Is 131I treatment necessary for postoperative DTC patients classified as intermediate- or high-risk with negative stimulated thyroglobulin?

IF 1.8 3区工程技术 Q3 CHEMISTRY, INORGANIC & NUCLEAR

Applied Radiation and Isotopes Pub Date : 2025-09-16 DOI:10.1016/j.apradiso.2025.112190

Yao Luo , Ruoxin Xu , Canran Xiao, Zeqing Xu, Caihua Tang

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引用次数: 0

Abstract

Purpose

Several studies have indicated that postoperative differentiated thyroid cancer (DTC) patients with stimulated thyroglobulin (sTg) levels <1 ng/mL could directly transition to thyroid stimulating hormone (TSH) suppression therapy. However, a number of cases with negative sTg have also shown residual thyroid tissue (RTT) or metastases through various imaging examinations. This study aimed to assess the necessity of ¹³¹I treatment for DTC patients classified as intermediate- or high-risk for recurrence with sTg levels below 1 ng/mL.

Methods

A retrospective analysis was conducted on a total of 158 postoperative DTC patients classified as intermediate- or high-risk for recurrence with pre-ablation sTg levels below 1 ng/mL, as well as a subgroup of 51 DTC patients with pre-ablation sTg levels below 0.04 ng/mL. A comprehensive comparison was conducted between the results of pre-ablation imaging examinations and post therapy ¹³¹I whole body scans (RxWBS, with SPECT/CT) in terms of RTT, cervical lymph nodes, or distant metastases. The therapeutic response of ¹³¹I treatment was also evaluated.

Results

The presences of RTT or unsuspected metastases were detected in 141 patients by RxWBS: 87.3 % (138/158) exhibited RTT, whereas 16.5 % (26/158) had metastatic lymph nodes. Compare to other pre-ablation imaging modalities, RxWBS demonstrated superior sensitivity in identifying both RTT (87.3 % vs. 37.3 %) and metastatic lymph nodes (16.5 % vs. 2.5 %). Among the 141 patients (89.2 %, 141/158) who were positive on RxWBS, 132 patients (93.6 %, 132/141) achieved an excellent response (ER) after the ¹³¹I treatment.

Conclusion

For postoperative DTC patients classified as intermediate or high risk for recurrence with negative sTg, RTT or metastases may still be present in most cases. ¹³¹I treatment is necessary for these patients regardless of serum sTg results, and a majority of them could have favorable therapeutic response.

查看原文本刊更多论文

甲状腺球蛋白刺激阴性的中高危DTC术后患者是否需要131I治疗？

多项研究表明，甲状腺球蛋白（sTg）刺激水平为1ng /mL的分化型甲状腺癌（DTC）术后患者可直接过渡到促甲状腺激素（TSH）抑制治疗。然而，许多sTg阴性的病例也通过各种影像学检查显示甲状腺组织残留（RTT）或转移。本研究旨在评估sTg水平低于1 ng/mL的复发中高风险DTC患者进行131I治疗的必要性。方法回顾性分析158例术前sTg水平低于1 ng/mL的复发中高危DTC术后患者，以及51例术前sTg水平低于0.04 ng/mL的DTC亚组患者。综合比较消融前影像学检查和治疗后131I全身扫描（RxWBS, SPECT/CT）在RTT、颈部淋巴结或远处转移方面的结果。并对131I治疗的疗效进行了评价。结果141例患者中RxWBS检测到RTT或未怀疑转移，其中87.3%（138/158）表现为RTT， 16.5%（26/158）为转移性淋巴结。与其他消融前成像方式相比，RxWBS在识别RTT （87.3% vs. 37.3%）和转移性淋巴结（16.5% vs. 2.5%）方面表现出更高的灵敏度。在141例RxWBS阳性患者（89.2%,141/158）中，132例（93.6%,132/141）患者经131I治疗后获得了极好的缓解（ER）。结论对于sTg阴性的DTC术后中、高危复发患者，大部分仍可能存在RTT或转移。无论血清sTg结果如何，这些患者都有必要进行i治疗，并且大多数患者可能有良好的治疗反应。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Applied Radiation and Isotopes 工程技术-核科学技术

CiteScore

3.00

自引率

12.50%

发文量

406

审稿时长

13.5 months

期刊介绍： Applied Radiation and Isotopes provides a high quality medium for the publication of substantial, original and scientific and technological papers on the development and peaceful application of nuclear, radiation and radionuclide techniques in chemistry, physics, biochemistry, biology, medicine, security, engineering and in the earth, planetary and environmental sciences, all including dosimetry. Nuclear techniques are defined in the broadest sense and both experimental and theoretical papers are welcome. They include the development and use of α- and β-particles, X-rays and γ-rays, neutrons and other nuclear particles and radiations from all sources, including radionuclides, synchrotron sources, cyclotrons and reactors and from the natural environment. The journal aims to publish papers with significance to an international audience, containing substantial novelty and scientific impact. The Editors reserve the rights to reject, with or without external review, papers that do not meet these criteria. Papers dealing with radiation processing, i.e., where radiation is used to bring about a biological, chemical or physical change in a material, should be directed to our sister journal Radiation Physics and Chemistry.