Evaluation of Discordance in Differentiated Thyroid Cancer Patients with Negative Radioiodine Scans and Positive Thyroglobulin Values at the Ablation Outcome Control

Yıl 2012, Cilt: 2012 Sayı: 1, 43 - 48, 01.01.2012

Zeynep Gözde Özkan İşık Adalet Cüneyt Türkmen Halim İşsever Yeşim Erbil Harika Boztepe Neşe Çolak Ferihan Aral

https://doi.org/10.5152/balkanmedj.2011.004

Öz

Objective: We aimed to evaluate the discordance of 5 mCi (185 MBq) I-131 whole body scan (WBS) and thyroglobulin (Tg) values at the ablation outcome control in differentiated thyroid cancer (DTC) patients who had thyroidectomy and then received radioiodine (RAI) ablation. Materials and Methods: We retrospectively evaluated 36 DTC patients who had RAI treatment in our department between 1992-2009 and whose 5 mCi (185 MBq) I-131 WBS were negative, but Tg values were ≥2 ng/ml during the ablation outcome control (Patient group). Thirty-six patients whose Tg values were < 2 ng/ml and showed no discordance at the same control made up the control group. Patient and control groups were compared in terms of age, gender, histopathological features, ablation dose, Tg value before ablation, and 24. hour RAI uptake value during ablation. The patient group was then evaluated for the cause of the discordance. Results: There were 28 female and 8 male patients whose mean age was 45.6±11.39 in patient group. In the control group, there were 29 female and 7 male patients whose mean age was 41.5±11.69. According to the reason of discordance at the ablation outcome control, the patient group was divided into 2 groups: 15 (42%) patients (9 female, 6 male patients, mean age: 50.66±10.73) who had metastatic lymph nodes as the reason of discordance constituted the lymph node group. The remaining 21 (58%) patients (19 female, 2 male patients, mean age: 41.5±10.44) were the micrometastatic group in which the cause of discordance could not be determined. There were statistically significant differences in soft tissue invasion (p<0.003), Tg levels before RAI treatment (p<0.002), and diameter of tumor >2 cm (p<0.035) between patient and control groups. Among the patient group, male gender (p<0.03), diameter of tumor >2 cm (p<0.05), thyroid capsule invasion (p<0.03), and age>40 (p<0.01) were significantly different between lymph node and micrometastatic groups. Conclusion: I-131 WBS/Tg level discordance at the ablation outcome control is mainly caused by metastatic lymph nodes. Turkish Başlık: Diferansiye Tiroid Karsinomlarında Ablasyon Kontrolü Sırasında Ortaya Çıkan 5 Mci İyot-131 Sintigrafisi Negatif, Tiroglobulin Pozitif Uyumsuzluğunun Değerlendirilmesi Anahtar Kelimeler: Diferansiye tiroid karsinomu, radyoaktif iyot tedavisi, I-131 tüm vücut tarama, lenf nodu metastazı Amaç: Diferansiye tiroid karsinomu (DTK) hastalarında, ablasyon kontrolü sırasında ortaya çıkan 5 mCi İyot-131 tüm vücut sintigrafisi ve tiroglobülin değeri uyumsuzluğunu ve bunun olası nedenlerini incelemeyi amaçladık. Hastalar ve Yöntemler: DTK tanılı hastalarda ablasyon kontrolü için yapılan 5 mCi TVS (-) ve Tg değeri ≥2ng/ml olan 36 hasta retrospektif olarak incelendi(hasta grubu). Tg değerleri <2ng/ml olan ve uyumsuzluk bulunmayan 36 hasta ise kontrol grubu olarak alındı. Hasta ve kontrol grubunun karşılaştırılmasında yaş, cinsiyet, histopatoloji, ablasyon dozu, ablasyon öncesi Tg değeri ve 24. saat RAİ uptake değeri kullanıldı. Ayrıca hasta grubu da uyumsuzluk nedeni açısından incelendi. Bulgular: Hasta grubunda 28K, 8E, yaş ort:45.6±11.39 ; kontrol grubunda 29K, 7E , yaş ort:41.5±11.69 idi. Hasta grubunda uyumsuzluk nedenine yönelik yapılan tetkikler sonucunda 15(%42) hastada lenf bezi metastazı saptanırken (lenf nodu grubu), 21(%58) hastada uyumsuzluk nedeni bulunamadı (mikrometastatik grup). Yapılan istatistiksel çalışmada, hasta ve kontrol grupları arasında yumuşak doku invazyonu, ablasyon öncesi Tg değeri ve tümör çapı>2cm açısından anlamlı fark bulundu. Hasta grubundaki değerlendirmede ise, E cinsiyet, tümör çapı>2cm, tiroid kapsül invazyonu ve yaş>40 gibi parametrelerin karşılaştırılmasında lenf nodu ve mikrometastatik grup arasında anlamlı fark bulundu. Sonuç: Ablasyon kontrolü sırasında ortaya çıkan 5 mCi-TVS (-), Tg (+) uyumsuzluğunda tespit edilebilen başlıca neden lenf nodu metastazıdır.

Anahtar Kelimeler

Differentiated thyroid carcinoma, radioiodine ablation, I-131 whole body scan, lymph node metastases

Evaluation of Discordance in Differentiated Thyroid Cancer Patients with Negative Radioiodine Scans and Positive Thyroglobulin Values at the Ablation Outcome Control

Öz

Kaynakça

• Silberstein EB. The treatment of thyroid malignant neoplasm. In: Henkin RE, Bova D, Dillehay GL, Halama JR, Karesh SM, Wagner RH, Zimmer Am (ed). Nuclear Medicine. Mosby Elsevier. Pennsyl- vania, USA, 2nd ed., 2006; pp 1576-87.
• Leboulleux S, Rubino C, Baudin E, Caillou B, Hartl DM, Bidart JM, et al. Prognostic factors for persistent or recurrent disease of papillary thyroid carcinoma with neck lymph node metastases and/or tumor extension beyond the thyroid capsule at initial di- agnosis. J Clin Endocrinol Metab 2005;90:5723-9. [CrossRef]
• Low H, Delbridge L, Sidhu S, Learoyd D, Robinson B, Roach P, et al. Lymph node status influences follow-up thyroglobulin levels in pap- illary thyroid cancer. Ann Surg Oncol 2008;15:2827-32. [CrossRef]
• Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19:1167-214. [CrossRef]
• Lin YK, Sheng JM, Zhao WH, Wang WB, Yu XF, Teng LS, et al. Multifocal papillary thyroid carcinoma: clinical analysis of 168 cases. Zhonghua Wai Ke Za Zhi 2009;47:450-3.
• Johnson NA, Tublin ME. Postoperative surveillance of differenti- ated thyroid carcinoma: rationale, technique, and controversies. Radiology 2008;249:429-44. [CrossRef]
• Alzahrani AS, Mohamed G, Al Shammary A, Aldasouqi S, Abdal- Salam S, Shoukri M. Long-term course and predictive factors of elevated serum thyroglobulin and negative diagnostic radioio- dine whole body scan in differentiated thyroid cancer. J Endocri- nol Invest 2005;28:540-6.
• Manxhuka-Kerliu S, Devolli-Disha E, Gerxhaliu A, Ahmetaj H, Ba- ruti A, Loxha S, et al. Prognostic values of thyroid tumours. Bosn J Basic Med Sci 2009;9:111-9.
• Kilfoy BA, Devesa SS, Ward MH, Zhang Y, Rosenberg PS, Holford TR, et al. Gender is an age-spesific effect modifier for papillary cancers of the thyroid gland. Cancer Epidemiol Biomarkers Prev 2009;18:1092-100. [CrossRef]
• Zaydfudim V, Feurer ID, Griffin MR, Phay JE. The impact of lymph node involvement on survival in patients with papillary and fol- licular thyroid carcinoma. Surgery 2008;144:1070-7. [CrossRef]
• Wada N, Masudo K, Nakayama H, Suganuma K, Matsuzu K, Hi- rakawa S, et al. Clinical outcomes of older or younger patients with papillary thyroid carcinoma: impact of lymphadenopathy and patient age. Eur J Surg Oncol 2008;34:202-7. [CrossRef]
• Bardet S, Malville E, Rame JP, Babin E, Samama G, De Raucourt D, et al. Macroscopic lymph-node involvement and neck dissec- tion predict lymph-node recurrence in papillary thyroid carcino- ma. Eur J Endocrinol 2008;158:551-60. [CrossRef]
• Ito Y, Higashiyama T, Takamura Y, Miya A, Kobayashi K, Matsu- zuka F, et al. Risk factors for recurrence to the lymph node in pap- illary thyroid carcinoma patients without preoperative detectable lateral node metastasis: validity of prophlactic modified radical neck dissection. World J Surg 2007;31:2085-91. [CrossRef]
• Davidson HC, Park BJ, Johnson JT. Papillary thyroid cancer: con- troversies in the management of neck metastases. Laryngoscope 2008;118:2161-5. [CrossRef]
• Sugitani I, Fujimoto Y, Yamada K, Yamamoto N. Prospective out- comes of selective lymph node dissection for papillary thyroid carcinoma based on preoperative ultrasonography. World J Surg 2008;32:2494-502. [CrossRef]
• Mirghani H, Francois A, Landry G, Hans S, Menard M, Brasnu D. Repeat of lymphatic dissection for thyroid cancers. Ann Otolar- yngol Chir Cervicofac 2009;126:37-42. [CrossRef]
• Gonzalez HE, Cruz F, O’Brien A, Goni I, Leon A, Claure R, et al. Impact of preoperative ultrasonographic staging of the neck in papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg 2007;133:1258-62. [CrossRef]
• Schmidt D, Szikszai A, Linke R, Bautz W, Kuwert T. Impact of 131I SPECT/Spiral CT on nodal staging of differentiated thyroid carcino- ma at the first radioablation. J Nucl Med 2009;50:18-23. [CrossRef]
• Schmidt D, Linke R, Uder M, Kuwert T. Five months’ follow-up of patients with and without iodine-positive lymph node metastases of thyroid carcinoma as disclosed by I131-SPECT/CT at the first radioablation. Eur J Nucl Med Mol Imaging 2010;37:699-705. [CrossRef]
• Spanu A, Solinas ME, Chessa F, Sanna D, Nuvoli S, Madeddu G. I131 SPECT/CT in the follow-up of differentiated thyroid carci- noma: incremental value versus planar imaging. J Nucl Med 2009;50:184-90. [CrossRef]
• Shammas A, Degirmenci B, Mountz JM, McCook BM, Branstet- ter B, Bencherif BB, et al. 18F-FDG PET/CT in patients with sus- pected recurrent or metastatic well-differentiated throid cancer. J Nucl Med 2007;48:221-6.
• Schlüter B, Bohuslavizki KH, Beyer W, Plotkin M,Buchert R, Clau- sen M. Impact of FDG PET on patients with differentiated thyroid cancer who present with elevated thyroglobulin and negative I-131 scan. J Nucl Med 2001;42:71-6.
• Hussain HK, Britton KE, Grossman AB, Reznek RH. Thyroid can- cer. In: Husband JE, Reznek RH (ed). Imaging in Oncology. Taylor and Francis. London, UK, 2nd ed., 2004; pp 669-709.