{"title":"小儿和青年分化型甲状腺癌术后诊断和治疗后碘-131全身扫描的最佳时间。","authors":"Praveen Kumar, Chandrasekhar Bal, Nishikant Avinash Damle","doi":"10.4103/ijnm.ijnm_133_24","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose of the study: </strong>The 2015 American Thyroid Association pediatric differentiated thyroid cancer (DTC) guidelines recommend posttherapy whole body scan (PTS) 4-7 days after (Iodine-131) I-131 activity administration. There is no recommendation of timing of performing a diagnostic whole-body scan (Dx-WBS). However, this 4-7 day time frame for PTS lacks a solid basis and is essentially arbitrary. This is especially crucial as it has the potential to significantly impact patient management. Our primary goal in this study was to establish the optimal timing for both Dx-WBS and PTS in pediatric and young adult patients with DTC.</p><p><strong>Methods: </strong>The DTC patients aged ≤21 years underwent serial whole-body scan (WBS) at 24 h, 48 h, and/or 72 h or more after the administration of diagnostic and therapeutic activities of I-131. The utility of Dx-WBS and PTS was assessed based on the identification of new lesions that could potentially influence the prescribed therapeutic activity of I-131. The optimal timing for acquiring Dx-WBS and PTS was determined based on when the first lesion appeared in the I-131 WBS.</p><p><strong>Results: </strong>Ninety-five patients (27 males and 68 females) with an average age of 17.9 ± 3 years received a 74 MBq I-131 for Dx-WBS. Ten patients (10.5%) showed no uptake in Dx-WBS, thus, no I-131 therapy was given. The remaining 85 patients received a therapeutic activity of 1.11-5.55 GBq I-131 based on the extent of their disease. The serial Dx-WBS or PTS showed no additional lesions in patients with thyroid remnants. However, additional nodes were detected in 2/32 patients in the ≥48 h Dx-WBS, and 1/32 patients in the known nodal disease patients, which were not clinically relevant. Importantly, 72 h PTS picked up pulmonary metastases in 17.6% (3 out of 17) of patients, which were missed in serial Dx-WBS. However, >72 h PTS did not have additional value.</p><p><strong>Conclusion: </strong>I-131 Dx-WBS is best to be performed at 48 h, and PTS at 72 h in pediatric and young adult patients with DTC.</p>","PeriodicalId":45830,"journal":{"name":"Indian Journal of Nuclear Medicine","volume":"39 6","pages":"428-435"},"PeriodicalIF":0.5000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020971/pdf/","citationCount":"0","resultStr":"{\"title\":\"Optimal Time of Diagnostic and Posttherapeutic Iodine-131 Whole-body Scan in Post-Operative Pediatric and Young Adult Differentiated Thyroid Cancer Patients.\",\"authors\":\"Praveen Kumar, Chandrasekhar Bal, Nishikant Avinash Damle\",\"doi\":\"10.4103/ijnm.ijnm_133_24\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose of the study: </strong>The 2015 American Thyroid Association pediatric differentiated thyroid cancer (DTC) guidelines recommend posttherapy whole body scan (PTS) 4-7 days after (Iodine-131) I-131 activity administration. There is no recommendation of timing of performing a diagnostic whole-body scan (Dx-WBS). However, this 4-7 day time frame for PTS lacks a solid basis and is essentially arbitrary. This is especially crucial as it has the potential to significantly impact patient management. Our primary goal in this study was to establish the optimal timing for both Dx-WBS and PTS in pediatric and young adult patients with DTC.</p><p><strong>Methods: </strong>The DTC patients aged ≤21 years underwent serial whole-body scan (WBS) at 24 h, 48 h, and/or 72 h or more after the administration of diagnostic and therapeutic activities of I-131. The utility of Dx-WBS and PTS was assessed based on the identification of new lesions that could potentially influence the prescribed therapeutic activity of I-131. The optimal timing for acquiring Dx-WBS and PTS was determined based on when the first lesion appeared in the I-131 WBS.</p><p><strong>Results: </strong>Ninety-five patients (27 males and 68 females) with an average age of 17.9 ± 3 years received a 74 MBq I-131 for Dx-WBS. Ten patients (10.5%) showed no uptake in Dx-WBS, thus, no I-131 therapy was given. The remaining 85 patients received a therapeutic activity of 1.11-5.55 GBq I-131 based on the extent of their disease. The serial Dx-WBS or PTS showed no additional lesions in patients with thyroid remnants. However, additional nodes were detected in 2/32 patients in the ≥48 h Dx-WBS, and 1/32 patients in the known nodal disease patients, which were not clinically relevant. Importantly, 72 h PTS picked up pulmonary metastases in 17.6% (3 out of 17) of patients, which were missed in serial Dx-WBS. However, >72 h PTS did not have additional value.</p><p><strong>Conclusion: </strong>I-131 Dx-WBS is best to be performed at 48 h, and PTS at 72 h in pediatric and young adult patients with DTC.</p>\",\"PeriodicalId\":45830,\"journal\":{\"name\":\"Indian Journal of Nuclear Medicine\",\"volume\":\"39 6\",\"pages\":\"428-435\"},\"PeriodicalIF\":0.5000,\"publicationDate\":\"2024-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020971/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Indian Journal of Nuclear Medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.4103/ijnm.ijnm_133_24\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/3/20 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q4\",\"JCRName\":\"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Indian Journal of Nuclear Medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4103/ijnm.ijnm_133_24","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/20 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
引用次数: 0
摘要
研究目的:2015年美国甲状腺协会儿童分化型甲状腺癌(DTC)指南建议在(碘-131)I-131活性治疗后4-7天进行全身扫描(PTS)。没有建议进行诊断性全身扫描(Dx-WBS)的时间。然而,这个4-7天的PTS时间框架缺乏坚实的基础,本质上是任意的。这一点尤其重要,因为它有可能对患者管理产生重大影响。我们在这项研究中的主要目标是为患有DTC的儿童和年轻成人患者建立Dx-WBS和PTS的最佳时机。方法:年龄≤21岁的DTC患者在给予诊断和治疗活性I-131后24小时、48小时和/或72小时或更长时间进行连续全身扫描(WBS)。Dx-WBS和PTS的效用是基于可能影响I-131规定治疗活性的新病变的识别来评估的。根据I-131 WBS中首次出现病变的时间确定获得Dx-WBS和PTS的最佳时机。结果:95例患者(男性27例,女性68例)平均年龄17.9±3岁,接受74 MBq I-131诊断Dx-WBS。10例患者(10.5%)未显示对Dx-WBS的摄取,因此未给予I-131治疗。其余85例患者根据其疾病程度接受了1.11-5.55 GBq I-131的治疗活性。系列Dx-WBS或PTS未显示甲状腺残余患者有其他病变。然而,≥48 h Dx-WBS中有2/32的患者检测到额外的淋巴结,在已知淋巴结疾病患者中有1/32的患者检测到额外的淋巴结,与临床无关。重要的是,17.6%的患者(17人中有3人)在72小时PTS中发现了肺转移,而在系列Dx-WBS中没有发现肺转移。然而,>72 h PTS没有额外的价值。结论:I-131 Dx-WBS在儿童和青壮年DTC患者中最好在48 h进行,在72 h进行PTS。
Optimal Time of Diagnostic and Posttherapeutic Iodine-131 Whole-body Scan in Post-Operative Pediatric and Young Adult Differentiated Thyroid Cancer Patients.
Purpose of the study: The 2015 American Thyroid Association pediatric differentiated thyroid cancer (DTC) guidelines recommend posttherapy whole body scan (PTS) 4-7 days after (Iodine-131) I-131 activity administration. There is no recommendation of timing of performing a diagnostic whole-body scan (Dx-WBS). However, this 4-7 day time frame for PTS lacks a solid basis and is essentially arbitrary. This is especially crucial as it has the potential to significantly impact patient management. Our primary goal in this study was to establish the optimal timing for both Dx-WBS and PTS in pediatric and young adult patients with DTC.
Methods: The DTC patients aged ≤21 years underwent serial whole-body scan (WBS) at 24 h, 48 h, and/or 72 h or more after the administration of diagnostic and therapeutic activities of I-131. The utility of Dx-WBS and PTS was assessed based on the identification of new lesions that could potentially influence the prescribed therapeutic activity of I-131. The optimal timing for acquiring Dx-WBS and PTS was determined based on when the first lesion appeared in the I-131 WBS.
Results: Ninety-five patients (27 males and 68 females) with an average age of 17.9 ± 3 years received a 74 MBq I-131 for Dx-WBS. Ten patients (10.5%) showed no uptake in Dx-WBS, thus, no I-131 therapy was given. The remaining 85 patients received a therapeutic activity of 1.11-5.55 GBq I-131 based on the extent of their disease. The serial Dx-WBS or PTS showed no additional lesions in patients with thyroid remnants. However, additional nodes were detected in 2/32 patients in the ≥48 h Dx-WBS, and 1/32 patients in the known nodal disease patients, which were not clinically relevant. Importantly, 72 h PTS picked up pulmonary metastases in 17.6% (3 out of 17) of patients, which were missed in serial Dx-WBS. However, >72 h PTS did not have additional value.
Conclusion: I-131 Dx-WBS is best to be performed at 48 h, and PTS at 72 h in pediatric and young adult patients with DTC.