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Total-Body Scintigraphy with Thallium-201 and Iodine-131 in the Follow-up of Differentiated Thyroid Cancer

Department of Nuclear Medicine, Marques de Valdecilla University Hospital, Santander, Spain

Correspondence: For correspondence or reprints contact: Prof. José Manuel Carril, Department of Nuclear Medicina, Hospital Universitario Marqués de Valdecilla, Avenda Valdecilla s/n, 39008 Santander, Spain.

ABSTRACT

We analyzed the significance of total body scintigraphy ²⁰¹Tl in the follow-up of patients with differentiated thyroid cancer, both in the preablation and ablated stages. Methods: Prospective assessment was performed in 116 patients who were involved in 178 studies (115 in preablation and 63 after ablation). For ablation, an absence of uptake in the thyroid bed was required in the total ¹³¹I follow-up scan after ¹³¹I ablation therapy. Each study consisted of a ²⁰¹Tl scan performed while the patient was receiving thyroid hormone therapy, an ¹³¹I scan performed when endogenous thyroid stimulating hormone levels were higher than 50 mlU/ml and determination of thyroglobulin (Ig) concentration using the same sample. Results: In the 115 scans in the preablation group, the findings for ²⁰¹Tl and ¹³¹I agreed in 26 scans and disagreed in 89 scans. In 59 discordant studies, only ¹³¹I detected focal accumulation, and, in 54 of these, Tg levels were undetectable. Of the other 30 discordant studies, ²⁰¹Tl and ¹³¹I detected focal uptake in 27 studies, although they did not reveal the same lesions, and in 3 studies, only ²⁰¹Tl detected focal accumulation; in these 30 studies, the association detectable Tg predominated. Of the 63 studies in the ablated group, the results agreed for the two tracers in 49 and disagreed in 14 studies. In 13 of the 14 discordant studies, ²⁰¹Tl detected focal uptake, and, in 10 of these, Tg was detectable. Thus, 31 of the 116 patients assessed (15 preablation and 16 ablated) had at least one lesion that was detected by ²⁰¹Tl but not detected by ¹³¹I. A definitive diagnosis could be established in 26 patients, and the presence of thyroid cancer was confirmed in 23. The sensitivity and specificity in the ablated group were 94% and 96%, respectivaly, for ²⁰¹Tl and 29% and 100%, respectively, for ¹³¹I. Conclusion: The high sensitivity of ²⁰¹Tl scintigraphy in detecting tumor tissue indicates that the inclusion of this technique in the follow-up of patients with differentiated thyroid carcinoma should be considered in both the preablation and the ablated stages.

Key Words: differentiated thyroid cancer • thallium-201 • iodine-131 • thyroglobulin

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