Undetectable or low (<1 ng/ml) postsurgical thyroglobulin values do not rule out metastases in early stage differentiated thyroid cancer patients
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Alfredo Campennì1, Luca Giovanella2, Salvatore Antonio Pignata1, Antonio Vento1, Angela Alibrandi4, Letterio Sturiale1, Riccardo Laudicella1, Alessio Danilo Comis1, Rossella Filice1, Giuseppe Giuffrida3, Maria Elena Stipo1, Salvatore Giovinazzo3, Francesco Trimarchi5, Rosaria Maddalena Ruggeri3 and Sergio Baldari1
1Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
2Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
3Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Messina, Messina, Italy
4Department of Economical, Business and Environmental Sciences and Quantitative Methods, University of Messina, Messina, Italy
5Accademia Peloritana dei Pericolanti, University of Messina, Messina, Italy
Alfredo Campennì, email: [email protected]
Keywords: differentiated thyroid cancer; 131-radioiodine treatment; 131-radioiodine thyroid remnant ablation; thyroglobulin; post-therapy whole body scintigraphy
Received: December 11, 2017 Accepted: February 26, 2018 Published: April 03, 2018
Background: Differentiated thyroid cancer (DTC) work-up is based on (near)total-thyroidectomy plus thyroid remnant ablation (TRA) with 131-radioiodine in many patients, and long-life follow-up. 131I-post therapy whole body scan (pT-WBS) and serum thyroglobulin (Tg) are used in identifying metastatic patients. Some authors have evaluated the possibility of using post-surgical Tg (ps-Tg) values in deciding for or against TRA. The aim of our study was to verify the diagnostic accuracy of 131I-pT-WBS and SPECT/CT imaging (post-therapeutic imaging) compared to serum Tg levels in detecting metastases in early stage of DTC patients.
Results: Post-therapeutic imaging revealed metastases in 82 out of 570 (14.4%) patients. Metastases were successively confirmed by other diagnostic tools or by histology (sensitivity and PPV = 100%). Seventy-three out of 82 patients (90.2%) showed ps-Tg levels ≤1 ng/ml. In fifty-four per cent of patients, serum Tg levels at TRA remained ≤1 ng/ml.
Conclusion: In conclusion, ps-Tg levels cannot be used in deciding for or against TRA. In early stage of DTC, post-therapeutic imaging (131I-pT-WBS and SPECT/CT) is an accurate method of detecting metastases, also in patients with stimulated serum Tg values ≤1 ng/ml
Methods: We retrospectively reviewed the records of 570 consecutive patients affected by pT1-pT3 DTC (F = 450, M = 120), referred to our Nuclear Medicine Units in the last five years to perform TRA after (near)-total-thyroidectomy.All patients underwent TRA 3-4 months after thyroid surgery either in euthyroid or in hypothyroid state. Serum Tg values evaluated in post-surgical period and at TRA were matched with post-therapeutic imaging results.
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