Positive predictive value of serum thyroglobulin levels, measured during the first year of follow-up after thyroid hormone withdrawal, in thyroid cancer patients
Positive predictive value of serum thyroglobulin levels, measured during the first year of follow-up after thyroid hormone withdrawal, in thyroid cancer patients
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DOI：
10.1210/jc.2002-021365
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发表时间：
2003-03-01
影响因子：
5.8
通讯作者：
Schlumberger, M
中科院分区：
文献类型：
--
作者：
Baudin, E;Do Cao, C;Schlumberger, M
甲状腺乳头状和滤泡性甲状腺癌患者甲状腺切除术和放射性碘消融后的随访主要基于血清甲状腺球蛋白（Tg）水平的测定。研究了256例连续分化型甲状腺癌患者在停用甲状腺激素后6-12个月随访期间测定的血清Tg水平阳性预测值（PPV）（初始Off L-T(4) Tg）。所有患者均行甲状腺全切除术和3.7 GBq (131)I消融；37例患者初始Off L-T4 Tg水平升高。本研究集中于这37例患者，其中9例有临床复发。目前的数据证实，在这一选定的患者队列中，74-185 MBq (131) i全身扫描（TBS）在最初的检查和随后的随访中没有临床意义，因为除了一名复发性疾病患者外，所有患者的TBS检查均为阴性。初始血清Off L-T4 Tg水平高于5 ng/ml和10 ng/ml的PPV分别为42%和53%；在复发或随后的控制时，PPV仅为50%。这种相对较低的PPV与该系列患者的低复发率有关，尽管随访时间较长，但37例患者中有14例（38%）在没有进一步治疗的情况下血清Tg水平下降。相反，甲状腺激素停药后血清Tg水平上升斜率的PPV（83%）很好。总之，我们确认（131）I-TBS对甲状腺癌患者的随访有有限的兴趣。随访应依靠血清Tg水平和预后参数；然而，初始血清Tg可能由不同意义的甲状腺组织产生，连续两次测定时升高表明疾病进展，降低与治疗的后期效应有关。最佳PPV由血清Tg水平斜率决定。
The follow-up of patients with papillary and follicular thyroid carcinoma after thyroidectomy and radioiodine ablation is mainly based on serum thyroglobulin (Tg) level determination.The positive predictive value (PPV) of serum Tg level after thyroid hormone withdrawal, measured during the first 6-12 months of follow-up (initial Off L-T(4) Tg), was studied in 256 consecutive differentiated thyroid cancer patients. All underwent a total thyroidectomy and 3.7 GBq (131)I ablation; 37 patients had an elevated initial Off L-T4 Tg level. This study focuses on these 37 patients, 9 of whom had a clinical recurrence.The present data confirm that in this selected cohort of patients, 74-185 MBq (131)I-total body scan (TBS) has no clinical interest in the initial work-up and during the subsequent follow-up because it was negative in all patients, except in one with recurrent disease. The PPV of initial serum Off L-T4 Tg level above 5 ng/ml and 10 ng/ml was 42% and 53%, respectively; this PPV was only 50% at the time of recurrence or subsequent control. This relatively low PPV is related to the low recurrence rate in this series of patients, despite a prolonged follow-up, and to the subsequent decrease of serum Tg level in 14 of 37 (38%) patients in the absence of any further treatment. In contrast, the PPV of the increasing slope of serum Tg levels obtained after thyroid hormone withdrawal (83%) was excellent.In conclusion, we confirm that (131)I-TBS has a limited interest for the follow-up of thyroid cancer patients. Follow-up should rely on serum Tg level and prognostic parameters; however, initial serum Tg may be produced by thyroid tissues of various significance, an increase at two consecutive determinations indicating disease progression and a decrease being related to late effects of therapy. The best PPV is brought by the slope of serum Tg levels.