Antonelli, Alessandro1, Fallahi, Poupak1, Ferrari, Silvia Martina1, Elia, Giusy1, Ruffilli, Ilaria1, Materazzi, Gabriele2, Miccoli, Paolo2
1 Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
2 Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy.
Purpose: We evaluated the early detection of metastatic lateral neck lymph nodes (LNL) by thyroglobulin (Tg) measurement and neck ultrasonography (NU) in 605 patients with papillary or follicular differentiated thyroid cancer (DTC), and long-term follow-up after I131 and/or surgery.
Methods: DTC-patients previously treated with near-total thyroidectomy and I131 ablation of residual tissue, underwent follow-up by Tg, NU, diagnostic and post-therapy whole body scan (WBS), alone or in combination.
Results: TSH-stimulated Tg alone had a diagnostic sensitivity of 87% for detecting LNL and a negative predictive value (NPV) of 84%, while NU had a sensitivity of 69%, and NPV of 68%. Combining Tg with NU, sensitivity increased to 97%, while NPV to 98%, respectively.
Patients with LNL (LNL-p) uptaking radioiodine were treated with I131, among them 49% responded after a median of 4 cycles (median 325 mCi, cumulative dose; 7.8 years median follow-up) with “disappearence of uptake at post-therapy WBS and Tg<1 ng/ml” (complete remission, CR), patients not responder had CR with other treatments in only 11% of cases.
LNL-p not uptaking or not responder to I131 (8%) were treated with surgery, and subsequent I131 readministration with CR in 24% of cases (6.1 years median follow-up).
Discussion & Conclusion: Early detection of LNL in DTC-patients may permit a CR by I131 in 49% after 4 or less I131 treatments. Patients not responding/not uptaking I131 can achieve a CR in 24% of cases combining different therapies.