Should patients with remnants from thyroid microcarcinoma really not be treated with iodine-131 ablation?

Gallicchio, Rosj; Giacomobono, S.; Capacchione, Daniela; Nardelli, Anna; Barbato, Francesco; Nappi, Antonio; Pellegrino, Teresa; Storto, Giovanni

doi:10.1007/s12020-013-9935-9

Cited by 40 publications

(25 citation statements)

References 33 publications

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“…These values are much lower than previous reports using the dynamic risk stratification system (11,12,13). We excluded patients with microcarcinomas in this study because of the controversy in using remnant RAI ablation for patients with microcarcinoma (24,25,26). Moreover, we only included patients who underwent surgery between 2000 and 2005 because routine neck US was performed during follow-up after 2000.…”

Section: Discussionmentioning

confidence: 99%

Modified dynamic risk stratification for predicting recurrence using the response to initial therapy in patients with differentiated thyroid carcinoma

Jeon

Kim

Park

et al. 2014

European Journal of Endocrinology

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Objective: A new risk stratification system was proposed to estimate the risk of recurrence in patients with differentiated thyroid carcinoma (DTC) using the response to initial therapy. Here, we describe the modified dynamic risk stratification system, which takes into consideration the status of serum anti-Tg antibody (TgAb), and validate this system for assessing the risk of recurrence in patients with DTC. Patients and methods: Patients who underwent total thyroidectomy with radioiodine remnant ablation due to DTC between 2000 and 2005 were included. We classified patients into four groups based on the response to the initial therapy ('excellent', 'acceptable', 'biochemical incomplete', and 'structural incomplete' response). Results: The median follow-up period of 715 patients with DTC was 8 years. The response to initial therapy was an important risk predictor for recurrent/persistent DTC. The relative risks (95% CI) of recurrence were 16.5 (6.3-43.0) in the 'acceptable response ' group, 41.3 (15.4-110.8) in the 'biochemical incomplete response' group, and 281.2 (112.9-700.5) in the 'structural incomplete response' group compared with the 'excellent response' group (P!0.001, P!0.001, and P!0.001 respectively). The disease-free survival rate of the 'excellent response' group to initial therapy was 98.3% whereas that of the 'structural incomplete response' group was only 6.8%. Conclusions: Our study validates the usefulness of the modified dynamic risk stratification system including the status of serum TgAb for predicting recurrent/persistent disease in patients with DTC. Personalized risk assessment using the response to initial therapy could be useful for the follow-up and management of patients with DTC.

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Section: Discussionmentioning

confidence: 99%

Modified dynamic risk stratification for predicting recurrence using the response to initial therapy in patients with differentiated thyroid carcinoma

Jeon

Kim

Park

et al. 2014

European Journal of Endocrinology

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“…R. Gallicchio и соавт. [67] провели ретроспектив-ное исследование 91 случая микрокарциномы низко-го риска с моно-или мультифокальным ростом без других факторов риска, которым не проводили РЙТ. Пациентам выполнены диагностическое сканирова-ние всего тела (СВТ) и однофотонная эмиссионная компьютерная томография (SPEСT-CТ).…”

Section: показания к рйтunclassified

Papillary thyroid microcarcinoma

et al. 2015

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“…Another study using diagnostic SPET-CT found that T1a tumors were associated with nodal metastases in 28/49 (57 %); unsuspected distant metastases were found in 2/49 cases (4 %) [24]. In a study of thyroid microcarcinoma, SPET-CT on post-therapy imaging was used to confirm a significant proportion (26/30 patients) as having regional nodal metastatic disease: the proportion of patients with N1 disease was 30/85 (35 %) [84].…”

Section: Comparison With Other Imaging Modalities In Thyroid Cancermentioning

confidence: 99%

SPET–CT in thyroid cancer: a systematic review

Wong

Wale

Fig

et al. 2014

Clin Transl Imaging

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The purpose of this study was to systematically review the utility of single-photon emission tomographycomputed tomography (SPET-CT) fusion imaging in the investigation of thyroid cancer. We performed a systematic search of the world literature on radionuclide SPET-CT imaging of thyroid cancer using the medical databases Medline (OVID) and PubMed. The following search terms were used to identify relevant studies: (a) thyroid, combined with (b) SPECT/CT or SPECT-CT or SPET/CT or SPET-CT. The electronic searches returned citations for 1,189 potentially eligible articles and 98 abstracts were reviewed for relevance by two co-authors. Thirty-one peerreviewed full articles reporting the utility, value and diagnostic performance of radioiodine SPET-CT for the imaging of well-differentiated thyroid cancer were selected. The quality of these studies was assessed using the quality assessment of diagnostic accuracy studies-2 tool.As there was heterogeneity in the studies, a systematic review analysis was conducted as our chosen research synthesis method. A total of 31 studies published between 2003 and 2014 report the utility of radioiodine SPET-CT. These studies uniformly found incremental diagnostic value of I-123 and I-131 SPET-CT over SPET and/or planar imaging. SPET-CT allows accurate characterization of radioiodine uptake in the neck and at distant sites, clarifies equivocal foci of radioactivity, improves specificity for disease, and evaluates benign physiological etiologies. Additional pilot uses of SPET-CT have been reported, e.g., for thyroid nodule evaluation, medullary thyroid cancer work-up, and investigation of lingual thyroid. Radioiodine SPET-CT fusion imaging of thyroid cancer has incremental utility, improving image interpretation as compared to planar and SPET imaging. It is likely to see more widespread application in the future.

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Should patients with remnants from thyroid microcarcinoma really not be treated with iodine-131 ablation?

Abstract: a significant part of low risk DTC patients, for whom RAI is not recommended, presents an incidental suspicion of lymph-nodal involvement at WBSt confirmed by subsequent SPECT/CT. Such setting would have not been treated by I-131.

Cited by 40 publications

References 33 publications

Modified dynamic risk stratification for predicting recurrence using the response to initial therapy in patients with differentiated thyroid carcinoma

Modified dynamic risk stratification for predicting recurrence using the response to initial therapy in patients with differentiated thyroid carcinoma

Papillary thyroid microcarcinoma

SPET–CT in thyroid cancer: a systematic review

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