Thyroglobulin and low-dose iodine-131 and technetium-99m-tetrofosmin whole-body scintigraphy in differentiated thyroid carcinoma.

Determination of thyroglobulin (Tg) levels, determined under endogenous thyroid-stimulating hormone stimulation after withdrawal of L-thyroxin treatment (off-T4), has been proven to be the most sensitive method for evaluation of patients with recurrent malignancy or distant metastases. This study uses a comparative approach between low-dose 131I scan and the previously reported highly sensitive 99mTc-tetrofosmin whole-body scintigraphy, using Tg-off-T4 as a basis for comparison.
Fifty-eight consecutive patients of our follow-up program with primary thyroid carcinoma ablated with thyroidectomy and radioiodine therapy were examined after L-thyroxin withdrawal over 3-4 wk with 131I (185 MBq) and 99mTc-tetrofosmin whole-body scintigraphy and Tg determination (off-T4) within 5 days. Patients with Tg levels above 0.5 ng/ml were defined as Group A (n = 29). Group B (n = 29) comprised patients who had Tg levels (off-T4) below 0.5 ng/ml.
Iodine-131 revealed only 19 of 44 tumor sites (43.18%). Additionally, three remnants could be demonstrated. Sensitivity showed decreasing values for local recurrences (4 of 7, 57.1%), bone lesions (7 of 13, 53.85%) and mediastinal (2 of 4, 50%), lung parenchymal (3 of 7, 42.85%) and lymph node (2 of 9, 22.2%) metastases. Whole-body scintigraphy with 99mTc-tetrofosmin revealed a total of 39 of 44 malignant lesions (88.6%). Sensitivity was superior for lung parenchymal metastases (9 of 9, 100%), mediastinum (4 of 4, 100%) and lymph nodes (9 of 10, 90%) and inferior for bone metastases (11 of 13, 84.6%). Local recurrences could be detected in 6 of 7 patients (85.7%), and thyroid remnants were detected in 2 cases (2 of 11, 18.2%). One liver metastasis could not be detected because of the physiologic tracer distribution of 99mTc-tetrofosmin. Thyroglobulin-off-T4 detected malignant recurrence or metastases in 18 of 19 patients (94.7%) when a cutoff of 3 ng/ml was used and in 16 of 19 patients (84.2%) when a cutoff of 10 ng/ml was used. Specificity was calculated as 71.8% when a cutoff of 0.5 ng/ml was used, 89.7% when a cutoff of 3 ng/ml was used and 100% when a cutoff of 10 ng/ml was used.
Scintigraphy with 99mTc-tetrofosmin showed clear advantages concerning sensitivity in most metastatic lesions when compared with low-dose 131I scan. Despite a slight lower specificity, 99mTc-tetrofosmin whole-body scintigraphy has, therefore, been proven to be a useful tool in the assessment of metastatic lesions in differentiated thyroid carcinoma.
AuthorsH J Gallowitsch, P Mikosch, E Kresnik, O Unterweger, I Gomez, P Lind
JournalJournal of nuclear medicine : official publication, Society of Nuclear Medicine (J Nucl Med) Vol. 39 Issue 5 Pg. 870-5 (May 1998) ISSN: 0161-5505 [Print] UNITED STATES
PMID9591591 (Publication Type: Comparative Study, Journal Article)
Chemical References
  • Iodine Radioisotopes
  • Organophosphorus Compounds
  • Organotechnetium Compounds
  • Radiopharmaceuticals
  • technetium Tc 99m 1,2-bis(bis(2-ethoxyethyl)phosphino)ethane
  • Thyroglobulin
  • Thyroxine
  • Adenocarcinoma, Follicular (radionuclide imaging, secondary, therapy)
  • Carcinoma, Papillary (radionuclide imaging, secondary, therapy)
  • Case-Control Studies
  • Combined Modality Therapy
  • Female
  • Humans
  • Iodine Radioisotopes (therapeutic use)
  • Male
  • Middle Aged
  • Neoplasm Metastasis
  • Neoplasm Recurrence, Local (radionuclide imaging)
  • Organophosphorus Compounds
  • Organotechnetium Compounds
  • Radiopharmaceuticals
  • Sensitivity and Specificity
  • Thyroglobulin (blood)
  • Thyroid Neoplasms (pathology, radionuclide imaging, therapy)
  • Thyroidectomy
  • Thyroxine (therapeutic use)

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