Value of Postoperative Thyroglobulin and Ultrasonography for the Indication of Ablation and<sup>131</sup>I Activity in Patients with Thyroid Cancer and Low Risk of Recurrence

Rosário, Pedro Weslley; Xavier, Arthur Cezar Malard; Calsolari, Maria Regina

doi:10.1089/thy.2010.0145

Cited by 89 publications

(92 citation statements)

References 17 publications

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“…Although undetectable pre-ablation Tg levels usually indicate complete previous surgery, our data reinforce earlier observations that, in a low percentage of patients, this situation may be related to non-detectable Tg or to the presence of TgAb (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)31). We believe that, when concurrent chronic thyroiditis is found by the pathologist, or when initial TNM stages are diswith DTC, compared with the 10% generally seen in the general population (20).…”

Section: Discussionsupporting

confidence: 90%

“…On the other hand, undetectable Tg levels at the time of ablation may reflect variable situations, according to different publications (12,16,30,31). Almost 30% of the reported patients in these series have an undetectable Tg levels after surgery.…”

Section: Discussionmentioning

confidence: 81%

“…In a study performed by Rosario and cols., the presence of undetectable Tg at the time of ablation enabled early prediction of long-term outcome of low risk patients (12). On the other hand, 57.7% of Park and cols.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, undetectable pre-ablation stimulated Tg (U Tg) is a condition that might indicate complete previous surgery, secretion of non-immunoreactive Tg, or the presence of non-measurable serum TgAb (9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

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Undetectable pre-ablation thyroglobulin levels in patients with differentiated thyroid cancer: it is not always what it seems

Pitoia

Bueno

Abelleira

et al. 2013

Arq Bras Endocrinol Metab

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Objective: To establish the frequency of U Tg (undetectable pre-ablation thyroglobulin) in TgAbnegative patients and to evaluate the outcome in the follow-up. Subjects and methods: We retrospectively reviewed 335 patients' records. Twenty eight patients (9%) had U Tg. Mean follow--up was 42 ± 38 months. All subjects had undergone total thyroidectomy, and lymph nodes were positive in 13 (46%) patients. Tg and TgAb levels were measured 4 weeks after surgery by IMA technology in hypothyroid state. No evidence of disease (NED) status was defined as undetectable (< 1 ng/mL) stimulated Tg and negative Tg-Ab and/or negative WBS, together with normal imaging studies. Results: Seventeen patients (61%) were considered with NED. Four patients (14%) had persistent disease (mediastinum, n = 1, lung n = 2, unknown n = 1), and 7 (25%) had detectable TgAb by other method during their follow-up. Conclusions: U Tg levels usually is associated to a complete surgery. However, in a low percentage of patients, this may be related to false negative Tg or TgAb measurement. Arq Bras Endocrinol Metab. 2013;57(4):300-6 Keywords Undetectable thyroglobulin levels; thyroglobulin; ablation; thyroid; cancer RESUMO Objetivo: Estabelecer a frequência de U Tg (tireoglobulina indetectável pré-ablação) em pacientes com TgAb negativo e avaliar o prognóstico no seguimento. Sujeitos e métodos: Foram analisados retrospectivamente 335 registros de pacientes. Vinte e oito pacientes (9%) tiveram U Tg. O acompanhamento médio foi de 42 ± 38 meses. Todos os participantes receberam uma tireoidectomia total, e os linfonodos foram positivos em 13 (46%) pacientes. Tg e TgAb foram medidos quatro semanas após a cirurgia pelo método IMA em estado de hipotireoidismo. A não evidência de doença (NED) foi definida como níveis indetectáveis (<1 ng/mL) de Tg estimulada com anticorpos anti-Tg negativos e/ou PCI negativo, com estudos de imagem normais. Resultados: Dezessete pacientes (61%) foram considerados com NED. Quatro pacientes (14%) tiveram doença persistente (mediastino, n = 1, pulmão n = 2, n = desconhecido 1), e 7 (25%) apresentavam anticorpos anti-Tg detectáveis por outro método durante acompanhamento. Conclusões: U Tg geralmente indica uma cirurgia completa. No entanto, em uma pequena porcentagem de pacientes, pode estar relacionada com uma medida de Tg ou de anticorpos anti--Tg falsamente negativos. Arq Bras Endocrinol Metab. 2013;57(4):300-6

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Undetectable pre-ablation thyroglobulin levels in patients with differentiated thyroid cancer: it is not always what it seems

Pitoia

Bueno

Abelleira

et al. 2013

Arq Bras Endocrinol Metab

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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: 57%

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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Author's reply: Prophylactic central neck dissection for papillary thyroid cancer (Br J Surg 2013; 100: 410–418)

Barczyński

2013

British Journal of Surgery

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Author's reply: Prophylactic central neck dissection for papillary thyroid cancer (Br J Surg 2013; 100: 410-418) SirIt has been described clearly in the methods section that this was a retrospective cohort study. However, the data were collected prospectively in a computerized database, which is a valuable research tool allowing a long-term retrospective analysis to be conducted with confidence in the validity of the data. The use of historical controls, temporal increase in surgical experience and increased use of radioactive iodine (RAI) in the central neck dissection (CND) group were discussed in detail as possible confounders. A retrospective power analysis is controversial, but it was presented on request of one of the referees. All statistical analyses were performed by a professional statistician. Only deaths from thyroid cancer were used for disease-specific survival calculation. The reason for each death was determined based on the death certificate, and verified by analysis of medical records including autopsy report.As the sensitivity of preoperative imaging is low for accurate staging of central lymph nodes (LNs) of the neck 1 , prophylactic CND in papillary thyroid cancer provides important staging information, allowing personalized adjuvant RAI treatment. Currently, selection of low-risk patients for RAI ablation can be done on the basis of the postoperative level of stimulated thyroglobulin level above 1.0 ng/ml 2,3 . However, the neck LN status should also be considered, as persistent disease was diagnosed on postablation whole-body scanning in 8 per cent of patients with neck LN metastases even though patients had a postoperative stimulated thyroglobulin level below 1.0 ng/ml 3 .

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Value of Postoperative Thyroglobulin and Ultrasonography for the Indication of Ablation and¹³¹I Activity in Patients with Thyroid Cancer and Low Risk of Recurrence

Abstract: Measurement of stimulated Tg combined with neck ultrasonography after total thyroidectomy may exclude the need for ablation in 56% of low-risk patients without TgAb (Tg <1 ng/mL) and permit the administration of an activity of 1.1 GBq ¹³¹I in another 34% with low Tg levels.

Cited by 89 publications

References 17 publications

Undetectable pre-ablation thyroglobulin levels in patients with differentiated thyroid cancer: it is not always what it seems

Undetectable pre-ablation thyroglobulin levels in patients with differentiated thyroid cancer: it is not always what it seems

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

Author's reply: Prophylactic central neck dissection for papillary thyroid cancer (Br J Surg 2013; 100: 410–418)

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Value of Postoperative Thyroglobulin and Ultrasonography for the Indication of Ablation and131I Activity in Patients with Thyroid Cancer and Low Risk of Recurrence

Abstract: Measurement of stimulated Tg combined with neck ultrasonography after total thyroidectomy may exclude the need for ablation in 56% of low-risk patients without TgAb (Tg <1 ng/mL) and permit the administration of an activity of 1.1 GBq ¹³¹I in another 34% with low Tg levels.

Cited by 89 publications

References 17 publications

Undetectable pre-ablation thyroglobulin levels in patients with differentiated thyroid cancer: it is not always what it seems

Undetectable pre-ablation thyroglobulin levels in patients with differentiated thyroid cancer: it is not always what it seems

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

Author's reply: Prophylactic central neck dissection for papillary thyroid cancer (Br J Surg 2013; 100: 410–418)

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Value of Postoperative Thyroglobulin and Ultrasonography for the Indication of Ablation and¹³¹I Activity in Patients with Thyroid Cancer and Low Risk of Recurrence