoma in the neck region and 131I whole-body scintigraphy) appears to give the best results in the follows-up patients with differentiated thyroid carcinoma.
分化型甲状腺癌患者的长期预后取决于转移灶和局部复发的早期诊断与治疗。我们评估了359例甲状腺切除术后及甲状腺残余组织放射性碘消融术后患者随访过程中的血清甲状腺球蛋白测量、颈部超声检查及超声引导下活检以及131I全身显像。
测定血清甲状腺球蛋白水平，当值>5 ng/ml时视为异常。使用5兆赫和7.5兆赫的换能器及23号针，对整个颈部区域进行超声检查，并对肿块或肿大淋巴结进行细针穿刺活检。给予185 MBq（5 mCi）131I后进行全身显像。
55例有转移或局部复发的患者中，40例（73%）甲状腺球蛋白水平升高（范围为12至>600 ng/ml）。超声检查发现了其他方法未检测到的隐匿性颈部肿块。23例患者颈部超声检查及超声引导下活检呈恶性阳性。这些患者中有12例（52%）甲状腺球蛋白水平检测不到，19例（83%）131I全身显像为阴性。
联合使用三种诊断方法（血清甲状腺球蛋白测量、颈部超声检查及超声引导下活检以检测颈部区域癌复发和131I全身显像）在分化型甲状腺癌患者的随访中似乎能取得最佳结果。
