Outcome of ablation of thyroid remnants with 100 mCi (3.7 GBq) iodine-131 in patients with thyroid cancer

A retrospective study was conducted on 186 patients with differentiated thyroid cancer without metastases who received an ablative dose of 100 mCi (3.7 GBq) iodine-131 after total thyroidectomy. Six months to one year after ablation, 155/186 patients (83%) had a negative scan. Diagnostic scanning with 5 mCi (185 MBq) performed 72 h or 3 months before ablation did not interfere with treatment success compared to patients not submitted to pre-therapy scanning. Pre-ablation cervical uptake values < 2% were associated with a higher ablation efficacy (94%), from 2 to 5% showed 80% success and values > 5%, 60% (p < 0.05). There were no significant differences between the responsive and no responsive groups in terms of age, sex, histological type or size of the primary tumor. 11% of the patients with low stimulated Tg (< 2 ng/ml) presented discrete thyroid bed uptake on follow-up diagnostic scan (< 0.5%) without definitive residual disease and 89% had negative uptake on scan. The patients with Tg > 2 ng/ml presented thyroid bed (10/12) or ectopic (2/12) uptake on follow-up diagnostic scan. An ablative dose of 100 mCi shows a high rate of efficacy, especially when cervical uptake is < 2%; no difference was noted between patients assessed by scan within 72 h or 3 months before treatment and those not scanned; follow-up diagnostic scan can be avoided in low risk patients with stimulated Tg < 2 ng/ml.     

Serum differential proteomics analysis between papillary thyroid cancer patients with 131I-avid and those with non-131I-avid lung metastases

Our aim was to compare the differences in serum protein fingerprints between papillary thyroid carcinoma (PTC) patients with (131)I-avid lung metastases and those with non-(131)I-avid lung metastases, and to establish a screening model for screening (131)I uptake in lung metastases. We collected serum samples from 46 PTC patients with (131)I-avid lung metastases (Group A) and 23 PTC patients with non-(131)I-avid lung metastases (Group B) respectively, and both groups were matched for age and sex, without history of other tumors. Among them, 28 cases (19 cases in Group A, and 9 cases in Group B) were enrolled in the training set to establish the decision tree model, and another 41 cases (27 cases in Group A, and 14 cases in Group B)were incorporated for blind test set. The serum protein fingerprints were profiled using surface enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF-MS, USA) and the difference between the two groups was compared using the Ciphergen Proteinchip 3.1 software. Bioinformatics analysis was performed to construct the decision tree model based on the data of the training set, and the blind test was also conducted for blind test set. Our results showed that a total of 151 valid protein peaks were detected at the molecular range of 1300 Da to 15,000 Da, among which 7 were significantly different between Group A and Group B (P< 0.05). The blind test was conducted via the decision tree model, with a sensitivity of 92.6% (25/27) and a specificity of 85.7% (12/14). In conclusion, the difference in the serum protein fingerprints between Group A and Group B is quite accurate for screenning (131)I uptake in the lung metastases from PTC, conferring important clinical value for the prediction of (131)I uptake and guiding of personalized (131)I treatment decisions.     

^131I治疗分化型甲状腺癌骨转移的疗效评价和生存分析

目的评价^131I治疗DTC骨转移的疗效及影响因素,评估生存率及其影响因素。方法回顾分析经^131I治疗的106例DTC骨转移患者的临床资料,分别基于^131I治疗后血清Tg的变化、骨痛缓解情况和影像学变化评价^131I治疗疗效,并对影响^131I疗效的因素进行单因素分析;采用寿命表法评估DTC骨转移患者的^131I治疗后总生存率;采用Kaplan—Meier法对影响生存率的因素进行分析,应用Log-rank法比较各组间差异。结果经^131I治疗后血Tg显著下降者37例,有效率34．9％。骨转移伴疼痛的61例DTC经^131I治疗后疼痛明显缓解者39例,有效率63．9％。患者年龄、病理类型、是否合并其他非骨性远端转移等因素对^131I治疗后血Tg的变化有影响（x2=6．443,11．455和6．756,P均〈0．05）,但对^131I治疗后骨痛缓解的影响无统计学意义（x2=0,0,0．060,P均〉0．05）。^131I治疗后77．4％的患者骨转移灶无明显影像学变化。该组DTC骨转移患者5年和10年生存率分别为86．47％和57．90％;骨转移灶数目、是否合并其他远端脏器转移、^131I治疗前是否行手术治疗对患者的10年生存率影响差异有统计学意义（Log-rank值为4．05,5．98和4．22,P均〈0．05）;患者的性别、年龄、病理类型、是否以骨转移症状首诊等因素对10年生存率无明显影响（Log—rank值为0．01,1．56,2．59和0．04,P均〉0．05）。结论^131I治疗可使DTC骨转移患者血清Tg下降、骨痛缓解、病灶保持稳定或缩小,是治疗DTC骨转移的有效手段;单发病灶、单纯骨转移、手术＋^131I治疗患者预后较好。     

分化型甲状腺癌切除术后多发骨转移一例

笔者报道了1例分化型甲状腺癌（DTC）切除术后多发骨转移的病例,其99Tcm-亚甲基二膦酸盐全身骨显像结果呈阴性,而经131I治疗后全身显像（Rx-WBS）结果呈阳性,通过实验室检查、组织病理学检查及影像学检查结果综合分析了该病的特点。综合分析结果提示131I Rx-WBS有利于发现DTC骨转移灶,且131I治疗对其效果显著。     

Whole-body (131)I washout in a patient with metastatic well-differentiated papillary thyroid carcinoma treated with repeated (131)I administration

We describe the case of a 37-year-old male patient suffering from papillary carcinoma of the thyroid gland with pulmonary metastases who after total thyroidectomy on 29/07/1998 was submitted to three treatments with high doses of (131)I and studied as to the whole body clearance of (131)I by measuring the dose rate of (131)I. The patient was referred to us for total ablation of post surgery remnant of thyroid tissue on 19/09/1998. Due to lymphadenic metastases and high Tg values: 450 ng/ml, he was purposely given therapeutically a high dose of 5146 MBq (131)I. On the whole body post-operative scintiscan that followed, a diffuse uptake of (131)I in the lungs and in the thyroid remnant was found. The patient was given 7307 MBq (131)I after 7 months and 5154 MBq of (131)I after another 10 months, because Tg was increased. Whole body scintiscan after the third treatment as mentioned above, showed poor uptake of (131)I in the thyroid gland area and in the lungs. No side effects were noticed, Tg fell to 4.5-7 ng/ml and the patient was in good condition with no abnormal findings on the X-rays or CT of the thorax. After iodine administration whole body measurements of the dose rate of the clearance of (131)I measured by an ionization chamber at a distance of 2 m from the thorax, were performed. For the first treatment effective half-lives of (131)I of the patient, as measured for the two components of the clearance curve, were 4.4 h and 16.8 h respectively. For the second and third treatment clearance curve had only one component and effective half-lives were 22.5 h and 11 h respectively. Remaining activity of (131)I at 48 h was for the first, second and third treatment: 13.3% (685 MBq), 22.8% (1670 MBq) and 4.2% (222 MBq) respectively. We do not know any similar case in the literature with whole body measurements of (131)I clearance in patients undergoing repeated (131)I treatment as above, especially with diffuse pulmonary uptake of (131)I indicating metastatic lesions after the first treatment of (131)I post total thyroidectomy. The interest of the above case also lies on the fact that there were three successive treatments with (131)I and three whole body (131)I measurements. Clearance rate indicated the need for additional treatment and the treatment followed was successful.     

131I治疗分化型甲状腺癌术后患者辐射剂量预测模型的研究

目的 探讨131I治疗分化型甲状腺癌（DTC）术后患者全身辐射剂量代谢的影响因素,为辐射防护提供指导。 方法 回顾性分析2018年4至9月于3家三甲医院住院的72例DTC术后患者[男性27例、女性45例,年龄15~75（42.79±14.23）岁]的临床资料,其中同济大学附属第十人民医院23例、上海交通大学医学院附属仁济医院24例、华中科技大学同济医学院附属协和医院25例。根据服用131I后48 h全身辐射剂量是否达到安全标准将患者分为安全组（48 h全身辐射剂量≤23.30 μSv/h）和危险组（48 h全身辐射剂量>23.30 μSv/h）,比较各因素对全身辐射剂量代谢的影响。计量资料的组间比较采用成组t检验或Wilcoxon秩和检验;计数资料的组间比较采用卡方检验或Fisher确切概率法。对各变量进行单因素分析,对单因素分析中差异有统计学意义的变量采用多因素Logistic回归分析。以各单因素及多因素联合指标绘制受试者工作特征（ROC）曲线,评估其最佳临界值及诊断效能。 结果 危险组和安全组比较的单因素分析结果显示,甲状腺2 h摄碘率（t=?2.56,P=0.01）、24 h摄碘率（Z=?2.07,P=0.04）、游离三碘甲腺原氨酸（Z=?2.83,P=0.01）、游离甲状腺素（Z=?2.70,P=0.01）、甲状腺球蛋白（Tg）水平（χ2=6.80,P=0.01）、甲状腺超声提示是否存在甲状腺残留组织（Fisher确切概率法,P=0.03）等6个指标显著影响了131I治疗DTC术后患者的全身辐射剂量代谢。多因素Logistic回归分析结果显示,24 h摄碘率[OR=1.27（95%CI:1.03~1.57）]和Tg水平[OR=2.51（95%CI:1.21~5.20）]对全身辐射剂量代谢有影响（P=0.03、0.01）,24 h摄碘率和Tg水平越高的患者其48 h全身辐射剂量达到安全水平的可能性越低。24 h摄碘率+Tg水平（联合指标）诊断的ROC曲线下面积为0.76（95%CI:0.65~0.87）、灵敏度为94.87%、特异度为46.88%、最佳临界值为?0.71。 结论 24 h摄碘率和Tg水平是131I治疗DTC术后患者全身辐射剂量代谢的影响因素,利用这两个因素建立联合指标进行辐射剂量评估可为调整患者住院时长提供参考。     

分化型甲状腺癌肺转移灶早期显影与^131I疗效关系分析

目的探讨DTC肺转移患者首次应用^131I清除甲状腺组织（简称清甲）时肺转移灶显像与^131I治疗效果的关系,及影响肺转移灶早期显影的因素。方法回顾分析1997至2009年41例DTC肺转移患者清甲治疗时肺转移灶显影情况,评价^131I治疗DTC肺转移疗效。疗效评价分临床治愈、好转和无效。前两者为治疗有效。采用SPSS11．5软件,对有效率、有无远处转移、显像特点进行,检验及交叉分类2×2列联表关联分析。结果41例患者中8例为临床治愈,18例好转,有效率63％（26／41）,14例无效,1例患者死亡,无效率37％（15／41）。清甲治疗时肺部转移灶显影患者^131I治疗有效率76％（22／29）,随访和重复治疗中显影患者^131I治疗有效率为33％（4／12）,两者差异有统计学意义0,2=4．911,P=0．027）;肺转移灶^131I摄取呈弥漫性或局灶性,两者间有效率分别为67％（12／18）和61％（14／23）,差异无统计学意义（χ2=0．146,P=0．702）;肺外有远处转移者^131I治疗DTC肺转移灶有效率为22％（2／9）,无远处转移者有效率为75％（24／32）,差异有统计学意义（χ2=6．312,P=0．012）;83％（24／29）行甲状腺全切的患者在首次清甲治疗时即有肺转移灶显影,而行甲状腺部分切除患者中仅有42％（5／12）,甲状腺手术方式与肺转移灶早期显影有相关性（r=0．411,P〈0．05）;乳头状癌和滤泡状癌患者中首次清甲治疗时肺转移灶早期显影患者分别为72％（23／32）和6／9,病理分型和肺转移灶显影早晚无关（r=0．047,P〉0．05）。结论DTC肺转移患者清甲治疗时转移灶显影阳性、无肺外远处转移灶者的^131I疗效好。     

Comparison of (123)I and (131)I for whole-body imaging in thyroid cancer.

We compared the diagnostic sensitivities of (123)I and (131)I whole-body imaging in differentiated thyroid cancer. METHODS: Twelve thyroidectomized patients (3 previously treated with (131)I) were studied. After a period of thyroid hormone withdrawal, whole-body imaging was performed approximately 24 and 72-96 h after administration of 74-185 MBq (2-5 mCi) (123)I and 111-185 MBq (3-5 mCi) (131)I, respectively. RESULTS: Both (123)I and (131)I revealed residual thyroid tissue, present in 9 patients. (131)I detected metastases in 5 studies of 4 patients. In 4 of 5 studies, (123)I missed metastases shown by (131)I in 8 body regions including the neck, mediastinum, lungs, and bone and detected 3 other sites of metastasis only in retrospect. No lesion was better seen with (123)I than with (131)I. CONCLUSION: Although (123)I is adequate for imaging residual thyroid tissue, it appears to be less sensitive than (131)I for imaging thyroid cancer metastases.     

甲状腺乳头状癌患者术后首次131I治疗后辐射剂量率的影响因素及出院时间的探讨

目的 探讨甲状腺乳头状癌(PTC)患者术后首次131I治疗后影响辐射剂量率降低的相关因素,并预估其住院隔离时间。方法 选取2015年5月至2018年11月于南方医科大学珠江医院住院并首次行131I治疗的PTC患者167例,其中男性43例、女性124例,年龄(37.14± 12.00)岁。将所有患者按治疗剂量分为高剂量组(63例)和低剂量组(104例),于治疗后24、48、72、96 h时测量距离患者1 m处的辐射剂量率,将治疗后患者体内滞留131I活度为400 MBq时的时间点定为出院时间。采用多重线性回归方法分析影响辐射剂量率降低的相关因素。组间比较采用两独立样本非参数检验或两独立样本t检验。结果 PTC患者首次行131I治疗后的辐射剂量率随时间推移迅速下降,高剂量组治疗后的24、48 h辐射剂量率[(70.62±34.45)、15.64 μSv/h]明显高于低剂量组[(11.27±5.13)、2.03 μSv/h],且差异均有统计学意义(t=-13.581、-7.952,均P <0.01)。81.0%(51/63)和90.5%(57/63)的高剂量组患者分别可在治疗48 h和72 h后出院,99%(103/104)的低剂量组患者可在治疗24 h后出院。多重线性回归分析显示,131I剂量和2 h摄碘率对高剂量组24 h辐射剂量率的影响有统计学意义(F=9.23,复相关系数R2=0.212,P<0.01),高剂量组24 h辐射剂量率与2 h摄碘率和131I剂量呈正相关;性别、24 h摄碘率和残甲法3对高剂量组48 h辐射剂量率的影响有统计学意义(F=34.45,复相关系数R2=0.622,P<0.01),48 h辐射剂量率与24 h摄碘率和残留甲状腺体积呈正相关,与性别呈负相关;131I剂量和24 h饮水量对低剂量组24 h辐射剂量率的影响有统计学意义(F=12.76,复相关系数R2=0.186 ,P<0.01),低剂量组24 h辐射剂量率与131I剂量呈正相关,与24 h饮水量呈负相关。结论 PTC术后患者首次131I治疗24 h后,影响其辐射剂量率降低的主要因素是服用131I的剂量,而48 h后的主要影响因素是24 h甲状腺摄碘率、残留甲状腺体积和性别。低剂量组和高剂量组平均住院时间分别为1 d和2 d左右。     

Guidelines for radio-iodine (131I) therapy in Graves' disease and thyroid cancer

Radio-iodine (131I) therapy has been using in Graves' disease and well differentiated thyroid cancer. The rules of control in the discharge from radio-isotope hospital were notified in 1999 in Japan. Guideline of the 131I therapy in Graves' disease and thyroid cancer were prepared by sub-group of Japanese Society of Nuclear Medicine.     

Radiation dose to the testes after 131I therapy for ablation of postsurgical thyroid remnants in patients with differentiated thyroid cancer.

Radioiodine-131 is used in differentiated thyroid cancer (DTC) for ablation of postsurgical thyroid remnants and destruction of metastases. The question may be raised of whether 131I treatment of DTC in male patients may give an irradiation dose to the testes that could impair fertility. Few data in the literature concern the dose absorbed by the testes after 1311 therapy for DTC. Because 131I kinetics may be altered by the hypothyroid condition commonly present at the time of treatment and by the radioiodinated iodoproteins released by the damaged thyroid tissue, the dose values reported in the International Commission on Radiological Protection (ICRP) tables for euthyroid men may not be appropriate. To clarify this problem, three male subjects undergoing 131I therapy for ablation of thyroid remnants shortly after thyroidectomy for DTC were studied. METHODS: The mean administered activity was 1256 MBq, and the duration of the study was 2 wk. The gamma dose was measured by thermoluminescent dosimeters (TLDs) applied to the lower poles of the testes. Correction factors were calculated for the distance of the TLD from the center of the testes and for attenuation by the testes of the gamma rays reaching the TLD. After correction, the gamma dose to the testes ranged from 21 to 29 mGy. The gamma dose calculated by the Medical Internal Radiation Dose (MIRD) method from blood and urine samples was similar (18-20 mGy) to that measured by TLDs. The beta dose was estimated by the MIRD method from blood activity and testicular volume and ranged between 14 and 31 mGy. Results: The total (beta and gamma) doses to testes were 30, 33 and 43 microGy/MBq in the three subjects. CONCLUSION: These values are close to those derived from the ICRP tables (26-37 microGy/MBq 131I) for euthyroid subjects. The present data indicate that significant irradiation is delivered to the testes after the administration of the 131I ablative dose to thyroidectomized patients. The relevance of the radiation absorbed by testes on fertility remains to be established.     

甲状腺癌及其转移灶~(131)I治疗过程中外周血象变化

目的　观察甲状腺癌及其转移灶治疗过程中131I累积剂量对骨髓抑制的影响。　方法甲状腺癌术后患者 177例 ,随访时分别测其白细胞 (WBC)、红细胞 (RBC)、血红蛋白 (Hb)和血小板(PLT) ,观察不同性别、年龄、131I累积治疗剂量、肿瘤病理类型以及转移时外周血象的变化 ,同时进行方差分析和相关回归分析。结果　性别对WBC和PLT影响不大 (FW =0 .399和FP=0 .90 3 ,P均 >0 0 5 ) ,但女性RBC和Hb明显低于男性 (FR=2 5 .2 17和FH=30 .895 ,P均 <0 .0 1) ;年龄、肿瘤病理类型以及转移状况对血象变化的影响无统计学意义。各131I累积治疗剂量组血象均值都在正常范围内 ,但组间差异有显著性 ,而且血象的变化与131I累积治疗剂量间呈线性关系 ,随着131I累积治疗剂量的增加 ,血象呈降低趋势。结论　131I累积治疗剂量对骨髓抑制有一定的影响 ,其外围血象的变化与131I累积治疗剂量呈负相关。     

Radio-guided surgery of differentiated thyroid cancer using (131)I or 99mTc-Sestamibi

The classical therapeutic approach to patients with differentiated thyroid cancer (DTC) is based on total or near-total thyroidectomy, followed by (131)I treatment and thyroid-stimulating hormone suppressive therapy. This approach allows complete cure in many patients, especially when the tumour is diagnosed at an early stage; it also allows long-term survival in patients with locoregional recurrences or distant metastases if they can be treated with (131)I. In contrast, when metastatic DTC deposits lose their ability to trap (131)I (non-functioning metastases), a worse prognosis is expected. Nevertheless, in patients with locoregional non-functioning recurrences, an early diagnosis and prompt surgical extirpation can lead to a favourable prognosis. In these cases, radical surgery is needed. This can be achieved with radio-guided surgery using a hand-held gamma probe and a tumour-seeking radiotracer to detect, intraoperatively, the smallest metastatic lesions. In this paper, we discuss the two principal techniques proposed in the literature for radio-guided surgery of non-functioning DTC metastatic recurrences, the first using high doses of (131)I and the second using low doses of 99mTc-Sestamibi.     

Multiple brown tumors simulating bone metastases: a case of parathyroid adenoma coexisting with papillary carcinoma of the thyroid

A 55-year-old man with multiple brown tumors who initially was thought to have multiple bone metastases is described. He had elevated parathyroid hormone levels and was referred to the nuclear medicine department, where a parathyroid adenoma was diagnosed. At surgery, abnormal lymph nodes were seen, which were found to contain metastatic thyroid papillary carcinoma cells. On further exploration, the patient's bone scintigraph revealed multiple sites of increased uptake but no bone abnormalities on whole-body iodine and Tc-99m MIBI scans.     

Value of 131I SPECT/CT for the evaluation of differentiated thyroid cancer: a systematic review of the literature

Purpose

In the present study, we performed a systematic review of the current literature to assess the incremental value of ¹³¹I single photon emission computed tomography (SPECT)/CT for the management of patients with differentiated thyroid cancer (DTC).

Methods

The search of PubMed/MEDLINE and EMBASE databases to identify studies and reference lists for articles was conducted using the terms “SPECT or SPECT/CT or SPECT-CT or single photon emission computed tomography/computed tomography and thyroid carcinoma or thyroid cancer.” Studies reporting the clinical value of ¹³¹I SPECT/CT were selected. All studies included were assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool (QUADAS-2). Two independent reviewers selected the studies, summarized and tabulated the data, and pooled estimates were obtained. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.

Results

A total of 14 studies involving 1,066 patients met the inclusion criteria. Data obtained included the impact of ¹³¹I SPECT/CT on staging or risk classification (three studies), diagnostic accuracy (six studies), and follow-up (five studies).

Conclusion

Integrated SPECT/CT is a useful tool for the diagnosis, staging, risk stratification, and follow-up of DTC. The impact of ¹³¹I SPECT/CT on the management of patients with thyroid cancer was evaluated.     

Comparison of 99Tcm-tetrofosmin with 201Tl and 131I in the detection of differentiated thyroid cancer metastases

The purpose of this study was to assess the detectability of metastatic lesions by 99Tcm-tetrofosmin in differentiated thyroid cancer, and to compare the results with those obtained using 201Tl-chloride and tracer doses of 131I. Twenty-four thyroidectomized patients with metastases were studied. There were 34 metastases, including 16 lung, nine lymph node and nine bone. Radiological studies (chest X-ray, computed tomography and magnetic resonance imaging), serum thyroglobulin assays and histopathological examinations were performed to verify the presence of metastases with positive uptake of the three radionuclides. Increased accumulation of 99Tcm-tetrofosmin was observed in 11 of 16 (68.8%) lung metastases, eight of nine (88.9%) lymph node metastases and eight of nine (88.9%) bone metastases. Increased accumulation of 201Tl and 131I was observed in 11 of 16 (both) (68.8%) lung metastases, eight (88.9%) and three (33.3%), respectively, of lymph node metastases and eight (88.9%) and nine (100%), respectively, of bone metastases. The detectability of thyroid cancer metastases using 99Tcm-tetrofosmin, 201Tl and 131I was 79.4%, 79.4% and 67.6%, respectively. The combined detectabilities of 99Tcm-tetrofosmin and 131I and of 201Tl and 131I were both 88.2%. 99Tcm-tetrofosmin and 201Tl imaging were found to be more sensitive than 131I for the detection of differentiated thyroid cancer metastases, particularly for regional lymph node. The combination of 99Tcm-tetrofosmin and 131I imaging may be a more sensitive and effective method for detecting metastases in differentiated thyroid cancer.