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. 2022 Jun 27;29(8):475-483.
doi: 10.1530/ERC-22-0038. Print 2022 Aug 1.

Is there a role for diagnostic scans in the management of intermediate-risk thyroid cancer?

Debora L S Danilovic  1   2 , George B Coura-Filho  1 , Giulianna M Recchia  2 , Luciana A Castroneves  1 , Suemi Marui  2 , Carlos A Buchpiguel  1 , Ana O Hoff  1 , Peter Kopp  3   4
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Is there a role for diagnostic scans in the management of intermediate-risk thyroid cancer?

Debora L S Danilovic et al. Endocr Relat Cancer. .

Abstract

Radioiodine (RAI) is selectively recommended for intermediate-risk differentiated thyroid carcinomas (DTC). The information gleaned from pretherapy stimulated thyroglobulin levels (sTg) and diagnostic 131I whole-body scans (DxWBS) to guide therapy remains controversial. The present study aimed at evaluating the impact of preablation sTg and DxWBS in the management of intermediate-risk DTC. A retrospective analysis of 301 intermediate-risk DTC patients submitted to total thyroidectomy and RAI therapy was performed. Pretherapy sTg and DxWBS and post-therapy WBS (RxWBS) findings were analyzed and compared to outcomes. Fifty-two patients (17.3%) had metastases diagnosed by DxWBS and/or RxWBS. The DxWBS identified 10.6% of patients with functioning metastases, including unexpected distant metastases. If combined with SPECT-CT, DxWBS detected RAI-avid metastases more frequently, particularly lymph node metastases (13.1% vs 4.2% planar WBS, P = 0.015). The DxWBS findings modified patient management in 8.3%. A pretherapy sTg <1 ng/mL was associated with a low false-negative rate for the presence of metastases (5.2%), and its performance in excluding metastasis was improved by a negative DxWBS (2.7% of patients with both negative exams had metastases in RxWBS). A sTg <1 ng/mL predicted statistically significant lower rates of recurrent/persistent disease and biochemical/structural incomplete responses. In conclusion, preablation sTg and DxWBS contribute to the detection of unknown or persistent metastatic disease in intermediate-risk DTC patients. A sTg <1 ng/mL in combination with a negative DxWBS is highly suggestive of the absence of remaining malignant disease, and one may consider deferring RAI ablation if both exams are negative. A stunning effect is rarely observed and it does not impair proper treatment of metastases.

Keywords: radioiodine therapy; risk stratification; thyroglobulin; thyroid carcinoma; whole body scan.

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