Unexpected radioactive iodine accumulation on whole-body scan after I-131 ablation therapy for differentiated thyroid cancer
Unexpected radioactive iodine accumulation on whole-body scan after I-131 ablation therapy for differentiated thyroid cancer
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DOI：
10.18999/nagjms.82.2.205
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发表时间：
2020-05-01
影响因子：
0.9
通讯作者：
Naganawa, Shinji
中科院分区：
文献类型：
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作者：
Iwano, Shingo;Ito, Shinji;Naganawa, Shinji
我们回顾性评估了分化型甲状腺癌（DTC）患者放射性碘（RAI）消融治疗后治疗后全身扫描（Rx-WBS）中放射性碘意外积聚的频率。我们在我们的机构数据库中检索了2012年至2019年间接受RAI消融或辅助治疗的DTC患者的Rx-WBSs。排除治疗前经CT或PET/CT诊断有远处转移的患者，以及既往接受过RAI治疗的患者。总共选择了293例患者（201例女性和92例男性，中位年龄54岁）。两名核医学医师通过确定甲状腺床、颈部和纵隔淋巴结、肺和骨的放射性碘摄取的视觉强度来解释Rx-WBS图像。采用卡方检验和中位数检验比较有无转移灶的患者的临床特征。进行逻辑回归分析以比较转移性积聚的存在与这些临床因素之间的关联。293例患者中有84例（28.7%）显示转移性蓄积。在TSH刺激下，具有转移性RAI积聚的患者显示出显著更高的病理性N1（pN 1）和血清甲状腺球蛋白（Tg）> 1.5 ng/ml的频率（分别为p = 0.035和p = 0.031）。Logistic回归分析表明，血清Tg > 1.5 ng/ml与转移性积聚的存在显著相关（比值比= 1.985; p = 0.033）。总之，Tg > 1.5 ng/ml的患者更可能显示转移性蓄积。此外，初次甲状腺手术时存在淋巴结转移也与这种意外的转移性积聚相关。
We retrospectively evaluated the frequency of unexpected accumulation of radioactive iodine on the post-therapy whole-body scan (Rx-WBS) after radioactive iodine (RAI) ablation therapy in patients with differentiated thyroid cancer (DTC). We searched our institutional database for Rx-WBSs of DTC patients who underwent RAI ablation or adjuvant therapy between 2012 and 2019. Patients with distant metastasis diagnosed by CT or PET/CT before therapy, and those had previously received RAI therapy were excluded. In total. 293 patients (201 female and 92 male, median age 54 years) were selected. Two nuclear medicine physicians interpreted the Rx-WBS images by determining the visual intensity of radioiodine uptake by the thyroid bed, cervical and mediastinal lymph nodes, lungs, and bone. Clinical features of the patients with and without the metastatic accumulation were compared by chi-square test and median test. Logistic regression analyses were performed to compare the association between the presence of metastatic accumulation and these clinical factors. Eighty-four of 293 patients (28.7%) showed metastatic accumulation. Patients with metastatic RAI accumulation showed a significantly higher frequency of pathological N1 (pN1) and serum thyroglobulin (Tg) > 1.5 ng/ml under TSH stimulation (p = 0.035 and p = 0.031, respectively). Logistic regression analysis indicated that a serum Tg > 1.5 ng/ml was significantly correlated with the presence of metastatic accumulation (odds ratio = 1.985; p = 0.033). In conclusion, Patients with Tg > 1.5 ng/ml were more likely to show metastatic accumulation. In addition, the presence of lymph node metastasis at the initial thyroid surgery was also associated with this unexpected metastatic accumulation.