Postoperative Stimulated Thyroglobulin of Less Than 1 ng/mL as a Criterion to Spare Low-Risk Patients with Papillary Thyroid Cancer from Radioactive Iodine Ablation

Rosário, Pedro Weslley; Filho, Augusto Flávio Campos Mineiro; Prates, Brenda Sá Senna; Silva, Lívia Cristina Oliveira; Calsolari, Maria Regina

doi:10.1089/thy.2012.0190

Cited by 60 publications

(58 citation statements)

References 16 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: 56%

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: 56%

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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“…below 2.8). Previous studies have shown that PRD is very unlikely when stimulated Tg levels (17,18), or even unstimulated Tg levels using highly sensitive Tg assays (19), are undetectable. In few patients, however, PRD can be observed in the presence of very low Tg levels after rhTSH (1.1 ng/ml in our study).…”

Section: Discussionmentioning

confidence: 99%

Stimulated thyroglobulin level at ablation in differentiated thyroid cancer: the impact of treatment preparation modalities and tumor burden

Ciappuccini¹,

Hardouin²,

Heutte³

et al. 2014

European Journal of Endocrinology

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Objective: In patients with differentiated thyroid cancer (DTC), the stimulated serum thyroglobulin (Tg) level at radioiodine ablation is a known predictive factor of persistent disease. This prognostic value is based on data obtained after thyroid hormone withdrawal (THW), but little is known about this prognostic value after recombinant human TSH (rhTSH) stimulation and about the relationship between the stimulated Tg level and the burden of persistent tumor. We aimed to assess the impact of both radioiodine preparation modalities and persistent tumor burden on stimulated Tg levels. Design and methods: The stimulated Tg level was measured at radioablation in 308 consecutive DTC patients without serum Tg antibodies. Of these, 123 (40%) were prepared with rhTSH and 185 with THW. Post-ablation scintigraphy included total-body scan and neck and thorax single photon emission computed tomography with computed tomography (SPECT-CT). During a mean follow-up of 43 months, persistent/recurrent disease (PRD) was found in 56 patients (18%). PRD was considered structural in the presence of lesions O1 cm and nonstructural otherwise. Results: Nonstructural PRD was more frequent in the rhTSH group than in the THW group (64 vs 26%, PZ0.01). Stimulated Tg levels were lower after rhTSH than after THW in patients with (13.5 vs 99.5 ng/ml, P!0.01) and without (1.2 vs 3.2 ng/ml, P!0.001) PRD. Also, Tg levels were lower in nonstructural disease than in structural disease in both rhTSH (3.8 vs 127.0 ng/ml, P!0.01) and THW (13.0 vs 143.5 ng/ml, P!0.0001) patients. The best Tg cutoff to predict PRD was 2.8 in rhTSH and 28 ng/ml in THW patients. Conclusion: Both radioiodine preparation modalities and the burden of persistent tumor affect the stimulated Tg level at ablation.

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Section: How Are the Tissues Remaining After Surgery Quantified?mentioning

confidence: 99%

“…For that purpose, neck US is superior to scintigraphy and also provides information on the persistence of lymph node metastases (89,90). For this purpose, a 3-month interval is required between surgery and ultrasonographic assessment (90). The analysis of vascularization using Doppler can be helpful in the differential diagnosis of Thyroid nodules and differentiated thyroid cancer lesions in the thyroid bed and in determining whether the lymph nodes are benign or metastatic.…”

Section: How Are the Tissues Remaining After Surgery Quantified?mentioning

confidence: 99%

“…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%

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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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Postoperative Stimulated Thyroglobulin of Less Than 1 ng/mL as a Criterion to Spare Low-Risk Patients with Papillary Thyroid Cancer from Radioactive Iodine Ablation

Abstract: Low-risk patients with PTC who have stimulated Tg ≤1 ng/mL after thyroidectomy do not require ablation with (131)I.

Cited by 60 publications

References 16 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

Stimulated thyroglobulin level at ablation in differentiated thyroid cancer: the impact of treatment preparation modalities and tumor burden

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

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