Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
권호 표지
DOI QR코드

DOI QR Code

Baseline Stimulated Thyroglobulin Level as a Good Predictor of Successful Ablation after Adjuvant Radioiodine Treatment for Differentiated Thyroid Cancers

  • Fatima, Nosheen (Department of Nuclear Medicine, Dr. Ziauddin Hospital) ;
  • uz Zaman, Maseeh (Department of Radiology, Aga Khan University Hospital) ;
  • Ikram, Mubashir (Department of Radiology, Aga Khan University Hospital) ;
  • Akhtar, Jaweed (Department of Radiology, Aga Khan University Hospital) ;
  • Islam, Najmul (Department of Radiology, Aga Khan University Hospital) ;
  • Masood, Qamar (Department of Radiology, Aga Khan University Hospital) ;
  • Zaman, Unaiza (Students MBBS, Dow University of Health Sciences) ;
  • Zaman, Areeba (Students MBBS, Dow University of Health Sciences)
  • Published : 2014.08.15
Download PDF
⟨ Previous Next ⟩

Abstract

Background: To determine the predictive value of the baseline stimulated thyroglobulin (STg) level for ablation outcome in patients undergoing adjuvant remnant radioiodine ablation (RRA) for differentiated thyroid carcinoma (DTC). Materials and Methods: This retrospective study accrued 64 patients (23 male and 41 female; mean age of $40{\pm}14$ years) who had total thyroidectomy followed by RRA for DTC from January 2012 till April 2014. Patients with positive anti-Tg antibodies and distant metastasis on post-ablative whole body iodine scans (TWBIS) were excluded. Baseline STg was used to predict successful ablation (follow-up STg <2 ng/ml, negative diagnostic WBIS and negative ultrasound neck) at 7-12 months follow-up. Results: Overall, successful ablation was noted in 37 (58%) patients while ablation failed in 27 (42%). Using the ROC curve, a cut-off level of baseline STg level of ${\leq}14.5ng/ml$ was found to be most sensitive and specific for predicting successful ablation. Successful ablation was thus noted in 25/28 (89%) of patients with baseline STg ${\leq}14.5ng/ml$ and 12/36 (33%) patients with baseline STg >14.5 ng/ml ((p value <0.05). Age >40 years, female gender, PTS >2 cm, papillary histopathology, positive cervical nodes and positive TWBIS were significant predictors of ablation failure. Conclusions: We conclude that in patients with total thyroidectomy followed by I-131 ablation for DTC, the baseline STg level is a good predictor of successful ablation based on a stringent triple negative criteria (i.e. follow-up STg < 2 ng/ml, a negative DWBIS and a negative US neck).

Keywords

References

  1. Beierwaltes WH, Rabbani R, Dmuchowski C, et al (1984). An analysis of ''ablation of thyroid remnants'' with I-131 in 511 patients from 1947-1984: experience at University of Michigan. J Nucl Med, 25, 1287-93.
  2. Budak A, GulhanI, Aldemir OS, et al (2013). Lack of influence of pregnancy on the prognosis of survivors of thyroid cancer. Asian Pac J Cancer Prev, 14, 6941-43. https://doi.org/10.7314/APJCP.2013.14.11.6941
  3. Cooper D, Doherty G, Haugen B, et al (2009). Revised American thyroid association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid, 19, 1167-214. https://doi.org/10.1089/thy.2009.0110
  4. Edwards B, Howe H, Ries L, et al (2002). Annual report to the nation on the status of cancer, 1973-1999, featuring implications of age and aging on US cancer burden. Cancer, 94, 2766-92. https://doi.org/10.1002/cncr.10593
  5. Giovanella L, Ceriani L, Ghelfo A, Keller F (2005). Thyroglobulin assay 4 weeks after thyroidectomy predicts outcome in lowrisk papillary thyroid carcinoma. Clin Chem Lab Med, 43, 843-47.
  6. Hyo L, Rha Y, Suk Jo Y, et al (2007). Predictive value of the preablation serum thyroglobulin level after thyroidectomy is combined with postablation 131I whole body scintigraphy for successful ablation in patients with differentiated thyroid carcinoma. Am J Clin Oncol, 30, 63-8. https://doi.org/10.1097/01.coc.0000239138.64949.0a
  7. Hussain Z, Zaman U, Malik S, et al (2014). Preablation stimulated thyroglobulin/TSH ratio as a predictor of successful I131remnant ablation in patients with differentiated thyroid cancer following total thyroidectomy. J Thyroid Res.
  8. Iyer NG, Morris LG, Tuttle RM, et al (2011). Rising incidence of second cancers in patients with low-risk (T1N0) thyroid cancer who receive radioactive iodine therapy. Cancer, 117, 4439-46. https://doi.org/10.1002/cncr.26070
  9. Karam M, Gianoukakis A, Feustel PJ, et al (2003). Influence of diagnostic and therapeutic doses on thyroid remnant ablation rates. Nucl Med Commun, 24, 489-95. https://doi.org/10.1097/00006231-200305000-00002
  10. Kim TY, Kim WB, Kim ES, et al (2005). Serum thyroglobulin levels at the time of 131I remnant ablation just after thyroidectomy are useful for early prediction of clinical recurrence in low-risk patients with differentiated thyroid carcinoma. J Clin Endocrinol Metab, 90, 1440-45. https://doi.org/10.1210/jc.2004-1771
  11. Lin Y, Li T, Liang J, et al (2011). Predictive value of preablation stimulated thyroglobulin and thyroglobulin/thyroidstimulating hormone ratio in differentiated thyroid cancer. Clinical Nuclear Medicine, 36, 1102-05. https://doi.org/10.1097/RLU.0b013e3182291c65
  12. Lim I, Kim S, Hwang S, Kim SW, et al (2012). Prognostic implication of thyroglobulin and quantified whole body scan after initial radioiodine therapy on early prediction of ablation and clinical response for the patients with differentiated thyroid cancer. Ann Nucl Med, 26, 777-86. https://doi.org/10.1007/s12149-012-0640-1
  13. Mazzaferri EL, Kloos RT (2001). Clinical review 128: current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab, 86, 1447-63. https://doi.org/10.1210/jcem.86.4.7407
  14. Mazzaferri E, Robbins R, Spencer C, et al (2003). A consensus report of the role of serum thyroglobulin as a monitoring method for low-risk patients with papillary thyroid carcinoma. J Clin Endocrinol Metab, 88, 1433-41. https://doi.org/10.1210/jc.2002-021702
  15. Mallick U, Harmer C, Yap B, et al (2012). Ablation with lowdose radioiodine and thyrotropin alfa in thyroid cancer. N Engl J Med, 366, 1674-85. https://doi.org/10.1056/NEJMoa1109589
  16. Robbins R, Schlumberger M (2005). The evolving role of I-13I for the treatment of differentiated thyroid carcinoma. J Nucl Med, 46, 28-37.
  17. Pacini F, Capezzone M, Elisei R, et al (2002). Diagnostic 131-iodine whole-body scan may be avoided in thyroid cancer patients who have undetectable stimulated serum Tg levels after initial treatment. J Clin Endocrinol Metab, 87, 1499-501. https://doi.org/10.1210/jcem.87.4.8274
  18. Pacini F, Schlumberger M, Dralle H, et al (2006). European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Europ Jourl of Endo, 154, 787-803. https://doi.org/10.1530/eje.1.02158
  19. Rosario PW, Reis JS, Barroso AL, et al (2004). Efficacy of low and high I-131 doses for thyroid remnant ablation in patients with differentiated thyroid carcinoma based on postoperative cervical uptake. Nucl Med Commun, 25, 1077-81. https://doi.org/10.1097/00006231-200411000-00002
  20. Schlumberger M. (1998). Papillary and follicular thyroid carcinoma. N Engl J Med, 338, 297-306. https://doi.org/10.1056/NEJM199801293380506
  21. Souza R, Barroso A, Rezende L, et al (2004). Post I-131 therapy scanning in patients with thyroid carcinoma metastases: an unnecessary cost or a relevant contribution? Clin Nucl Med, 29, 795-98. https://doi.org/10.1097/00003072-200412000-00005
  22. Sritara C, Charoenphun P, Ponglikitmongkol M, et al (2012). Serum oncofetal fibronectin (onfFN) mRNA in differentiated thyroid carcinoma (DTC): large overlap between diseasefree and metastatic oatients. Asian Pac J Cancer Prev, 13, 4203-08. https://doi.org/10.7314/APJCP.2012.13.8.4203
  23. Schlumberger M, Catargi B, Borget I, et al (2012). Strategies of radioiodine ablation in patients with low-risk thyroid cancer. N Engl J Med, 366, 1663-73. https://doi.org/10.1056/NEJMoa1108586
  24. Vaisman F, Shaha A, Fish S, et al (2001). Initial therapy with either thyroid lobectomy or total thyroidectomy without radioactive iodine remnant ablation is associated with very low rates of structural disease recurrence in properly selected patients with differentiated thyroid cancer. Clinical Endocrinology, 75, 112-9.
  25. Verburg F, deKeizer B, Lips C, et al (2005). Prognostic significance of successful ablation with radioiodine of differentiated thyroid cancer patients. Eur J Endocrinol, 152, 33-37. https://doi.org/10.1530/eje.1.01819
  26. Zaman M, Fatima N, Padhy AK, Zaman U (2013). Controversies about radioactive iodine-131 remnant ablation in low risk thyroid cancers: are we near a consensus? Asian Pac J Cancer Prev, 14, 6209-13. https://doi.org/10.7314/APJCP.2013.14.11.6209

Cited by

  1. Comparable Ablation Efficiency of 30 and 100 mCi of I-131 for Low to Intermediate Risk Thyroid Cancers Using Triple Negative Criteria vol.17, pp.3, 2016, https://doi.org/10.7314/APJCP.2016.17.3.1115
  2. The predictive value for excellent response to initial therapy in differentiated thyroid cancer vol.39, pp.5, 2018, https://doi.org/10.1097/MNM.0000000000000827