Stimulated Thyroglobulin and Neck Ultrasonography Facilitates Postsurgical Radioactive Iodine Remnant Ablation Selection in Patients with Low-Risk Well-Differentiated Thyroid Carcinoma

Hernandez, Karen; Etarsky, Daniel; Orlov, Steven; Walfish, Paul G.

doi:10.1089/thy.2011.0453

Cited by 3 publications

(2 citation statements)

References 3 publications

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“…An abnormal POCUS is highly predictive of PD with high sensitivity, especially when combined with RAI-Tg levels. Rosario et al's results (12,21) showed that a RAI-Tg threshold value O10 mg/l is predictive of PD, but this report only included LR patients without initial LN metastasis. This finding should be taken with caution for patients with interfering anti-Tg antibodies.…”

Section: Comparison Of Pocus With Rai-tg and Twbsmentioning

confidence: 92%

Post-operative neck ultrasound and risk stratification in differentiated thyroid cancer patients with initial lymph node involvement

Lepoutre-Lussey

Maddah

Russ

et al. 2014

European Journal of Endocrinology

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Objective: Cervical ultrasound (US) scan is a key tool for detecting metastatic lymph nodes (N1) in patients with papillary thyroid cancer (PTC). N1-PTC patients are stratified as intermediate-risk and high-risk (HR) patients, according to the American Thyroid Association (ATA) and European Thyroid Association (ETA) respectively. The aim of this study was to assess the value of post-operative cervical US (POCUS) in local persistent disease (PD) diagnosis and in the reassessment of risk stratification in N1-PTC patients. Design: Retrospective cohort study. Methods: Between 1997 and 2010, 638 N1-PTC consecutive patients underwent a systematic POCUS. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of POCUS for the detection of PD were evaluated and a risk reassessment using cumulative incidence functions was carried out. Results: After a median follow-up of 41.6 months, local recurrence occurred in 138 patients (21.6%), of which 121 were considered to have PD. Sensitivity, specificity, NPV, and PPV of POCUS for the detection of the 121 PD were 82.6, 87.4 95.6, and 60.6% respectively. Cumulative incidence of recurrence at 5 years was estimated at 26% in ETA HR patients, 17% in ATA intermediate-risk patients, and 35% in ATA HR patients respectively. This risk fell to 9, 8, and 11% in the above three groups when the POCUS result was normal and to !6% when it was combined with thyroglobulin results at ablation. Conclusion: POCUS is useful for detecting PD in N1-PTC patients and for stratifying individual recurrence risk. Its high NPV could allow clinicians to tailor follow-up recommendations to individual needs.

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Section: Comparison Of Pocus With Rai-tg and Twbsmentioning

confidence: 92%

Post-operative neck ultrasound and risk stratification in differentiated thyroid cancer patients with initial lymph node involvement

Lepoutre-Lussey

Maddah

Russ

et al. 2014

European Journal of Endocrinology

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“…Under these circumstances, Tg concentrations ranging from undetectably low to up to 5-10 μg/L are associated with a better prognosis, i.e., lower probability of metastatic disease and of persistent or recurrent disease. Indeed, patients with low-risk papillary thyroid cancer who do not receive RAI on the basis of postoperative stimulated Tg levels of b1 μg/L to up to b5 μg/L are unlikely to harbor persistent disease or to develop a recurrence after a mean follow-up of 6 years [10,11].…”

mentioning

confidence: 99%

Lessons learned from thyroglobulin concentrations after total thyroidectomy and radioactive iodine ablation for differentiated thyroid cancer

Gomez-Hernandez

Ezzat

2015

Clinical Biochemistry

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Post-operative stimulated thyroglobulin and neck ultrasound as personalized criteria for risk stratification and radioactive iodine selection in low- and intermediate-risk papillary thyroid cancer

et al. 2015

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The purpose of this study was to demonstrate the utility of a personalized risk stratification and radioactive iodine (RAI) selection protocol (PRSP) using post-operative stimulated thyroglobulin (Stim-Tg) and neck ultrasound in low- and intermediate-risk papillary thyroid carcinoma (PTC) patients. Patients with PTC tumors ≥1 cm were prospectively followed after total thyroidectomy and selective therapeutic central compartment neck dissection. Low/intermediate risk was defined as PTC confined to the thyroid or central (level VI) lymph nodes. Stim-Tg and neck ultrasound were performed approximately 3 months after surgery and used to guide RAI selection. Patients with Stim-Tg < 1 µg/L did not receive RAI, while those with Stim-Tg >5 µg/L routinely did. Those with Stim-Tg 1-5 µg/L received RAI on the basis of several clinical risk factors. Patients were followed for >6 years with serial neck ultrasound and basal/stimulated thyroglobulin. Among the 129 patients, 84 (65 %) had undetectable Stim-Tg after initial surgery, 40 (31 %) had Stim-Tg of 1-5 µg/L, and 5 (4 %) had Stim-Tg >5 µg/L. RAI was administered to 8 (20 %) patients with Stim-Tg 1-5 µg/L and 5 (100 %) with Stim-Tg >5 µg/L. Using this approach, RAI therapy was avoided in 17/20 (85 %) patients with tumors >4 cm, in 72/81 (89 %) patients older than 45 years, and in 6/9 (67 %) patients with central lymph node involvement. To date, 116 (90 %) patients in this cohort have not received RAI therapy with no evidence of residual/recurrent disease, whereas among the 13 patients who received RAI, 1 (8 %) had pathologic residual/recurrence disease. Using the proposed PRSP, RAI can be avoided in the majority of low/intermediate-risk PTC patients. Moreover, traditional risk factors considered to favor RAI treatment were not always concordant with the PRSP and may lead to overtreatment.

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Stimulated Thyroglobulin and Neck Ultrasonography Facilitates Postsurgical Radioactive Iodine Remnant Ablation Selection in Patients with Low-Risk Well-Differentiated Thyroid Carcinoma

Cited by 3 publications

References 3 publications

Post-operative neck ultrasound and risk stratification in differentiated thyroid cancer patients with initial lymph node involvement

Post-operative neck ultrasound and risk stratification in differentiated thyroid cancer patients with initial lymph node involvement

Lessons learned from thyroglobulin concentrations after total thyroidectomy and radioactive iodine ablation for differentiated thyroid cancer

Post-operative stimulated thyroglobulin and neck ultrasound as personalized criteria for risk stratification and radioactive iodine selection in low- and intermediate-risk papillary thyroid cancer

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