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Early preablation rhTSH-stimulated thyroglobulin predicts outcome of differentiated thyroid cancer (DTC) patients

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

Abstract

Aim

Total thyroidectomy and risk-adapted 131-radioiodine therapy (RaIT) are the treatments of choice in differentiated thyroid cancer (DTC) patients. The response to treatments is assessed 6–12 months after RaIT. However, thyroglobulin (Tg) values obtained just before RaIT also provide reliable informations on patients’outcome. As available data were mostly obtained in hypothyroid status, we evaluated the predictive role of preablation-Tg in patients underwent RaIT after rhTSH stimulation.

Material and methods

We enrolled 299 low-to-intermediate risk DTC patients underwent rhTSH-stimulated RaIT (standard protocol). Serum Tg levels were measured before rhTSH administration (basal Tg), before RaIT (early-stimulated Tg), and 2 days after RaIT (late-stimulated Tg). The early response assessment was done 12 months after RaIT according to 2015 American Thyroid Association (2015 ATA) criteria.

Results

Most patients (277/299, 92.6%) had an excellent response (ER) to RaIT, while 15/299 (5.1%) and 7/299 (2.3%) patients showed biochemical incomplete/indeterminate response or persistent structural disease, respectively. At receiver operating characteristic analysis, the optimal cutoff to predict ER was set at 1.55 (AUC = 0.792), 2.6 (AUC = 0.931), and 4.9 (AUC = 0.874) ng/mL, for basal, early-, and late-stimulated Tg, respectively. The overall sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) for basal, early-, and late-stimulated Tg were 50%, 96.7%, 93.3%, 55%, and 96.1%; 90.9%, 84.5%, 84.9%, 31.7%, and 99.1%; and 90.9%, 71.8%, 73.2%, 20.4%, and 99%, respectively. In univariate and multivariate logistic regression analysis, early-stimulated Tg cutoff resulted as an independent prognostic marker for predicting ER regardless of gender, age, histotype, histological variant, tumor size, risk classification, and stage of disease.

Conclusion

Early-stimulated Tg is a reliable diagnostic tool for predicting the response to primary treatment of DTC.

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Authors and Affiliations

  1. Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Via Consolare Valeria nr.1, 98125, Messina, Italy

    Alfredo Campennì, Massimiliano Siracusa, Alessio Danilo Comis, Davide Romano, Antonio Vento, Helena Lanzafame & Sergio Baldari

  2. Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy

    Rosaria Maddalena Ruggeri

  3. Service Department Macerata Hospital, ASUR Marche AV3, Nuclear Medicine Unit, Macerata, Italy

    Francesca Capoccetti

  4. Unit of Statistical and Mathematical Sciences, Department of Economics, University of Messina, Messina, Italy

    Angela Alibrandi

  5. Clinic for Nuclear Medicine and Competence Centre for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland

    Luca Giovanella

  6. Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland

    Luca Giovanella

Authors
  1. Alfredo Campennì
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  2. Rosaria Maddalena Ruggeri
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  3. Massimiliano Siracusa
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  4. Alessio Danilo Comis
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  5. Davide Romano
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  6. Antonio Vento
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  7. Helena Lanzafame
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  8. Francesca Capoccetti
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  9. Angela Alibrandi
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  10. Sergio Baldari
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  11. Luca Giovanella
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Contributions

Alfredo Campenni: contributed to conception, design, and wrote the manuscript.

Rosaria Maddalena Ruggeri: acquired, analyzed, and interpreted the data.

Massimiliano Siracusa: acquired, analyzed, and interpreted the data.

Alessio Danilo Comis: acquired, analyzed, and interpreted the data.

Davide Romano: acquired, analyzed and interpreted the data.

Antonio Vento: acquired, analyzed, and interpreted the data.

Helena Lanzafame: acquired, analyzed, and interpreted the data.

Francesca Capoccetti: acquired, analyzed, and interpreted the data.

Angela Alibrandi: wrote the statistical analysis.

Sergio Baldari: revised the manuscript.

Luca Giovanella: contributed to conception, design and revised the manuscript.

Corresponding author

Correspondence to Alfredo Campennì.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Ente Ospedaliero Cantonale Institutional Review Board and the Canton Tessin Ethical Committee, Bellinzona (Switzerland) [reference BASEC 2019–00662] and the institutional review board of the Medical Faculty of the University of Messina. All procedures performed were in accordance with the principles of the 1964 Declaration of Helsinki and its later amendments.

Informed consent

In all patients, written informed consent for both diagnostic examinations and therapy were always obtained prior to the procedures.

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Campennì, A., Ruggeri, R.M., Siracusa, M. et al. Early preablation rhTSH-stimulated thyroglobulin predicts outcome of differentiated thyroid cancer (DTC) patients. Eur J Nucl Med Mol Imaging 48, 2466–2475 (2021). https://doi.org/10.1007/s00259-020-05153-7

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  • DOI: https://doi.org/10.1007/s00259-020-05153-7

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