Application of post‐surgical stimulated thyroglobulin for radioiodine remnant ablation selection in low‐risk papillary thyroid carcinoma

Vaisman, A; Orlov, Steven; Yip, Jonathan; Hu, Cindy; Lim, Terence; Dowar, Mark; Freeman, Jeremy L.; Walfish, Paul G.

doi:10.1002/hed.21371

Cited by 73 publications

(65 citation statements)

References 39 publications

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“…In low-risk patients without LNM (cN0), postoperative Tg < 1 ng/mL has shown an excellent negative predictive value (NPV) for PRD (41)(42)(43)(44)(45), even when they are not submitted to ablation with 131 I (41,44,45). In the present study, also in the subgroup of patients with LNM (cN1), postoperative stimulated Tg combined with neck US had an excellent NPV for persistent disease and tumor recurrence.…”

Section: Factors Predicting Persistent or Recurrent Tumorssupporting

confidence: 57%

Persistent and recurrent disease in patients with papillary thyroid carcinoma with clinically apparent (cN1), but not extensive, lymph node involvement and without other factors for poor prognosis

Furtado

Rosário

Calsolari

2015

Arch. Endocrinol. Metab.

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Objective: Lymph node metastases (LNM) are frequent in patients with papillary thyroid cancer (PTC). The risk of persistent disease (PD) and tumor recurrence (TR) is increased when factors for poor prognosis other than LNM exist, when LNM are numerous, large, detected by preoperative ultrasonography (US), or exhibit extranodal extension. This study evaluated the risk of PD and TR in patients with LNM not exhibiting these characteristics. Subjects and methods: Eighty-six patients with 5 or fewer LNM detected during intraoperative inspection, but not by preoperative US, who had no other factors for poor prognosis [tumors > 4 cm, extensive extrathyroid invasion, vascular invasion, aggressive histological subtype, distant metastases, incomplete tumor resection], were studied. All patients underwent total thyroidectomy followed by radioiodine ablation. PD was defined as metastases on initial post-therapy whole-body scans (RxWBS) or detected by imaging methods up to 12 months after ablation. TR was defined as structural disease diagnosed more than one year after ablation in patients without PD. Results: PD was diagnosed in 3/86 patients (3.5%). TR was observed in 2/83 patients (2.5%) after 62 months of follow-up. There was no case of death due to the disease. A correlation was observed between pre-ablation Tg and PD or TR [1/48 (2%) with Tg ≤ 2 ng/mL versus 2/22 (9%) with Tg > 2 ≤ 10 ng/mL versus 2/7 (28.5%) with Tg ≥ 10 ng/ml)]. It is noteworthy that 38 patients had up to 3 positive LN and pre-ablation Tg ≤ 2 ng/ml, and none of them had PD or TR. Conclusions: The frequency of PD and TR was low in patients with PTC with 5 or fewer LNM and without other factors for poor prognosis. Low postoperative stimulated Tg was predictive of the absence of PD and TR in these patients. Arch Endocrinol Metab. 2015;59(4):285-91

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Section: Factors Predicting Persistent or Recurrent Tumorssupporting

confidence: 57%

Persistent and recurrent disease in patients with papillary thyroid carcinoma with clinically apparent (cN1), but not extensive, lymph node involvement and without other factors for poor prognosis

Furtado

Rosário

Calsolari

2015

Arch. Endocrinol. Metab.

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“…In such cases, administration of 131 I may confer additional benefits such as improvement of the serum Tg specificity and the early detection of metastasis on a whole body scan (WBS). Nevertheless, in patients with stimulated Tg levels ≤ 1 ng/ml and no abnormalities on an US a few months after thyroidectomy, the specificity of that marker is not affected by the remaining tissue; it is known that a WBS after 131 I administration does not detect metastases (97,98); and the risk of relapse is low, even when 131 I is not administered (90,99,100). For those reasons, this criterion suggests to dismiss ablation in the low-risk group (90,(97)(98)(99)(100).…”

Section: Recommendation 35mentioning

confidence: 99%

Thyroid nodules and differentiated thyroid cancer: update on the Brazilian consensus

Rosário

Ward

Carvalho

et al. 2013

Arq Bras Endocrinol Metab

123

147

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Thyroid nodules are frequent findings, especially when sensitive imaging methods are used. Although thyroid cancer is relatively rare, its incidence is increasing, particularly in terms of small tumors, which have an uncertain clinical relevance. Most patients with differentiated thyroid cancer exhibit satisfactory clinical outcomes when treatment is appropriate, and their mortality rate is similar to that of the overall population. However, relapse occurs in a considerable fraction of these patients, and some patients stop responding to conventional treatment and eventually die from their disease. Therefore, the challenge is how to identify the individuals who require more aggressive disease management while sparing the majority of patients from unnecessary treatments and procedures. We have updated the Brazilian Consensus that was published in 2007, emphasizing the diagnostic and therapeutic advances that the participants, representing several Brazilian university centers, consider most relevant in clinical practice. The formulation of the present guidelines was based on the participants' experience and a review of the relevant literature. Arq Bras Endocrinol Metab. 2013;57(4):240-64 Keywords Thyroid nodules; thyroid cancer; Brazilian consensus; update RESUMO Nódulos tireoidianos são muito frequentes, sobretudo quando se empregam métodos sensí-veis de imagem. Embora o câncer seja proporcionalmente raro, sua incidência vem aumentando, especialmente de tumores pequenos, cuja evolução clínica é incerta. A maioria dos pacientes com carcinoma diferenciado de tireoide evolui bem quando adequadamente tratada, com índices de mortalidade similares à população geral. Por outro lado, um percentual não desprezível apresenta recidivas e alguns eventualmente não respondem às terapias convencionais, evoluindo para óbito. Assim, o desafio é distinguir os pacientes merecedores de condutas mais agressivas e, ao mesmo tempo e não menos importante, poupar a maioria de tratamentos e procedimentos desnecessários. Atualizamos o Consenso Brasileiro publicado em 2007, ressaltando os avanços diagnósticos e terapêuticos que os participantes, de diferentes Centros Universitários do Brasil, consideram mais relevantes para prática clínica. A elaboração dessas diretrizes foi baseada na experiência dos participantes e revisão da literatura pertinente. Arq Bras Endocrinol Metab. 2013;57(4):240-64 Descritores

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“…En los últimos años la pTg ha sido evaluada como un elemento más para definir aquel subgrupo de pacientes en los cuales podría no ser necesario realizar ablación con 131 I, postulándose que pacientes con pTg ≤ 1 ng/ml y con AcTg negativos podrían manejarse sólo con cirugía, ya que la ablación con 131 I no conllevaría un beneficio mayor respecto al pronóstico y sobrevida libre de enfermedad en estos pacientes, lo cual incluso ha sido recomendado por la versión 2013 de la guía NCCN 3,[15][16][17] .…”

Section: Discussionunclassified

Importancia de la tiroglobulina sérica preablativa en la predicción de sobrevida libre de enfermedad en cáncer diferenciado de tiroides

2013

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Application of post‐surgical stimulated thyroglobulin for radioiodine remnant ablation selection in low‐risk papillary thyroid carcinoma

Abstract: Stim-Tg measurement performed several months after total thyroidectomy is a useful objective parameter in assisting RRA decision-making for patients with low-risk WDTC. (

Cited by 73 publications

References 39 publications

Persistent and recurrent disease in patients with papillary thyroid carcinoma with clinically apparent (cN1), but not extensive, lymph node involvement and without other factors for poor prognosis

Persistent and recurrent disease in patients with papillary thyroid carcinoma with clinically apparent (cN1), but not extensive, lymph node involvement and without other factors for poor prognosis

Thyroid nodules and differentiated thyroid cancer: update on the Brazilian consensus

Importancia de la tiroglobulina sérica preablativa en la predicción de sobrevida libre de enfermedad en cáncer diferenciado de tiroides

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