Thyroglobulin Value Predict Iodine-123 Imaging Result in Differentiated Thyroid Cancer Patients
Author:
Campennì Alfredo1ORCID, Ruggeri Rosaria Maddalena2ORCID, Siracusa Massimiliano1, Romano Davide1, Giacoppo Giulia1, Crocè Ludovica1, Rosarno Helena1, Russo Simona1, Cardile Davide1, Capoccetti Francesca3, Alibrandi Angela4ORCID, Baldari Sergio1, Giovanella Luca56ORCID
Affiliation:
1. Unit of Nuclear Medicine, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98124 Messina, Italy 2. Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy 3. Nuclear Medicine Unit, Service Department Macerata Hospital, ASUR Marche AV3, 62100 Macerata, Italy 4. Unit of Statistical and Mathematical Sciences, Department of Economics, University of Messina, 98125 Messina, Italy 5. Clinic for Nuclear Medicine and Competence Centre for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland 6. Clinic for Nuclear Medicine, University Hospital and University of Zurich, 8006 Zurich, Switzerland
Abstract
Background: In differentiated thyroid cancer (DTC) patients, the response to initial treatments is evaluated 6–12 months after radioiodine therapy (RIT) according to the 2015 American Thyroid Association (2015 ATA) criteria. In selected patients, diagnostic 131-radioiodine whole-body scintigraphy (Dx-WBS) is recommended. We evaluated the diagnostic performance of 123I-Dx-WBS-SPECT/CT imaging in detecting incomplete structural responses in the early follow-up of DTC patients and, additionally, derived optimized basal-Tg value as a yardstick for scintigraphic imaging. Methods: We reviewed the records of 124 low or intermediate-risk DTC patients with negative anti-thyroglobulin antibody. All patients had undergone (near)-total-thyroidectomy followed by RIT. The response to initial treatments was evaluated 6–12 months after RIT. Results: According to the 2015 ATA criteria, 87, 19 and 18 DTC patients were classified to have excellent response (ER), indeterminate/incomplete biochemical response (BIndR/BIR) or structural incomplete response (SIR), respectively. Among patients with less than ER, 18 had a positive 123I-Dx-WBS-SPECT/CT. Metastatic disease at 123I-Dx-WBS-SPECT/CT mainly involved lymph nodes within the central compartment, and corresponding neck ultrasound examinations were negative. The ROC curve analysis was performed to define the best basal-Tg cut-off (i.e., 0.39 ng/mL; AUC = 0.852) able to discriminate patients with and without positive 123I-Dx-WBS-SPECT/CT, respectively. The overall sensitivity, specificity, accuracy, PPV and NPV were 77.8%, 89.6%, 87.9%, 56.0% and 95.9%, respectively. Basal-Tg cut-off was an independent risk factor for having a positive 123I-Dx-WBS-SPECT/CT. Conclusion: 123I-Dx-WBS-SPECT/CT identified lymph node metastases in 14/37 patients with less than ER and a negative neck ultrasound, thus modifying the management of such patients. The diagnostic performance of 123I-Dx-WBS-SPECT/CT significantly increased in patients with basal-Tg values ≥ 0.39 ng/mL.
Subject
Cancer Research,Oncology
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