Timing of post 131I ablation diagnostic whole body scan in differentiated thyroid cancer patients

M. Winter; J. Winter; A. Heinzel; F. F. Behrendt; T. Krohn; F. M. Mottaghy; F. A. Verburg

doi:10.3413/Nukmed-0733-15-03

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2015; 54(04): 151-157
DOI: 10.3413/Nukmed-0733-15-03

Original article

Schattauer GmbH

Timing of post ¹³¹I ablation diagnostic whole body scan in differentiated thyroid cancer patients

Less than four months post ablation may be too early

M. Winter

¹RWTH University Hospital Aachen, Department of Nuclear Medicine, Aachen, Germany

,

J. Winter

¹RWTH University Hospital Aachen, Department of Nuclear Medicine, Aachen, Germany

,

A. Heinzel

¹RWTH University Hospital Aachen, Department of Nuclear Medicine, Aachen, Germany

,

F. F. Behrendt

¹RWTH University Hospital Aachen, Department of Nuclear Medicine, Aachen, Germany

,

T. Krohn

¹RWTH University Hospital Aachen, Department of Nuclear Medicine, Aachen, Germany

,

F. M. Mottaghy

¹RWTH University Hospital Aachen, Department of Nuclear Medicine, Aachen, Germany

²Maastricht University Medical Center, Department of Nuclear Medicine, Maastricht, the Netherlands

,

F. A. Verburg

¹RWTH University Hospital Aachen, Department of Nuclear Medicine, Aachen, Germany

²Maastricht University Medical Center, Department of Nuclear Medicine, Maastricht, the Netherlands

› Author Affiliations

Abstract

Zusammenfassung

Ziel: Beantwortung der Frage, ob drei Monate nach ¹³¹I-Ablation als zu früh für eine diagnostische Radioiod-Ganzkörperszintigraphie (dxWBS) bei Patienten mit einem differenzierten Schilddrüsenkarzinom (DTC) anzusehen sind. Patienten, Material, Methode: Daten von 462 DTC-Patienten, die in unserem Klinikum behandelt worden waren, wurden analysiert. Alle Patienten wurden thyreoid ektomiert. Von 129 Patienten waren folgende Daten verfügbar a) eine dxWBS mit gleichzeitiger TSH-stimulierter Thyreoglobulin-Messung, die innerhalb von vier Monaten (max. 120 Tage) nach ¹³¹I-Ablation durchgeführt wurde ohne weitere therapeutische Maßnahmen zwischen Ablation und dxWBS, b) eine zweite dxWBS oder ¹³¹I-Therapie (rxWBS), die innerhalb von 1,5 Jahren nach Ablation durchgeführt wurde. Ergebnisse: Bei 25/129 Patienten stimmten die Ergebnisse der initialen und weiteren Scans nicht überein: Bei 15 von 54 Patienten (27%) mit einem positiven initialen dxWBS widersprachen diese Ergebnisse dem zweiten dxWBS oder rxWBS. Neue Läsionen wurden bei 10/74 (14%) Patienten mit einem initial negativen dxWBS entdeckt. Eine Diskordanz zwischen dem ersten und weiteren in der Nachsorge gemessenen stimulierten Tg-Werten wurde in 5/129 (4%) der Patienten gefunden: Bei 2/90 (2%) Patienten mit einer negativen ersten stimulierten Tg-Bestimmung wurde nachfolgend ein positives Ergebnis gefunden. Bei 3/29 (10%) Patienten mit einer positiven ersten Bestimmung wurde bei der zweiten Untersuchung ein negatives Ergebnis festgestellt. Schlussfolgerung: Weniger als vier Monate nach ¹³¹I-Ablation ist zu früh für eine diagnostische Radioiod-Ganzkörperszintigraphie mit zeitgleich TSH-stimulierter Tg-Messung. Die Ermittlung des richtigen späteren Zeitpunkts erfordert weitere Untersuchungen.

Das Zeitintervall zwischen 131I Ablation und diagnostischer Ganzkörperszintigraphie bei Patienten mit differenziertem Schilddrüsenkarzinom Weniger als vier Monate nach Ablation dürfte zu früh sein

Summary

Aim: to determine whether the first three months after ¹³¹I ablation is too early to perform radioiodine diagnostic whole body scintigraphy (dxWBS) in differentiated thyroid carcinoma patients. Patients, material, methods: The files of 462 patients who were treated for DTC in our hospital were reviewed. All patients underwent surgical thyroidectomy. 146 patients had data available on a. a dxWBS which was performed less than four months (max 120 days) after ¹³¹I ablation with concurrent stimulated TSH stimulated thyroglobulin (Tg) measurement without further therapeutic measures between ablation and dxWBS and b. a second dxWBS or ¹³¹I therapy (rxWBS) within 1.5 years after ablation. Results: A discordance between the initial and follow-up scan was found in 25/129 (19%) patients: of 54 patients with a positive initial dxWBS, scan results of a second dxWBS or rxWBS obtained with a suitable distance to the initial scan contradicted the initial one in 15 patients (27%). New lesions were discovered in 10/74 negative first dxWBS cases (14%). A discordance between the initial and follow-up stimulated Tg was found in 5/129 (4%) patients: 2/90 (2%) of patients with a negative stimulated Tg at initial dxWBS subsequently showed a positive results whereas 3/29 (10%) patients with an initially positive Tg showed a negative Tg level at the second procedure. Conclusion: Less than four months after ¹³¹I ablation is too early to perform radioiodine diagnostic whole body scintigraphy with concurrent TSH stimulated Tg measurement. The identification of the right, later, timepoint however requires further research.

Schlüsselwörter

Differenziertes Schilddrüsenkarzinom - ¹³¹I-Ablation - Behandlungserfolg - diagnostische Radioiod-Ganzkörperszintigraphie

Keywords

Differentiated thyroid cancer - ¹³¹I ablation - treatment success - diagnostic whole body scintigraphy

Full Text

References

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