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Recurrent/metastatic thyroid carcinomas false negative for serum thyroglobulin but positive by posttherapy I-131 whole body scans

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

Abstract

Purpose

Serum Tg and I-131 WBS have been used to detect recurrent and metastatic thyroid cancers postoperatively. Tg is known to be more sensitive than I-131 WBS, and therefore, false-negative WBS cases with elevated Tg levels are frequently found. However, the clinical characteristics of false-negative Tg cases with positive WBS have not been clarified.

Materials and methods

The authors evaluated 824 postoperative patients with differentiated thyroid carcinoma who underwent post-ablation/therapy I-131 WBS. Tg negativity was defined as a Tg level of ≤2 ng/mL without TgAb under thyroid-stimulating hormone stimulation. Remission, recurrence, and metastasis were confirmed using pathologic or clinically findings.

Results

Fifty-two patients (6.3%) with functioning metastasis and negativity for TgAb were Tg-negative and posttherapy I-131 WBS-positive (TgN group), and 128 patients with functioning metastases were Tg positive and WBS positive (TgP group). The TgN group consisted of 45 cases of cervical/mediastinal lymph node metastases (86.5%) and seven cases of distant metastasis to lung or bone by follow-up WBS. The TgN group demonstrated significantly higher profiles of regional involvement than the TgP group (P < 0.029). In 47 patients in the TgN group, metastatic uptake disappeared in 33, ameliorated in four, and persisted in ten during follow-up.

Conclusions

A significant number of differentiated thyroid cancer patients were Tg-/TgAb-negative despite a positive WBS finding. Cervical and mediastinal lymph nodes were predominant sites of metastasis in the TgN group. WBS should be undertaken routinely as a complementary modality to detect functioning recurrence and metastasis regardless of serum Tg results.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-Gu, Seoul, 110-744, Korea

    Eun-Kyung Park, June-Key Chung, Il Han Lim, Dong Soo Lee & Myung Chul Lee

  2. Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea

    June-Key Chung & Il Han Lim

  3. Medical Research Center of Tumor Immunity, Seoul National University College of Medicine, Seoul, Korea

    June-Key Chung

  4. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea

    Do Joon Park & Bo Youn Cho

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  1. Eun-Kyung Park
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Correspondence to June-Key Chung.

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Park, EK., Chung, JK., Lim, I.H. et al. Recurrent/metastatic thyroid carcinomas false negative for serum thyroglobulin but positive by posttherapy I-131 whole body scans. Eur J Nucl Med Mol Imaging 36, 172–179 (2009). https://doi.org/10.1007/s00259-008-0912-0

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  • DOI: https://doi.org/10.1007/s00259-008-0912-0

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