경북의대 / 이창희, 안병철*
Abstract
OBJECTIVE:
Post I-131 ablation single-photon emission computed tomography (SPECT)/CT can show radioactive iodine (RAI)-avid cervical metastatic lymph nodes (mLN) in differentiated thyroid cancer. This study aimed to evaluate the incidence of RAI-avid mLN on post I-131 ablation SPECT/CT and the risk factors related to metastasis among patients with papillary thyroid cancer (PTC) in the low- or intermediate-risk groups.
STUDY DESIGN AND SETTING:
Among 339 patients with PTC who underwent total thyroidectomy followed by I-131 ablation, 292 (228 women, 64 men) belonging to the low- or intermediate-risk groups before I-131 ablation, and with sufficient clinical follow-up data were enrolled. The risk groups were classified based on the American Thyroid Association 2015 guideline. Each patient was followed-up for at least 24 months after the ablation (median: 30 months). The clinical, pathologic, and biochemical factors of PTC were reviewed, and their relationships to RAI-avid mLN on SPECT/CT were analyzed.
RESULTS:
Of the 292 patients, 61 and 231 belonged to the low-and intermediate-risk groups, respectively. Four (6.5%) patients in the low-risk group and 31 (13.0%) patients in the intermediate-risk group had RAI-avid mLN. A high preablation TSH-stimulated serum thyroglobulin (Tg) level in the low- or intermediate-risk group predicted the presence of RAI-avid mLN (cut-off = 0.5; hazard ratio (HR): 2.96; p = 0.04). In the subgroup analysis by risk group, TSH-stimulated serum Tg only predicted RAI-avid mLN in the low-risk group (cut-off = 1.0; HR: 5.3; p = 0.03).
CONCLUSION:
The incidence of RAI-avid mLN on postablation SPECT/CT was relatively high in both low- and intermediate-risk patients with PTC, and high preablation TSH-stimulated serum Tg level was a predictor of metastasis, especially in the low-risk group. A selective treatment approach should be considered in patients with high preablation TSH-stimulated serum Tg level.
Author information
Lee CH1,2, Jung JH1,2, Son SH1, Hong CM1,2, Jeong JH1,2, Jeong SY1,2, Lee SW1,2, Lee J1,2, Ahn BC1,2.
1
Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea.
2
Department of Nuclear Medicine, Kyungpook National University Hospital, Daegu, South Korea.
편집위원
유두상 갑상선암에서 림프절전이가 비교적 흔히 발생됨을 보여주었고,TSH 자극 thyroglobulin 치가 radioiodine avid lymph node metastasis를 예측할 수 있음을 보여준 임상연구 결과임. 갑상선암 진료의사 및 방사성요오드 치료를 시행한는 핵의학의사에게 유용한 정보를 제공할 것으로 생각됨.
2018-09-13 15:53:38
편집위원2
저위험군에서도 림프절전이의 예측인자로 자극 Tg level이 중요함을 증명하여 치료 선택에 도움을 줄 것으로 예상됨.
2018-09-13 16:25:44