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Difficulties in deciding whether to ablate patients with putatively “low–intermediate-risk” differentiated thyroid carcinoma: do guidelines mainly apply in the centres that produce them? Results of a retrospective, two-centre quality assurance study

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

An Erratum to this article was published on 02 November 2015

Abstract

Purpose

We determined the reasons for radioiodine thyroid remnant ablation, and the procedure’s necessity based on postsurgical remnant size, in patients with putatively “low–intermediate-risk” differentiated thyroid carcinoma (DTC). We identified key clinicopathological, treatment and remnant characteristics, and factors associated with remnant size in 336 patients with pT1/2, M0 DTC ablated during the period September 2010 to October 2013 at one Cypriot or one Greek referral centre.

Methods

Clinicopathological/treatment characteristics were compiled from charts. Experienced nuclear medicine physicians rated the numbers/intensities of uptake foci in the thyroid bed on postablation planar scintigrams using scales of 0–4 points and 0–3 points, respectively. The product of these scores was taken as the “remnant score” that ranged from 0 (no remnant) to 12 (multiple remnants, intense uptake).

Results

DTC was predominantly papillary. The median [25th–75th percentile] longest primary tumour diameter was 1.0 cm [0.7–1.5 cm]. Despite favourable histotypes and primary tumour classifications, patients often had preablation characteristics suggesting elevated or uncertain risk: 31.0 % of patients (104 of 336) had primary tumour multifocality, 22.0 % (74) had confirmed cervical lymph node metastases, 37.2 % (125) had unknown nodal status, and 38.1 % (128) had antithyroglobulin antibody seropositivity. The median [25th–75th percentile] remnant score was 4 [2–6]; 39.9 % of patients (134 of 336) had scores ≥6. For the entire cohort, T or N stages (r ≤ 0.174, P ≤ 0.05) correlated positively with the remnant score in a univariate Spearman analysis. The numbers of patients referred by the surgeon, cervical lymph nodes excised and metastatic nodes excised correlated negatively (r ≤ 0.243, P ≤ 0.038) with the remnant score, and the first two factors independently predicted the remnant score (P ≤ 0.037) in a multivariate analysis.

Conclusion

Patients with putatively “low–intermediate-risk” DTC frequently had disease characteristics denoting high or uncertain risk, suggesting that “selective” radioiodine ablation in such patients may seldom be applicable outside international centres of excellence. Proxies for surgeon experience and surgical completeness correlated with remnant number/uptake intensity and may aid ablation-related decision-making.

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Acknowledgment

The support in the form of a grant from Genzyme, a Sanofi company, is acknowledged.

Compliance with ethical standards

ᅟ

Funding

This was an investigator-initiated study funded from the regular budgets of the Departments of Nuclear Medicine of the two participating centres. However, the work of one of the authors (R.J.M.) in developing this paper was supported by a grant  from Genzyme, a Sanofi company, the rhTSH manufacturer.

Conflict of interest

The work of one of the authors (R.J.M.) in developing this paper, including descriptive statistical analysis, organization and presentation of data, drafting and editing the manuscript, and handling part of manuscript submission logistics, was supported by a grant from Genzyme, a Sanofi company, the rhTSH manufacturer. This author is an independent medical editor, whose clients include Genzyme. The other authors declare that they have no conflicts of interest.

Ethical approval

This was a retrospective study, entailing no additional procedures. However, all procedures described here were in accordance with the ethical standards of the institutional and/or national research committees and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required. However, written informed consent was obtained from all patients included in the study before they underwent the radioiodine treatment described here. This consent included allowing the use of their data in analyses such as those presented here.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Bank of Cyprus Oncology Centre, 32 Acropoleos Avenue, Strovolos, Nicosia, 2006, Cyprus

    Savvas Frangos, Nicolaos Eftychiou, Loukia Patsali, Anna Vanezi & Androulla Savva

  2. Department of Nuclear Medicine, Aristotle University, Papageorgiou Hospital, 56403, Thessaloniki, Greece

    Ioannis P. Iakovou, Vassilis Mpalaris & Evanthia I. Giannoula

  3. Spencer-Fontayne Corporation, 33 Bentley Avenue, Jersey City, NJ, 07304-1901, USA

    Robert J. Marlowe

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  1. Savvas Frangos
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  2. Ioannis P. Iakovou
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Correspondence to Savvas Frangos.

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Frangos, S., Iakovou, I.P., Marlowe, R.J. et al. Difficulties in deciding whether to ablate patients with putatively “low–intermediate-risk” differentiated thyroid carcinoma: do guidelines mainly apply in the centres that produce them? Results of a retrospective, two-centre quality assurance study. Eur J Nucl Med Mol Imaging 42, 2045–2055 (2015). https://doi.org/10.1007/s00259-015-3124-4

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