Applied radiation and isotopes : including data, instrumentation and methods for use in agriculture, industry and medicine · 2025
Is 131I treatment necessary for postoperative DTC patients classified as intermediate- or high-risk with negative stimulated thyroglobulin?
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Luo Yao, Xu Ruoxin, Xiao Canran, Xu Zeqing, Tang Caihua
Аннотация
PURPOSE: Several studies have indicated that postoperative differentiated thyroid cancer (DTC) patients with stimulated thyroglobulin (sTg) levels <1 ng/mL could directly transition to thyroid stimulating hormone (TSH) suppression therapy. However, a number of cases with negative sTg have also shown residual thyroid tissue (RTT) or metastases through various imaging examinations. This study aimed to assess the necessity of 131I treatment for DTC patients classified as intermediate- or high-risk for recurrence with sTg levels below 1 ng/mL.
METHODS: A retrospective analysis was conducted on a total of 158 postoperative DTC patients classified as intermediate- or high-risk for recurrence with pre-ablation sTg levels below 1 ng/mL, as well as a subgroup of 51 DTC patients with pre-ablation sTg levels below 0.04 ng/mL. A comprehensive comparison was conducted between the results of pre-ablation imaging examinations and post therapy 131I whole body scans (RxWBS, with SPECT/CT) in terms of RTT, cervical lymph nodes, or distant metastases. The therapeutic response of 131I treatment was also evaluated.
RESULTS: The presences of RTT or unsuspected metastases were detected in 141 patients by RxWBS: 87.3 % (138/158) exhibited RTT, whereas 16.5 % (26/158) had metastatic lymph nodes. Compare to other pre-ablation imaging modalities, RxWBS demonstrated superior sensitivity in identifying both RTT (87.3 % vs. 37.3 %) and metastatic lymph nodes (16.5 % vs. 2.5 %). Among the 141 patients (89.2 %, 141/158) who were positive on RxWBS, 132 patients (93.6 %, 132/141) achieved an excellent response (ER) after the 131I treatment.
CONCLUSION: For postoperative DTC patients classified as intermediate or high risk for recurrence with negative sTg, RTT or metastases may still be present in most cases. 131I treatment is necessary for these patients regardless of serum sTg results, and a majority of them could have favorable therapeutic response.
METHODS: A retrospective analysis was conducted on a total of 158 postoperative DTC patients classified as intermediate- or high-risk for recurrence with pre-ablation sTg levels below 1 ng/mL, as well as a subgroup of 51 DTC patients with pre-ablation sTg levels below 0.04 ng/mL. A comprehensive comparison was conducted between the results of pre-ablation imaging examinations and post therapy 131I whole body scans (RxWBS, with SPECT/CT) in terms of RTT, cervical lymph nodes, or distant metastases. The therapeutic response of 131I treatment was also evaluated.
RESULTS: The presences of RTT or unsuspected metastases were detected in 141 patients by RxWBS: 87.3 % (138/158) exhibited RTT, whereas 16.5 % (26/158) had metastatic lymph nodes. Compare to other pre-ablation imaging modalities, RxWBS demonstrated superior sensitivity in identifying both RTT (87.3 % vs. 37.3 %) and metastatic lymph nodes (16.5 % vs. 2.5 %). Among the 141 patients (89.2 %, 141/158) who were positive on RxWBS, 132 patients (93.6 %, 132/141) achieved an excellent response (ER) after the 131I treatment.
CONCLUSION: For postoperative DTC patients classified as intermediate or high risk for recurrence with negative sTg, RTT or metastases may still be present in most cases. 131I treatment is necessary for these patients regardless of serum sTg results, and a majority of them could have favorable therapeutic response.