Early preablation rhTSH-stimulated thyroglobulin predicts outcome of differentiated thyroid cancer (DTC) patients

Campennì, Alfredo; Ruggeri, Rosaria Maddalena; Siracusa, Massimiliano; Comis, Alessio Danilo; Romano, Davide; Vento, Alessandro; Lanzafame, Helena; Capoccetti, Francesca; Alibrandi, Angela; Baldari, Sergio; Giovanella, Luca

doi:10.1007/s00259-020-05153-7

Cited by 20 publications

(12 citation statements)

References 24 publications

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“…In adults, the pre-ablation stimulated thyroglobulin (sTg) had high predictive value in identifying the risk of disease persistence/recurrence after initial treatment and overall survival [3,8,11] regardless the DTC stage. Instead, the role of sTg in DTC pediatric patients remains to be fully established [12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Prognostic factors in children and adolescents with differentiated thyroid carcinoma treated with total thyroidectomy and RAI: a real-life multicentric study

Cistaro

Quartuccio

Garganese

et al. 2021

Eur J Nucl Med Mol Imaging

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Purpose This multicentric study aimed to investigate the main prognostic factors associated with treatment response at 1 year after radioactive iodine therapy (RAIT) and the last disease status in pediatric patients affected by differentiated thyroid carcinoma (DTC). Materials and methods In the period 1990–2020, all consecutive patients ≤ 18 years from six different centers were retrospectively included. Patients were classified as low, intermediate, and high risk for persistence/recurrence. The response to RAIT was evaluated and scored 1 year later according to 2015 ATA guidelines. Moreover, at the last follow-up, the disease status was evaluated and dichotomized as no evidence of disease (NED) or persistent disease. Results Two hundred and eighty-five patients (197 female, 88 male; mean age 14.4 years) were recruited. All, except nine, underwent near-total thyroidectomy followed by RAIT. One-year after first RAIT, 146/276 (53%) patients had excellent response, 37/276 (14%) indeterminate response, and 91/276 (33%) incomplete response. One-year after RAIT, children with excellent response had significantly lower stimulated thyroglobulin (sTg) compared to not excellent group (median sTg 4.4 ng/ml vs 52.5 ng/ml, p < 0.001). ROC curve showed sTg higher than 27.2 ng/ml as the most accurate to predict 1-year treatment response. After a median follow-up of 133 months, NED was present in 241 cases (87%) while persistent disease in 35 (13%). At multivariate analysis, sTg and 1-year treatment response categories were both significantly associated with the last disease status (p value 0.023 and < 0.001). Conclusions In pediatric DTC, sTg is significantly associated with 1-year treatment response and final outcome. However, 1-year response is the principal prognostic factor able to predict pediatric DTCs outcome.

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Section: Introductionmentioning

confidence: 99%

Prognostic factors in children and adolescents with differentiated thyroid carcinoma treated with total thyroidectomy and RAI: a real-life multicentric study

Cistaro

Quartuccio

Garganese

et al. 2021

Eur J Nucl Med Mol Imaging

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“…At early assessment time (i.e. 12 months after RaIT), an iodine-131/123 Dx-WBS with or without SPECT/CT imaging (performed on request of attending nuclear medicine physician) was obtained in all patients, as previously reported (10,17,18,19).…”

Section: Nuclear Medicine Imagingmentioning

confidence: 99%

Isthmus topography is a risk factor for persistent disease in patients with differentiated thyroid cancer

Campennì

Ruggeri²,

Siracusa

et al. 2021

European Journal of Endocrinology

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Aim: The risk of differentiated thyroid cancer (DTC) recurrence is widely evaluated according to the 2015 ATA Risk Stratification System. Topography of malignant nodules has been previously reported as an additional risk factor but is not included in the ATA system. Thus, our study aimed to evaluate the relationship between DTC topography and response to initial therapy. Patients and Methods: We enrolled 401 low- to intermediate-risk patients with DTC who had undergone thyroidectomy and radioiodine therapy. DTC topography was recorded and compared with the response to therapy as assessed 12 months after end of therapy. Results: Overall, 366/401 (91.3%) patients had an excellent response to initial therapy while 22/401 (5.5%) and 13/401 (3.2%) had incomplete biochemical or structural response, respectively. Incomplete response occurred in 10/36 (27.8%), 5/125 (4.0%), and 4/111 (3.6%) patients whose unifocal malignant nodules were located in the isthmus, right lobe, or left lobe. Incomplete response was also observed in 4/54 (7.4%) and 12/75 (16%) patients carrying multifocal cancers in one or both lobes, respectively. Patients with isthmic cancer more frequently demonstrated incomplete response compared with those who had cancer in other locations (p=0.00). No significant relationship was found with age, gender, maximum size of malignant nodule, Hashimoto’s thyroiditis, vascular invasion, and extrathyroidal extension (p=0.78, p=0.77, p=0.52, p=0.19, p=0.73, and p=0.26, respectively). The risk of incomplete response was about 65% higher in patients with isthmic lesions compared with other patients (odds ratio=6.725). A log-rank test demonstrated that disease-free survival (DFS) of patients with isthmic lesions was significantly shorter than that of other patients (p=0.02). Conclusion: Our data show that isthmus topography of malignant thyroid nodules is a risk factor for having both persistent disease 12 months after primary treatment and reduced DFS.

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“…Thyroid cancer represents the most frequent endocrine malignancy [ 1 , 2 , 3 , 4 ], with differentiated thyroid cancer (DTC) being the most common subtype (80% and more of all thyroid cancers). The incidence of DTC has been increasing in the last decades with an overall increased annual incidence of about 3%, mainly represented by papillary histotype, small tumors and female patients [ 5 , 6 , 7 , 8 , 9 , 10 ]. Thyroidectomy followed by risk-adapted 131 I therapy (RIT) and levothyroxine (LT4) therapy are the standard of care leading to excellent response in more than 80% of patients.…”

Section: Introductionmentioning

confidence: 99%

“…Thyroidectomy followed by risk-adapted 131 I therapy (RIT) and levothyroxine (LT4) therapy are the standard of care leading to excellent response in more than 80% of patients. Notwithstanding, long-term follow-up is recommended after primary treatment since the risk of persistent or recurrent disease is not negligible, especially among intermediate to high-risk patients [ 5 , 11 , 12 , 13 , 14 ]. According to the 2015 ATA guidelines [ 15 ], the response to initial treatments is evaluated at 6–12 months by using basal and/or stimulated serum thyroglobulin (Tg) and neck-ultrasound (nUS).…”

Section: Introductionmentioning

confidence: 99%

“…According to the 2015 ATA guidelines [ 15 ], the response to initial treatments is evaluated at 6–12 months by using basal and/or stimulated serum thyroglobulin (Tg) and neck-ultrasound (nUS). The use of diagnostic whole-body scintigraphy (Dx-WBS) with iodine radioisotopes ( 123 I or 131 I) is suggested in selected DTC patients [ 5 , 15 , 16 ]. Additional single photon emission computed tomography/computed tomography (SPECT/CT) is recommended in addition to planar imaging whenever possible [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

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Thyroglobulin Value Predict Iodine-123 Imaging Result in Differentiated Thyroid Cancer Patients

Campennì

Ruggeri

Siracusa

et al. 2023

Cancers

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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.

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Early preablation rhTSH-stimulated thyroglobulin predicts outcome of differentiated thyroid cancer (DTC) patients

Cited by 20 publications

References 24 publications

Prognostic factors in children and adolescents with differentiated thyroid carcinoma treated with total thyroidectomy and RAI: a real-life multicentric study

Prognostic factors in children and adolescents with differentiated thyroid carcinoma treated with total thyroidectomy and RAI: a real-life multicentric study

Isthmus topography is a risk factor for persistent disease in patients with differentiated thyroid cancer

Thyroglobulin Value Predict Iodine-123 Imaging Result in Differentiated Thyroid Cancer Patients

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