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Abstract
Objective:Differentiated thyroid cancers (DTC) are tumors with good prognosis. However, local recurrence or distant metastasis can be observed. In our study, we aimed to investigate the incidence of recurrence and the importance of diagnostic iodine-131 whole body scan (WBS) in clinical follow-up in patients with DTC.Methods:The clinical data of 217 patients with DTC who were followed-up more than 3 years were reviewed retrospectively. The incidence of recurrence was investigated in a group of patients who had radioactive iodine (RAI) treatment and showed no sign of residual thyroid tissue or metastasis with diagnostic WBS that was performed at 6-12 months after therapy and had a thyroglobulin (Tg) level lower than 2 ng/dl.Results:At the time of diagnosis, ten cases had thyroid capsule invasion, 25 cases had extra-thyroid soft tissue invasion, 11 patients showed lymph node metastasis and four patients had distant organ metastasis. One hundred forty-five patients had RAI treatment at ablation dose (75-100 mCi), whereas 35 patients had RAI treatment at metastasis dose (150-200 mCi). Thirty-seven patients with papillary microcarcinoma did not receive RAI treatment. In 12 (%7.5) of the 160 patients who were considered as “successful ablation”, a recurrence was identified. Recurrence was detected by diagnostic WBS in all cases and stimulated Tg level was <2 ng/dL with the exception of the two cases who had distant metastasis.Conclusion:Identification of pathological findings with WBS in patients who developed local recurrence in the absence of elevated Tg highlights the importance of diagnostic WBS in clinical follow-up.
Highlights
Differentiated thyroid cancers (DTC) is a group of tumors with slow growth potential [1]; long survival and a good clinical outcome is common, even in a patient with metastasis, when they are adequately treated with effective therapeutic approaches such as surgery, radioactive iodine (RAI) and thyroid hormone suppression [2]
Recurrence was detected at years 12 and 16 in patients who had distant metastasis, and within the first 5 years in the ten patients who had a local recurrence
I-131 whole body scan (WBS) identified a recurrence in all these patients (Figure 1)
Summary
Differentiated thyroid cancers (DTC) is a group of tumors with slow growth potential [1]; long survival and a good clinical outcome is common, even in a patient with metastasis, when they are adequately treated with effective therapeutic approaches such as surgery, radioactive iodine (RAI) and thyroid hormone suppression [2]. The 10-year survival rate in these tumors with good prognosis is above 90%. The cervical US, serum Tg, and I-131 WBS are powerful tools to detect recurrence. In patients with I-131 negative recurrence, in addition to conventional radiologic imaging modalities, F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) and somatostatin receptor scintigraphy may yield significant information in detecting recurrence and metastasis [7].
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