Evaluation of 131I scintigraphy and stimulated thyroglobulin levels in the follow up of patients with DTC: a retrospective analysis of 1420 patients

Carvalho, José Manuel Gonzalez; Görlich, Dennis; Schober, Otmar; Wenning, Christian; Riemann, Burkhard; Verburg, Frederik A.; Vrachimis, Alexis

doi:10.1007/s00259-016-3581-4

Cited by 24 publications

(11 citation statements)

References 17 publications

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“…The use of Dx-WBS in lowrisk patients is generally discouraged if serum Tg is undetectable and neck ultrasound is negative at the first response assessment. However, an analysis by Gonzalez-Carvalho et al of a large series of patients followed for up to 25 years suggested that routine Dx-WBS is useful at the first followup (6-12 months after RaIT) in all cases [58]. Moreover, there is agreement on the relevant role of Dx-WBS in patients who are positive for TgAb [59], or with extrathyroid uptake at post-therapy-WBS (pT-WBS) or large thyroid remnants precluding pT-WBS, and in selected cases based on individual risk profiles (e.g., isthmus location of malignant nodule).…”

Section: Long-term Follow-upmentioning

confidence: 99%

Personalized management of differentiated thyroid cancer in real life – practical guidance from a multidisciplinary panel of experts

et al. 2020

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Purpose The standard of care for differentiated thyroid carcinoma (DTC) includes surgery, risk-adapted postoperative radioiodine therapy (RaIT), individualized thyroid hormone therapy, and follow-up for detection of patients with persistent or recurrent disease. In 2019, the nine Martinique Principles for managing thyroid cancer were developed by the American Thyroid Association, European Association of Nuclear Medicine, Society of Nuclear Medicine and Molecular Imaging, and European Thyroid Association. In this review, we present our clinical practice recommendations with regard to implementing these principles in the diagnosis, treatment, and long-term follow-up of patients with DTC. Methods A multidisciplinary panel of five thyroid cancer experts addressed the implementation of the Martinique Principles in routine clinical practice based on clinical experience and evidence from the literature. Results We provide a suggested approach for the assessment and diagnosis of DTC in routine clinical practice, including the use of neck ultrasound, measurement of serum thyroid-stimulating hormone and calcitonin, fine-needle aspiration, cytology, and molecular imaging. Recommendations for the use of surgery (lobectomy vs. total thyroidectomy) and postoperative RaIT are also provided. Long-term follow-up with neck ultrasound and measurement of serum anti-thyroglobulin antibody and basal/stimulated thyroglobulin is standard, with 123/131I radioiodine diagnostic whole-body scans and 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography suggested in selected patients. Management of metastatic DTC should involve a multidisciplinary team. Conclusions In routine clinical practice, the Martinique Principles should be implemented in order to optimize clinical management/outcomes of patients with DTC.

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Section: Long-term Follow-upmentioning

confidence: 99%

Personalized management of differentiated thyroid cancer in real life – practical guidance from a multidisciplinary panel of experts

et al. 2020

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“…A study by Carvalho et al reported on only a marginal risk of recurrence in 1420 DTC patients if patients showed negative WBS and Tg levels at 12 months after RAI therapy [17].…”

Section: Discussionmentioning

confidence: 99%

Initial Evaluation of Therapy Response after Adjuvant Radioiodine Therapy in Patients with Early-Stage Papillary Thyroid Cancer—Does Time Matter?

Grawe

Cramm

Fabritius

et al. 2022

Cancers

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Background: The aim was to assess ablation success after initial radioiodine (RAI) therapy in early-stage PTC patients and compare outcomes of first diagnostic control after 6 and 9 months (6m/9m-DC) to examine whether time could possibly avoid unnecessary overtreatment. Methods: There were 353 patients who were matched regarding age, sex, and tumor stage and divided in two groups depending on time of first DC (6m- and 9m-DC). Therapy response was defined as thyroglobulin level <0.5 ng/mL, no pathological uptake in the diagnostic I-131 whole-body scintigraphy (WBS), and no further RAI therapy courses. The 6m-DC group was further divided into endogenously and exogenously stimulated TSH before RAI therapy and compared regarding outcome. Results: No significant differences were found between 6m-DC vs. 9m-DC regarding I-131 uptake in WBS (p = n.s.), Tg levels (p = n.s.), re-therapy rates (p = n.s.), and responder rates (p = n.s.). Significantly less relevant pathological I-131 uptake was found in WBS (p = 0.006) in endogenously compared to exogenously stimulated 6m-DC patients, resulting in lower re-therapy (p = 0.028) and higher responder rates (p = 0.001). Conclusion: DC at 6 months after RAI therapy and stimulation with recombinant human thyroid-stimulating hormone (rhTSH) represent the most balanced solution. Particularly regarding quality of life and mental relief of patients, early DC with rhTSH represents sufficient and convenient assessment of ablation success.

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“…It was shown previously that [ 131 I]iodine WBS/SPECT-CT is inferior to TG levels in detecting patients that develop metastases or local recurrence [ 18 ]. Gonzalez Carvalho et al stated that up to 25% of patients with recurrent DTC had two subsequent negative [ 131 I]iodine dxWBS image acquisitions [ 18 ]. This indicates that [ 131 I]iodine dxWBS is not ideal for detecting recurrent DTC.…”

Section: Discussionmentioning

confidence: 99%

Incremental diagnostic value of [18F]tetrafluoroborate PET-CT compared to [131I]iodine scintigraphy in recurrent differentiated thyroid cancer

Dittmann

Carvalho

Rahbar

et al. 2020

Eur J Nucl Med Mol Imaging

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Introduction Efficient therapy of recurrent differentiated thyroid cancer (DTC) is dependent on precise molecular imaging techniques targeting the human sodium iodide symporter (hNIS), which is a marker both of thyroid and DTC cells. Various iodine isotopes have been utilized for detecting DTC; however, these come with unfavorable radiation exposure and image quality ([ 131 I]iodine) or limited availability ([ 124 I]iodine). In contrast, [ 18 F]tetrafluoroborate (TFB) is a novel radiolabeled PET substrate of hNIS, results in PET images with high-quality and low radiation doses, and should therefore be suited for imaging of DTC. The aim of the present study was to compare the diagnostic performance of [ 18 F]TFB-PET to the clinical reference standard [ 131 I]iodine scintigraphy in patients with recurrent DTC. Methods Twenty-five patients with recurrent DTC were included in this retrospective analysis. All patients underwent [ 18 F]TFB-PET combined with either CT or MRI due to newly discovered elevated TG levels, antiTG levels, sonographically suspicious cervical lymph nodes, or combinations of these findings. Correlative [ 131 I]iodine whole-body scintigraphy (dxWBS) including SPECT-CT was present for all patients; correlative [ 18 F]FDG-PET-CT was present for 21 patients. Histological verification of [ 18 F]TFB positive findings was available in 4 patients. Results [ 18 F]TFB-PET detected local recurrence or metastases of DTC in significantly more patients than conventional [ 131 I]iodine dxWBS and SPECT-CT (13/25 = 52% vs. 3/25 = 12%, p = 0.002). The diagnosis of 6 patients with cervical lymph node metastases that showed mildly increased FDG metabolism but negative [ 131 I]iodine scintigraphy was changed: [ 18 F]TFB-PET revealed hNIS expression in the metastases, which were therefore reclassified as only partly de-differentiated (histological confirmation present in two patients). Highest sensitivity for detecting recurrent DTC had the combination of [ 18 F]TFB-PET-CT/ MRI with [ 18 F]FDG-PET-CT (64%). Conclusion In the present cohort, [ 18 F]TFB-PET shows higher sensitivity and accuracy than [ 131 I]iodine WBS and SPECT-CT in detecting recurrent DTC. The combination of [ 18 F]TFB-PET with [ 18 F]FDG-PET-CT seems a reasonable strategy to characterize DTC tumor manifestations with respect to their differentiation and thereby also individually plan and monitor treatment. Future prospective studies evaluating the potential of [ 18 F]TFB-PET in recurrent DTC are warranted.

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Evaluation of 131I scintigraphy and stimulated thyroglobulin levels in the follow up of patients with DTC: a retrospective analysis of 1420 patients

Cited by 24 publications

References 17 publications

Personalized management of differentiated thyroid cancer in real life – practical guidance from a multidisciplinary panel of experts

Personalized management of differentiated thyroid cancer in real life – practical guidance from a multidisciplinary panel of experts

Initial Evaluation of Therapy Response after Adjuvant Radioiodine Therapy in Patients with Early-Stage Papillary Thyroid Cancer—Does Time Matter?

Incremental diagnostic value of [18F]tetrafluoroborate PET-CT compared to [131I]iodine scintigraphy in recurrent differentiated thyroid cancer

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