Diagnostic 131I whole-body scintigraphy 1 year after thyroablative therapy in patients with differentiated thyroid cancer: correlation of results to the individual risk profile and long-term follow-up

  • Frank Berger
  • Ulla Friedrich
  • Peter Knesewitsch
  • Klaus Hahn
Original Article

Abstract

Purpose

131I whole-body scan (WBS) and serum thyroglobulin (TG) are important in detecting thyroid remnants or recurrent disease in patients with differentiated thyroid cancer. Usually, a diagnostic WBS is carried out 6 months after ablation to exclude residual disease. We retrospectively analysed results of a second routine diagnostic WBS and TG measurements at 1 year after thyroablation and correlated these to the risk profile of patients with long-term follow-up.

Methods

A total of 197 patients were followed up after thyroidectomy and ablative 131I therapy. Follow-up included clinical examination, radioiodine WBS and thyroid-stimulating hormone (TSH), free thyroxine and TG measurements at 3–6 months and 1 year after ablation. WBS (+) patients received a therapeutic activity of 131I. The risk profile of patients was defined according to clinical results before the 1-year control. Clinical results at 1 year after ablation were analysed in correlation to the patient risk profile and long-term follow-up data (mean 7.2 years).

Results

One year after thyroablation, 95.8% of low-risk patients had no residual disease when diagnostic WBS was carried out using 370 MBq 131I; 4.2% of low-risk patients had residual disease at this time point. In the high-risk group of this cohort, 54.5% were disease-free 1 year after ablation, but 45.5% demonstrated residual disease. After the 1-year control, 94% of all applied radioiodine therapies were executed in the high-risk group, compared with 6% in the low-risk group (p < 0.01).

Conclusion

A second routine WBS 1 year after thyroablation is not indicated in low-risk patients. Risk stratification according to the early clinical course effectively identified patients with higher likelihood of persistent or recurrent disease in the long-term follow-up.

Keywords

Diagnostic 131I whole-body scintigraphy Thyroablative therapy Differentiated thyroid cancer 

References

  1. 1.
    Reiners C, Dietlein M, Luster M. Radio-iodine therapy in differentiated thyroid cancer: indications and procedures. Best Pract Res Clin Endocrinol Metab 2008;22:989–1007.CrossRefPubMedGoogle Scholar
  2. 2.
    Junginger T. Leitlinien der Deutschen Krebsgesellschaft e.V. zur Therapie maligner Schilddrüsentumoren. Forum Dtsch Krebsgesellschaft 1997;2:14–21.Google Scholar
  3. 3.
    Dietlein M, Dressler J, Eschner W, Grünwald F, Lassmann M, Leisner B, et al. Procedure guideline for iodine-131 whole-body scintigraphy for differentiated thyroid cancer (version 3). Nuklearmedizin 2007;46:206–12. German.PubMedGoogle Scholar
  4. 4.
    Black EG, Sheppard MC, Hoffenberg R. Serial serum thyroglobulin measurements in the management of differentiated thyroid carcinoma. Clin Endocrinol (Oxf) 1987;27:115–20.CrossRefGoogle Scholar
  5. 5.
    Charles MA, Dodson Jr LE, Waldeck N, Hofeldt F, Ghaed N, Telepak R, et al. Serum thyroglobulin levels predict total body iodine scan findings in patients with treated well-differentiated thyroid carcinoma. Am J Med 1980;69:401–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Ozata M, Suzuki S, Miyamoto T, Liu RT, Fierro-Renoy F, DeGroot LJ. Serum thyroglobulin in the follow-up of patients with treated differentiated thyroid cancer. J Clin Endocrinol Metab 1994;79:98–105.CrossRefPubMedGoogle Scholar
  7. 7.
    Ronga G, Fiorentino A, Paserio E, Signore A, Todino V, Tummarello MA, et al. Can iodine-131 whole-body scan be replaced by thyroglobulin measurement in the post-surgical follow-up of differentiated thyroid carcinoma? J Nucl Med 1990;31:1766–71.PubMedGoogle Scholar
  8. 8.
    Tuttle RM. Risk-adapted management of thyroid cancer. Endocr Pract 2008;14:764–74.PubMedGoogle Scholar
  9. 9.
    Tuttle RM, Leboeuf R, Shaha AR. Medical management of thyroid cancer: a risk adapted approach. J Surg Oncol 2008;97:712–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Schlumberger M, Fragu P, Gardet P, Lumbroso J, Violot D, Parmentier C. A new immunoradiometric assay (IRMA) system for thyroglobulin measurement in the follow-up of thyroid cancer patients. Eur J Nucl Med 1991;18:153–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Schlumberger MJ. Papillary and follicular thyroid carcinoma. N Engl J Med 1998;338:297–306.CrossRefPubMedGoogle Scholar
  12. 12.
    Cailleux AF, Baudin E, Travagli JP, Ricard M, Schlumberger M. Is diagnostic iodine-131 scanning useful after total thyroid ablation for differentiated thyroid cancer? J Clin Endocrinol Metab 2000;85:175–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Pacini F, Schlumberger M, Dralle H, Elisei R, Smit JW, Wiersinga W, et al. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol 2006;154:787–803.CrossRefPubMedGoogle Scholar
  14. 14.
    Schlumberger M, Berg G, Cohen O, Duntas L, Jamar F, Jarzab B, et al. Follow-up of low-risk patients with differentiated thyroid carcinoma: a European perspective. Eur J Endocrinol 2004;150:105–12.CrossRefPubMedGoogle Scholar
  15. 15.
    Mazzaferri EL, Kloos RT. Clinical review 128: current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab 2001;86:1447–63.CrossRefPubMedGoogle Scholar
  16. 16.
    Brierley JD, Tsang RW. External beam radiation therapy for thyroid cancer. Endocrinol Metab Clin North Am 2008;37:497–509, xi.CrossRefPubMedGoogle Scholar
  17. 17.
    Roelants V, Nayer PD, Bouckaert A, Beckers C. The predictive value of serum thyroglobulin in the follow-up of differentiated thyroid cancer. Eur J Nucl Med 1997;24:722–7.PubMedGoogle Scholar
  18. 18.
    Spencer CA, Lopresti JS. Measuring thyroglobulin and thyroglobulin autoantibody in patients with differentiated thyroid cancer. Nat Clin Pract Endocrinol Metab 2008;4:223–33.CrossRefPubMedGoogle Scholar
  19. 19.
    Waxman A, Ramanna L, Chapman N, Chapman D, Brachman M, Tanasescu D, et al. The significance of 1-131 scan dose in patients with thyroid cancer: determination of ablation: concise communication. J Nucl Med 1981;22:861–5.PubMedGoogle Scholar
  20. 20.
    Phan TT, van Tol KM, Links TP, Piers DA, de Vries EG, Dullaart RP, et al. Diagnostic I-131 scintigraphy in patients with differentiated thyroid cancer: no additional value of higher scan dose. Ann Nucl Med 2004;18:641–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Pineda JD, Lee T, Ain K, Reynolds JC, Robbins J. Iodine-131 therapy for thyroid cancer patients with elevated thyroglobulin and negative diagnostic scan. J Clin Endocrinol Metab 1995;80:1488–92.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Frank Berger
    • 2
  • Ulla Friedrich
    • 1
  • Peter Knesewitsch
    • 1
  • Klaus Hahn
    • 1
  1. 1.Department of Nuclear MedicineLudwig-Maximilians University of MunichMunichGermany
  2. 2.Department of Clinical RadiologyLudwig-Maximilians University of MunichMunichGermany

Personalised recommendations